J Korean Foot Ankle Soc.  2024 Jun;28(2):41-47. 10.14193/jkfas.2024.28.2.41.

Application of Negative Pressure Wound Therapy in the Foot and Ankle Field

• Ahn J
• Nam DC

• KMID: 2556552
• DOI: http://doi.org/10.14193/jkfas.2024.28.2.41

Abstract

Negative pressure wound therapy (NPWT) has emerged as a valuable tool for managing complex wounds within the foot and ankle field. This review article discusses the expanding applications of NPWT in this specialized field. Specifically, it discusses the efficacy of NPWT for various wound types, including diabetic foot wounds, traumatic wounds, surgical wounds, and wounds involving exposed bone or soft tissue defects. NPWT demonstrates versatile utility for foot and ankle wound management by promoting healing, potentially reducing the need for secondary surgery, improving diabetic and neuropathic ulcer healing times and outcomes, and optimizing the healing of high-risk incisions. In addition, this review explores the underlying mechanisms through which NPWT might enhance wound healing. By synthesizing current evidence, this review provides a comprehensive overview of the role of NPWT in foot and ankle surgery and offers valuable insights to clinicians navigating the complexities of wound care in this challenging anatomical area.

Keyword

Foot; Ankle; Negative-pressure wound therapy; Wound healing

Figure

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  Figure 1 Schematic diagram of negative pressure wound therapy and the concept of macrodeformation and microdeformation are depicted. As the polyurethane foam shrinks and pulls the edge of the wound, the overall size of the wound gradually decreases (macrodeformation), and sound pressure is properly distributed into the wound through the microscopic holes in the polyurethane foam, causing fine deformation on the wound surface (microdeformation). NPWT: negative pressure wound therapy.

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  Figure 2 The basic components of negative pressure wound therapy include negative pressure pump, storage container (canister), suction tube and port, polyurethane sponge foam, and adhesive sealing film.

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  Figure 3 Adequate debridement was performed for a diabetic foot ulcer accompanied by suppurative tenosynovitis (A). After controlling local infection, polyurethane foam was cut to fit the size of the lesion (B), holes were made at the site to attach the negative pressure pump (C), and an absorption cap was attached (D). Subsequently, healthy granulation tissue proliferated (E).

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  Figure 4 A patient with an open comminuted fracture of the distal tibia due to a motor vehicle accident presented to the hospital (A). The open wound revealed severe contamination and a diagnosed Gustilo-Anderson type IIIb fracture (B). After applying an external fixation device and performing debridement, antibiotics-loaded cement beads were inserted, and negative pressure wound therapy was applied (C). Subsequently, the infection was controlled, and the wound size gradually decreased (D). A reverse sural flap was then performed (E). This was followed by intramedullary nailing (F).

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