Pressure ulcers are a serious health issue, leading to clinical, financial, and emotional challenges. Numerous treatment modalities are available to promote wound healing, yet clinicians may be unsure how to incorporate these treatment options into an overall plan of care for the patient with a pressure ulcer. A consensus panel of experienced wound care clinicians convened in July 2004 to review the mechanisms of action and research basis for one such treatment modality: negative pressure wound therapy. After answering key questions about this modality, they developed an algorithm to assist the clinician in making decisions about using negative pressure wound therapy appropriately in patients with Stage III and Stage IV pressure ulcers.

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The challenges of managing pressure ulcers are often not limited to clinical decisions; they may impact other areas that encompass patient care, including financial, emotional, psychosocial, regulatory, and medical-legal aspects. The difficulty in managing these complex factors is magnified by recent gains in understanding of the pathophysiology of wounds related to pressure, which serves as the basis for the etiology, diagnosis, staging, and management of these wounds. This article summarizes the current and evolving knowledge related to pressure ulcers and discusses an algorithm recently developed to assist in clinical management decisions related to patients with pressure ulcers, with emphasis on appropriate utilization of Negative Pressure Wound Therapy delivered by V.A.C. Therapy (KCI USA, Inc.) in patients with Stage III and Stage IV pressure ulcers.

Negative Pressure Wound Therapy, also known as Vacuum Assisted Closure (V.A.C.), is a new treatment in which controlled negative pressure is used to provide evacuation of wound fluid, stimulation of granulation tissue, and a decrease in bacterial colonization. A brief discussion of the physiology of wound healing is accompanied by an explanation of vacuum assisted wound closure. Indications and contraindications for V.A.C. are discussed. The authors present several case studies of patients with nonhealing wounds who benefitted from V.A.C.