Skip to main content

Negative-Pressure Wound Therapy for Large Burn Wounds

  • Chapter
  • First Online:
Burns, Infections and Wound Management

Abstract

Negative-pressure wound therapy (NPWT) has become a widely used and well-described treatment for acute and chronic wounds. The authors discuss advantages of XL-NPWT for large burns, infection prevention, promoting re-epithelialization, and fluid management. The techniques are described such as the “total body wrap” or “sandwich” technique, in which affected areas are sandwiched between large polyurethane dressings and silver-impregnated nonadherent foam that is applied to both recipient and donor sites, as well as over any intervening intact skin or burn wound. Although relatively new, XL-NPWT has proven to be safe and effective in treating burns ≥15% TBSA.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Orgill DP, Bayer LR (2011) Update on negative-pressure wound therapy. Plast Reconstr Surg 127(Suppl 1):105S–115S

    Article  CAS  PubMed  Google Scholar 

  2. Wang X, Zhang Y, Han C (2014) Topical negative pressure improves autograft take by altering nutrient diffusion: a hypothesis. Med Sci Monit 20:61–63

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Xia CY, Yu AX, Qi B, Zhou M, Li ZH, Wang WY (2014) Analysis of blood flow and local expression of angiogenesis associated growth factors in infected wounds treated with negative pressure wound therapy. Mol Med Rep 9:1759–1754

    Google Scholar 

  4. Fischer S, Wall J, Pomahac B, Riviello R, Halvorson EG (2016) Extra-large negative pressure wound therapy dressings for burns – initial experience with technique, fluid management, and outcomes. Burns 42(2):457–465

    Article  PubMed  Google Scholar 

  5. Steinstraesser L, Sand M, Steinau HU (2009) Giant VAC in a patient with extensive necrotizing fasciitis. Int J Low Extrem Wounds 8(1):28–30

    Article  PubMed  Google Scholar 

  6. Chong SJ, Liang WH, Tan BK (2010) Use of multiple VAC devices in the management of extensive burns: the total body wrap concept. Burns 36(7):e127–e129

    Article  PubMed  Google Scholar 

  7. Kamolz LP, Lumenta DB, Parvizi D, Wiedner M, Justich I, Keck M, Pfurtscheller K, Schintler M (2014) Skin graft fixation in severe burns: use of topical negative pressure. Ann Burns Fire Disasters 27(3):141–145

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Low OW, Chong SJ, Tan BK (2013) The enhanced total body wrap – the new frontier in dressing care for burns. Burns 39(7):1420–1422

    Article  PubMed  Google Scholar 

  9. Kantak NA, Mistry R, Halvorson EG (2016) A review of negative-pressure wound therapy in the management of burn wounds. Burns 42(8):1623–1633

    Article  PubMed  Google Scholar 

  10. Church D, Elsayed S, Reid O, Winston B, Lindsay R (2006) Burn wound infections. Clin Microbiol Rev 19(2):403–434

    Article  PubMed  PubMed Central  Google Scholar 

  11. Erol S, Altoparlak U, Akcay MN, Celebi F, Parlak M (2004) Changes of microbial flora and wound colonization in burned patients. Burns 30(4):357–361

    Article  PubMed  Google Scholar 

  12. Sheridan RL (2000) Evaluating and managing burn wounds. Dermatol Nurs 12(1):17–18 21–28

    CAS  PubMed  Google Scholar 

  13. Watts AM, Tyler MP, Perry ME, Roberts AH, McGrouther DA (2001) Burn depth and its histological measurement. Burns 27(2):154–160

    Article  CAS  PubMed  Google Scholar 

  14. Papp A, Kiraly K, Harma M, Lahtinen T, Uusaro A, Alhava E (2004) The progression of burn depth in experimental burns: a histological and methodological study. Burns 30(7):684–690

    Article  CAS  PubMed  Google Scholar 

  15. Kloppenberg FW, Beerthuizen GI, ten Duis HJ (2001) Perfusion of burns wounds assessed by laser Doppler imaging is related to burn depth and healing time. Burns 27(4):359–363

    Article  CAS  PubMed  Google Scholar 

  16. Monstrey S, Hoeksema H, Verbelen J, Pirayesh A, Blondeel P (2008) Assessment of burn depth and burn wound healing potential. Burns 34(6):761–769

    Article  PubMed  Google Scholar 

  17. Gamelli RL, He LK, Liu H (1994) Marrow granulocyte-macrophage progenitor cell response to burn injury as modified by endotoxin and indomethacin. J Trauma 37(3):339–346

    Article  CAS  PubMed  Google Scholar 

  18. Kim GH, Oh KH, Yoon JW, Koo JW, Kim HJ, Chae DW, Noh JW, Kim JH, Park YK (2003) Impact of burn size and initial serum albumin level on acute renal failure occurring in major burn. Am J Nephrol 23(1):55–60

    Article  PubMed  Google Scholar 

  19. Demling RH, Kramer G, Harms B (1984) Role of thermal injury-induced hypoproteinemia on fluid flux and permeability in burned and nonburned tissue. Surgery 95(2):136–144

    CAS  PubMed  Google Scholar 

  20. Lehnhardt M, Jafari HJ, Druecke D, Steinstraesser L, Steinau HU, Klatte W, Schwake R, Homann HH (2005) A qualitative and quantitative analysis of protein loss in human burn wounds. Burns 31(2):159–167

    Article  CAS  PubMed  Google Scholar 

  21. Ma Z, Shou K, Li Z, Jian C, Qi B, Yu A (2016) Negative pressure wound therapy promotes vessel destabilization and maturation at various stages of wound healing and thus influences wound prognosis. Exp Ther Med 11(4):1307–1317

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Rex S (2012) Burn injuries. Curr Opin Crit Care 18(6):671–676

    Article  PubMed  Google Scholar 

  23. Greene AK, Puder M, Roy R, Arsenault D, Kwei S, Moses MA, Orgill DP (2006) Microdeformational wound therapy: effects on angiogenesis and matrix metalloproteinases in chronic wounds of 3 debilitated patients. Ann Plast Surg 56(4):418–422

    Article  CAS  PubMed  Google Scholar 

  24. Chen SZ, Li J, Li XY, Xu LS (2005) Effects of vacuum-assisted closure on wound microcirculation: an experimental study. Asian J Surg 28(3):211–217

    Article  PubMed  Google Scholar 

  25. Grimm A, Dimmler A, Stange S, Labanaris A, Sauer R, Grabenbauer G, Horch RE (2007) Expression of HIF-1 alpha in irradiated tissue is altered by topical negative-pressure therapy. Strahlenther Onkol 183(3):144–149

    Article  PubMed  Google Scholar 

  26. Labler L, Rancan M, Mica L, Harter L, Mihic-Probst D, Keel M (2009) Vacuum-assisted closure therapy increases local interleukin-8 and vascular endothelial growth factor levels in traumatic wounds. J Trauma 66(3):749–757

    Article  CAS  PubMed  Google Scholar 

  27. Petkar KS, Dhanraj P, Kingsly PM, Sreekar H, Lakshmanarao A, Lamba S, Shetty R, Zachariah JR (2011) A prospective randomized controlled trial comparing negative pressure dressing and conventional dressing methods on split-thickness skin grafts in burned patients. Burns 37(6):925–929

    Article  PubMed  Google Scholar 

  28. Moisidis E, Heath T, Boorer C, Ho K, Deva AK (2004) A prospective, blinded, randomized, controlled clinical trial of topical negative pressure use in skin grafting. Plast Reconstr Surg 114(4):917–922

    Article  PubMed  Google Scholar 

  29. Banwell PE, Musgrave M (2004) Topical negative pressure therapy: mechanisms and indications. Int Wound J 1(2):95–106

    Article  PubMed  Google Scholar 

  30. Kamolz LP, Andel H, Haslik W, Winter W, Meissl G, Frey M (2004) Use of subatmospheric pressure therapy to prevent burn wound progression in human: first experiences. Burns 30(3):253–258

    Article  PubMed  Google Scholar 

  31. Genecov DG, Schneider AM, Morykwas MJ, Parker D, White WL, Argenta LC (1998) A controlled subatmospheric pressure dressing increases the rate of skin graft donor site reepithelialization. Ann Plast Surg 40(3):219–225

    Article  CAS  PubMed  Google Scholar 

  32. Greenhalgh DG (2010) Burn resuscitation: the results of the ISBI/ABA survey. Burns 36:176–182

    Article  PubMed  Google Scholar 

  33. Fahlstrom K, Boyle C, Makic MB (2013) Implementation of a nurse-driven burn resuscitation protocol: a quality improvement project. Crit Care Nurse 33(1):25–35

    Article  PubMed  Google Scholar 

  34. Walker TL, Rodriguez DU, Coy K, Hollen LI, Greenwood R, Young AE (2014) Impact of reduced resuscitation fluid on outcomes of children with 10-20% body surface area scalds. Burns 40(8):1581–1586

    Article  CAS  PubMed  Google Scholar 

  35. Imm A, Carlson RW (1993) Fluid resuscitation in circulatory shock. Crit Care Clin 9(2):313–333

    Article  CAS  PubMed  Google Scholar 

  36. Aboelatta Y, Abdelsalam A (2013) Volume overload of fluid resuscitation in acutely burned patients using transpulmonary thermodilution technique. Burn Care Res 34(3):349–354

    Article  Google Scholar 

  37. Boswick JA, Thompson JD, Kershner CJ (1977) Critical care of the burned patient. Anesthesiology 47(2):164–170

    Article  PubMed  Google Scholar 

  38. Lamke LO, Liljedahl SO (1971) Evaporative water loss from burns, grafts and donor sites. Scand J Plast Reconstr Surg 5:17–22

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to David E. Varon .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Varon, D.E., Smith, J.D., Mistry, R., Kantak, N.A., Halvorson, E.G. (2018). Negative-Pressure Wound Therapy for Large Burn Wounds. In: Shiffman, M., Low, M. (eds) Burns, Infections and Wound Management. Recent Clinical Techniques, Results, and Research in Wounds, vol 2. Springer, Cham. https://doi.org/10.1007/15695_2018_112

Download citation

  • DOI: https://doi.org/10.1007/15695_2018_112

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-10685-0

  • Online ISBN: 978-3-030-10686-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics