NPWT Presentation by Siddharth Mandal

• 1. info@npwtindia.comContact: +91 9971722111www.npwtindia.comINTRODUCTION OFCLOSED CYCLIC NEGATIVE PRESSURE WOUND THERAPY in management of wounds By SIDDHARTH MANDAL CEO TRIAGE MEDITECH PVT. LTD. +91 9971722111 AN ISO 13485:2003 CERTIFIED COMPANY

2. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWhat is Closed Cyclic Negative Pressure Wound Therapy(CCNPWT)? Negative Pressure Wound Therapy also widely known as NPWT, WOUND VAC or TNP(Tropical Negative Pressure) is a widely accepted wound management modality today, i.e., A specially designed foam dressing applied on a wound bed, sealed with a PU/PE drape further connected with a drainage tubing to regulated / controlled negative pressure source.AN ISO 13485:2003 CERTIFIED COMPANY 3. info@npwtindia.comContact: +91 9971722111www.npwtindia.comHow does CCNPWT promote wound healing? Removing excess fluid (infections and non-infectious), allowing tissue decompression Stimulates granulation tissue formation by increasing vascular perfusion, Encourages mechanical stretching, approximates wound edges, enhances overall wound contraction Protects wound from microbe imbalance Maintains a moist wound healing environmentAN ISO 13485:2003 CERTIFIED COMPANY 4. info@npwtindia.comCONSUMABL ES PORTFOLIOContact: +91 9971722111www.npwtindia.comALL PRODUCTS ARECERTIFIEDSINGLE USE ONLYALL PRODUCTS ARE MANUFACTURED UNDER STRICT PARAMETERS OF ISO 13485:2003 AN ISO 13485:2003 CERTIFIED COMPANY 5. info@npwtindia.comContact: +91 9971722111www.npwtindia.com 5. Stick the drainage tubing aligning the hole made1. Rinse the wound thoroughly & Debride majority of necrotic tissues4. Make a small hole in the centre2. Cut the foam dressing in the shape of the wound3. Place it on the wound bed & seal with PU drape 6. INITIATE the Therapy & observe AN ISO 13485:2003 CERTIFIED COMPANY 6. info@npwtindia.comContact: +91 9971722111www.npwtindia.comAN ISO 13485:2003 CERTIFIED COMPANY 7. info@npwtindia.comContact: +91 9971722111www.npwtindia.comCCNPWT creates an Environment of Wound Healing at the Cellular LevelAN ISO 13485:2003 CERTIFIED COMPANY 8. info@npwtindia.comContact: +91 9971722111www.npwtindia.comAN ISO 13485:2003 CERTIFIED COMPANY 9. info@npwtindia.comContact: +91 9971722111www.npwtindia.comAN ISO 13485:2003 CERTIFIED COMPANY 10. CCNPWT THERAPY DRESSING BENEFITS Flexible foam dressing adapts to the contours of deep & irregular surface of the wound bedSpecially designed hydrophobic, non-linear networked foam dressing removes bacteria colonised wound exudate The CCNPWT foam dressing aggressively promotes uniform healthy granulation tissue throughout the wound bed 11. info@npwtindia.comContact: +91 9971722111www.npwtindia.comCCNPWT THERAPY DRESSING BENEFITS Flexible foam dressing adapts to the contours of deep & irregular surface of the wound bed Specially designed hydrophobic, non-linear networked foam dressing removes bacteria colonised wound exudateThe CCNPWT foam dressing aggressively promotes uniform healthy granulation tissue throughout the wound bedAN ISO 13485:2003 CERTIFIED COMPANY 12. info@npwtindia.comContact: +91 9971722111www.npwtindia.comCCNPWT provides a closed sterile & moist wound healing environmentPromotes granulation tissue formation, recentstudies suggest mechanical stretching may result in increased mitosis (Cell Replication) Controlled Negative Pressure Therapy decreases wound volume approximating wound edges, helps uniformly draw wounds closedPromotes continuous wound debridement byremoving wound debris & bacteria colonized wound output/interstitial fluid allowing tissue decompressionAN ISO 13485:2003 CERTIFIED COMPANY 13. info@npwtindia.comContact: +91 9971722111www.npwtindia.comContd..Reduces oedema Reduces bacterial load Stimulates cell proliferation Enchances dermal perfusion Promotes micro angiogenesis Protects wound from re-infection, crossinfection or spreading further infection Promotes Skin Graft/Flap uptake (The flexible foam dressing gently presses the skin graft or flap ensuring full contact with the wound bedAN ISO 13485:2003 CERTIFIED COMPANY 14. info@npwtindia.comContact: +91 9971722111www.npwtindia.comIncreased Perfusion Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman: NPWT: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation. Annals of Plastic Surgery, 1997Peak blood flow recorded at 125 mmHg Study helped establish original pressure protocol with Foam Dressing (400-600 micron pore-size)Positive effect on perfusion with 100-125 mmHgHypothesized that reduction in oedema decompresses small blood vessels and increases flow Frank Ischaemia and Wound HypoxiaAN ISO 13485:2003 CERTIFIED COMPANY 15. info@npwtindia.comContact: +91 9971722111www.npwtindia.comReduction of Inhibitory Factors Morykwas Michael J, Argenta Louis C, Shelton-Brown Erica I, McGuirt Wyman: NPWT: A New Method for Wound Control and Treatment: Animal Studies and Basic Foundation. Annals of Plastic Surgery, 1997Reduction of oedema has positive effect in wound healing Reduction of inhibitory factors contained in interstitial fluid (chemical) Decompression of small blood vessels, which restores flow (mechanical)Negative Pressure Wound Therapy increases perfusion and oxygenation, therapy likely enhances resistance to infectionAN ISO 13485:2003 CERTIFIED COMPANY 16. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWHAT TYPE OF WOUNDS BENEFIT FROM CCNPWT? Pressure ulcers Full thickness and partial thickness burns Diabetic / Neuropathic ulcers Venous Insufficiency ulcers Post-operative and dehisced surgical Traumatic Wounds Skin Flaps and Grafts Explored fistulasAN ISO 13485:2003 CERTIFIED COMPANY 17. info@npwtindia.comContact: +91 9971722111www.npwtindia.comAN ISO 13485:2003 CERTIFIED COMPANY 18. info@npwtindia.comContact: +91 9971722111www.npwtindia.comAN ISO 13485:2003 CERTIFIED COMPANY 19. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWHEN IS CCNPWT CONTRAINDICATED? Wounds containing malignant tissue Untreated osteomyelitis Necrotic tissue such as slough or eschar Unexplored or non-enteric fistulas Exposed or unprotected organs, blood vesselsAN ISO 13485:2003 CERTIFIED COMPANY 20. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWHAT CONDITIONS INDICATE CAUTION? Active bleeding or patient on anticoagulant therapy Proximity of blood vessels, organs, muscle, and fascia requiring protection Irradiated vessels and tissue Bony fragments Untreated malnutrition Non-compliant or combative behaviourAN ISO 13485:2003 CERTIFIED COMPANY 21. info@npwtindia.comContact: +91 9971722111www.npwtindia.comCCNPWT helps in Flaps & Graft uptake Fixation of skin graft (mesh-grafts) or flap until the graft has taken (4-6 days). In these special cases,Topical Negative Presure Therapy is used for the secure fixation of a split skin graft to the wound The soft foam helps gently press the graft/flap onto the wound bed and thus ensures full contact between the graft and the underlying wound bed, irrespective of the wound contours and the formation of pockets, also continuously drains out the wound output, ensures infection free graft uptakeAN ISO 13485:2003 CERTIFIED COMPANY 22. info@npwtindia.comContact: +91 9971722111www.npwtindia.comDRESSING APPLICATION TECHNIQUESTEP 1 : DEBRIDE & CLEAN THE WOUND WITH ISOTONIC SOLUTIONSTEP 3: SEAL THE WOUND WITH SEMI-PERMEABLE DRAPE & MAKE A SMALL HOLE IN THE CENTRESTEP 2 : CUT THE FOAM DRESSING IN THE SHAPE OF WOUND AND PLACE IT ON WOUND BEDSTEP 4 : STICK THE MAPC TUBING DISTAL END KEEPING SYMMETRY WITH HOLE IN CENTRE & CONNECT WITH THE NEGATIVE PRESSURE SOURCE AN ISO 13485:2003 CERTIFIED COMPANY 23. info@npwtindia.comContact: +91 9971722111www.npwtindia.comINDICATED for TRAUMA WOUNDSAN ISO 13485:2003 CERTIFIED COMPANY 24. info@npwtindia.comContact: +91 9971722111www.npwtindia.comINDICATED for DIABETIC FOOT ULCERS Granulation after 3 days of applicationAN ISO 13485:2003 CERTIFIED COMPANY 25. info@npwtindia.comContact: +91 9971722111www.npwtindia.comIndicated for all Grade II, III & IV Pressure UlcersAN ISO 13485:2003 CERTIFIED COMPANY 26. info@npwtindia.comContact: +91 9971722111www.npwtindia.comINDICATED FOR VENUS/ARTERIAL LEG ULCERSAN ISO 13485:2003 CERTIFIED COMPANY 27. info@npwtindia.comContact: +91 9971722111INDICATED FOR ABDOMINAL COMPARTMENT SYNDROMEwww.npwtindia.comInfected Laprotomy**Please seek advice for special Dressing selection AN ISO 13485:2003 CERTIFIED COMPANY 28. info@npwtindia.comContact: +91 9971722111www.npwtindia.comVenus Leg ulcer with complications of sickle cell anaemiaAN ISO 13485:2003 CERTIFIED COMPANY 29. info@npwtindia.comContact: +91 9971722111www.npwtindia.comCCNPWT application for 10 days 20 days post follow-upAN ISO 13485:2003 CERTIFIED COMPANY 30. info@npwtindia.comContact: +91 9971722111www.npwtindia.comROAD ACCIDENT LACERATION AN ISO 13485:2003 CERTIFIED COMPANY 31. info@npwtindia.comContact: +91 9971722111www.npwtindia.comAN ISO 13485:2003 CERTIFIED COMPANY 32. info@npwtindia.comContact: +91 9971722111www.npwtindia.comRoad Accident case : with no vessels for primary closure (results of 13days NPWT Dressing Application)AN ISO 13485:2003 CERTIFIED COMPANY 33. info@npwtindia.comContact: +91 9971722111www.npwtindia.comINFECTED COMPOUND FRACTUREAN ISO 13485:2003 CERTIFIED COMPANY 34. info@npwtindia.comContact: +91 9971722111www.npwtindia.comAFTER Ist DRESSING CHANGEAN ISO 13485:2003 CERTIFIED COMPANY 35. info@npwtindia.comContact: +91 9971722111www.npwtindia.comAFTER 2nd DRESSING CHANGEAN ISO 13485:2003 CERTIFIED COMPANY 36. info@npwtindia.comContact: +91 9971722111www.npwtindia.comFOLLOW-UP POST FLAPAN ISO 13485:2003 CERTIFIED COMPANY 37. info@npwtindia.comContact: +91 9971722111www.npwtindia.comCrushed InjuryAmputation CCNPWT applied for 4 daysAN ISO 13485:2003 CERTIFIED COMPANY 38. info@npwtindia.comContact: +91 9971722111www.npwtindia.comROAD ACCIDENT LACERATIONPatient : HBsAg PositiveAN ISO 13485:2003 CERTIFIED COMPANY 39. info@npwtindia.comContact: +91 9971722111www.npwtindia.comCCNPWT Applied for 7 daysAN ISO 13485:2003 CERTIFIED COMPANY 40. info@npwtindia.comContact: +91 9971722111www.npwtindia.comPRESSURE ULCER (GRADE IV)AN ISO 13485:2003 CERTIFIED COMPANY 41. info@npwtindia.comContact: +91 9971722111www.npwtindia.comResult of 8 days / 2 dressing changeAN ISO 13485:2003 CERTIFIED COMPANY 42. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWHAT INTERVENTIONS WILL MAXIMIZE HEALING? Debride wound prior to Negative Pressure Therapy Off load pressure ulcers consistently Minimize time off NPWT to < 4 hours in a day Manage co-morbid condition Increased blood flow Reduce oedema Minimize infection Control blood glucose levelAN ISO 13485:2003 CERTIFIED COMPANY 43. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWHAT ARE THE EXPECTED OUTCOMES? May observe increased exudate and wound size duringthe first 48-72 hours due to the decompression of interstitial space and removal of extra-cellular fluid and debris. Gradual reduction of fluid and surface area should be observed with each assessment. Colour of wound bed should become a deeper red as perfusion to the site increases. Measurements should decrease weekly. If healing is not observed in a week, treatment should be re-evaluated. The average treatment with NPWT is 1-4 weeks. Length of treatment is determined by goals of therapy.AN ISO 13485:2003 CERTIFIED COMPANY 44. info@npwtindia.comContact: +91 9971722111www.npwtindia.comHOW DO YOU MANAGE WOUND WITH CCNPWT?Change dressing two/three times per week. Monitor frequently Observe wound and peri-wound area for signs and symptoms of infection Remove dressings carefully to protect new tissue growth. Bright gush flow red blood in canister requires immediate evaluation. Measure and document per facility protocol Note : To initiate it is recommended to follow CCNPWT protocol, to ensure optimal results, as ithese are tried and tested protocol designed by various CCNPWT expert wound managersAN ISO 13485:2003 CERTIFIED COMPANY 45. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWOUND ASSESMENT CHARTAN ISO 13485:2003 CERTIFIED COMPANY 46. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWOUND ASSESMENT CHARTAN ISO 13485:2003 CERTIFIED COMPANY 47. info@npwtindia.comContact: +91 9971722111www.npwtindia.comWOUND TREATMENT PLAN CHARTAN ISO 13485:2003 CERTIFIED COMPANY 48. info@npwtindia.comContact: +91 9971722111www.npwtindia.comThank you for your patience For any queries feel free to contact our local representativeor visit www.npwtindia.com email: info@npwtindia.com or npwtindia@gmail.comTRIAGE MEDITECH PVT. LTD. Care : +91 9971722111/9650440444 AN ISO 13485:2003 CERTIFIED COMPANY