International Wound Journal ISSN 1742-4801

P R O L O G U E

Breakthrough ideas leading to new futures: next stepsChristian Willy

Department of Traumatology and Orthopaedics, Septic and Plastic Surgery, Bundeswehrkrankenhaus Berlin, Berlin, Germany

Key words

ABThera™ therapy; Incisions; NPWT; Openabdomen; Prevena™ therapy

Correspondence to

C Willy, MD, Professor of Surgery, ColonelDepartment of Traumatology andOrthopaedics, Septic and Plastic SurgeryBundeswehrkrankenhaus BerlinScharnhorststr. 13Berlin 10115GermanyE-mail: christianwilly@bundeswehr.org

doi: 10.1111/iwj.12236

Willy C. Breakthrough ideas leading to new futures: next steps. Int Wound J 2014; 11(suppl. 1):1–2

Abstract

In 2010, the educational International Surgical Wound Forum (ISWF) was created tofacilitate discussion among global experts regarding modern wound treatment chal-lenges and how negative pressure wound therapy (NPWT) could be used to addressthose challenges. This is the second of two supplements, which are based on 2012 and2013 ISWF presentations and demonstrate the evolution of NPWT’s role in wound care.The previous supplement provided an overview of critical health care issues and currentclinical practice and reviewed evidence and experience using NPWT with instillationof topical wound solutions. This supplement presents clinical experience using nega-tive pressure over closed surgical incisions, in the open abdomen, and in wounds withenteroatmospheric fistulas.

Since negative pressure wound therapy (NPWT; V.A.C.® Ther-apy) was commercialised in the mid-1990s, physicians aroundthe world have used this adjunct therapy in a variety ofcare settings (e.g. hospital, home and combat hospital) toaddress an expanding number of wound types. The exten-sive international body of evidence on the subject of vac-uum therapy created the need to integrate recent knowledgepublished in journals or presented at international meetingsand to discuss future developments for NPWT and woundcare in general. In 2010, the educational International Sur-gical Wound Forum (ISWF) was created to facilitate discus-sion among global experts regarding modern wound treatmentchallenges and techniques.

The first of two supplements based on presentations anddiscussions at ISWFs in 2012 (Sitges, Spain) and 2013 (Istan-bul, Turkey) was published in December 2013. This docu-ment provided an overview of the current challenge of healthcare-associated infections, including surgical site infections(SSIs) and biofilm, and current clinical strategies for treatinginfected wounds. Results from studies using NPWT with instil-lation of topical wound solutions to cleanse infected wounds asadjunctive therapy demonstrated favourable clinical outcomes.

This second supplement reports the use of negative pressureover closed surgical incisions, in the open abdomen, and inwounds with fistulas. SSIs result in increased morbidity for thepatient and higher cost of care. To address SSIs, physiciansbegan to use NPWT over closed surgical incisions in patientswho were at high risk of developing post-surgical woundcomplications (e.g. infection and dehiscence) because of

comorbidities and/or type of surgery. Surgical incision man-agement (SIM; Prevena™ Incision Management System) wasdeveloped to simplify application of NPWT over incisions.Clinical experience with the use of NPWT is reported in sep-arate studies of patients with risk factors, such as diabetes orobesity, whose incisions post vascular, sternal, or orthopaedicsurgery were managed with either incisional NPWTor SIM.

Abdominal surgery can also result in complex problems,including the need for temporary abdominal closure whentreatment requires an open abdomen. The value of negativepressure therapy (NPT; ABThera™ Therapy) in this indicationis presented in the context of a large retrospective study of115 patients. The authors report favourable results using their

Key Messages

• this supplement, which is based on presentations at the2012 and 2013 International Surgical Wound Forum ses-sions, presents clinical experience using negative pres-sure over closed surgical incisions in the open abdomenand in wounds with fistulas

• studies using incisional negative pressure wound therapyor surgical incision management over closed incisions inpatients with multiple risk factors have reported reducedrates of wound complications

• favourable results have also been reported in studies usingnegative pressure therapy in the open abdomen

© 2014 The AuthorInternational Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd 1

Breakthrough ideas leading to new futures: next steps C. Willy

“narrowing” technique with NPT to facilitate primary fascialclosure.

Fistula management is another critical concern when deal-ing with abdominal wounds, and enteroatmospheric fistulas(EAFs) are particularly challenging. Case studies are includedthat demonstrate techniques for the use of NPWT in complexabdominal wounds, including those with EAFs.

The goal of this supplement is to introduce less experiencedusers to the value of using NPWT over incisions and in abdomi-nal wounds to help address health care concerns such as woundinfection and management of the open abdomen. The clinicalor practical user will welcome the collection of interesting caseexamples, as well as practical advice regarding the applicationof NPWT in these clinical situations.

Conflicts of Interest

Dr. CW presented as a faculty member during the 2012 and2013 International Surgical Wound Forum (ISWF), an annualeducational event sponsored by Kinetic Concepts, Inc. (KCI).He is the Guest Editor for this and a previous KCI-fundededucational supplement based on faculty presentations at 2012and 2013 ISWF sessions related to wound care strategies witha focus on use of NPWT. KCI assisted with editorial reviewof the manuscript. All trademarks designated in this article areproprietary to KCI Licensing, Inc., its affiliates and/or licensors.

© 2014 The Author2 International Wound Journal © 2014 Medicalhelplines.com Inc and John Wiley & Sons Ltd