title: EWMA Document: Negative Pressure Wound Therapy.
abstract: 1. Introduction Since its introduction in clinical practice in the early 1990's negative pressure wounds therapy (NPWT) has become widely used in the management of complex wounds in both inpatient and outpatient care.1NPWT has been described as a effective treatment for wounds of many different aetiologies2,3and suggested as a gold standard for treatment of wounds such as open abdominal wounds,4-6dehisced sternal wounds following cardiac surgery7,8and as a valuable agent in complex non-healing wounds.9,10Increasingly, NPWT is being applied in the primary and home-care setting, where it is described as having the potential to improve the efficacy of wound management and help reduce the reliance on hospital-based care.11While the potential of NPWT is promising and the clinical use of the treatment is widespread, highlevel evidence of its effectiveness and economic benefits remain sparse.12-14The ongoing controversy regarding high-level evidence in wound care in general is well known. There is a consensus that clinical practice should be evidence-based, which can be difficult to achieve due to confusion about the value of the various approaches to wound management; however, we have to rely on the best available evidence. The need to review wound strategies and treatments in order to reduce the burden of care in an efficient way is urgent. If patients at risk of delayed wound healing are identified earlier and aggressive interventions are taken before the wound deteriorates and complications occur, both patient morbidity and health-care costs can be significantly reduced. There is further a fundamental confusion over the best way to evaluate the effectiveness of interventions in this complex patient population. This is illustrated by reviews of the value of various treatment strategies for non-healing wounds, which have highlighted methodological inconsistencies in primary research. This situation is confounded by differences in the advice given by regulatory and reimbursement bodies in various countries regarding both study design and the ways in which results are interpreted. In response to this confusion, the European Wound Management Association (EWMA) has been publishing a number of interdisciplinary documents15-19with the intention of highlighting: The nature and extent of the problem for wound management: from the clinical perspective as well as that of care givers and the patients Evidence-based practice as an integration of clinical expertise with the best available clinical evidence from systematic research The nature and extent of the problem for wound management: from the policy maker and healthcare system perspectives The controversy regarding the value of various approaches to wound management and care is illustrated by the case of NPWT, synonymous with topical negative pressure or vacuum therapy and cited as branded VAC (vacuum-assisted closure) therapy. This is a mode of therapy used to encourage wound healing. It is used as a primary treatment of chronic wounds, in complex acute wounds and as an adjunct for temporary closure and wound bed preparation preceding surgical procedures such as skin grafts and flap surgery. Aim An increasing number of papers on the effect of NPWT are being published. However, due to the low evidence level the treatment remains controversial from the policy maker and health-care system's points of view-particularly with regard to evidence-based medicine. In response EWMA has established an interdisciplinary working group to describe the present knowledge with regard to NPWT and provide overview of its implications for organisation of care, documentation, communication, patient safety, and health economic aspects. These goals will be achieved by the following: Present the rational and scientific support for each delivered statement Uncover controversies and issues related to the use of NPWT in wound management Implications of implementing NPWT as a treatment strategy in the health-care system Provide information and offer perspectives of NPWT from the viewpoints of health-care staff, policy makers, politicians, industry, patients and hospital administrators who are indirectly or directly involved in wound management.
authors.affiliation: Department of Endocrinology, University Hospital of Malmö, 205 02 Malmö, Sweden and Division for Clinical Sciences, University of Lund, 221 00 Lund, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Apelqvist
authors.affiliation: Department of Trauma & Orthopedic Surgery, Septic & Reconstructive Surgery, Bundeswehr Hospital Berlin, Research and Treatment Center for Complex Combat Injuries, Federal Armed Forces of Germany, 10115 Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Willy
authors.affiliation: Department of Clinical Science and Education, Karolinska Institutet, and Wound Centre, Södersjukhuset AB, SE-118 83 Stockholm, Sweden.
authors.forename: Ann-Mari
authors.initials: AM
authors.lastname: Fagerdahl
authors.affiliation: Plastic Surgery Unit, ASO Città della Salute e della Scienza of Turin, University of Turin, 10100 Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Fraccalvieri
authors.affiliation: Clinical Sciences, Lund University, Lund, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Malmsjö
authors.affiliation: Department of Endocrinology and Metabolism, Pisa University Hospital, 56125 Pisa, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Piaggesi
authors.affiliation: Kreiskliniken Reutlingen GmbH, 72764 Reutlingen, Germany.
authors.forename: Astrid
authors.initials: A
authors.lastname: Probst
authors.affiliation: Faculty of Life Sciences, University of Bradford, and Honorary Consultant Vascular Surgeon, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Vowden
mesh_terms: D017048:Health Care Costs; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D011182:Postoperative Care; D016038:Skin Transplantation; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000628:therapy*