The Role of Negative Pressure Wound Therapy With Reticulated Open Cell Foam in the Treatment of War Wounds

Abstract

The treatment of war wounds poses many unique challenges to all healthcare providers (surgeons, flight medics, nurses, etc.), whether they are located at the far forward trauma hospitals located in or near areas of conflict, at regional hospitals such as Landstuhl Medical Center in Germany, or the larger military hospitals in the United States. These complex wounds often involve massive loss of soft tissue and bone, are contaminated, and are unlike most injuries seen at civilian hospitals. Treatment guidelines, or doctrine, are the result of lessons learned in conflicts over the past few centuries dating back to early 19th century Europe through the Vietnam and recent Persian Gulf war. Advances in surgical and medical treatment have resulted from the complex challenges presented to the war trauma surgeon. More than 1 million patients have been treated for chronic pressure ulcers, abdominal wounds, diabetic ulcers, and acute civilian trauma wounds with negative pressure wound therapy with reticulated open cell foam (NPWT/ROCF) as delivered by V.A.C.(R) Therapy (KCI, San Antonio, TX) for over the past decade. However, the use of NPWT/ROCF for the care of war wounds at battlefield trauma hospitals and/or in the aeromedical evacuation transport system aboard aircraft is a new application of this wound treatment not yet accepted as doctrine. Investigational studies are ongoing to study the safety and efficacy of the treatment of battlefield wounds with NPWT/ROCF both for those national citizens treated at the trauma hospitals in Iraq and Afghanistan and for those wounded American and coalition patients who are transported through the aeromedical transport system to medical centers in the United States.

Negative Pressure Wound Therapy in the Management of Combat Wounds: A Critical Review

“…The use of NPWT was widely reported during Operation Iraqi Freedom and OEF. 3,5 It rapidly gained popularity among the military surgeons worldwide due to its versatility, ease of application, and varied indications in combat-related wounds. NPWT became a preferred method in combat trauma as compared to traditional methods, with saline-soaked dressings.…”

“…It may be used after damage control surgery and temporary abdominal closure in abdominal trauma. 3 Its use during casualty air evacuation decreases infection rates, reduces discomfort of dressing changes during transit, and helps in early wound closure. 5,7 Wound preparation for final surgical closure .…”

“…The wound appearance changes to red as the granula- Clinical use and protocols based on NPWT in managing combat wounds We started using NPWT in combat wounds based on various reports published in literature. 3,4 Casualties with gunshot wounds and mine blast injuries were managed with NPWT followed by delayed soft tissue cover. Patients were transferred from forward surgical center to a tertiary care center where advanced facilities of combat casualty care were available.…”

“…The benefits of NPWT in combat trauma have been reported by various authors. 2,3 The popularity of NPWT can be gauged by the fact that during Operation Enduring Freedom (OEF) in March 2003, about 46% of wounds were managed with NPWT and in September 2003 its use had increased to over 90% of admitted wounds. 4 Further technical refinements have validated its use during air transport, allowing casualties to receive continuous NPWT during air evacuation, from forward surgical center to a tertiary care center.…”

Description of a Technique for Vacuum-Assisted Deep Drains in the Management of Cavitary Defects and Deep Infections in Devastating Military and Civilian Trauma

“…Similarly, military orthopedic surgeons have noted difficulties in applying VACT to cavitary war wounds. 18 One solution for the management of these wounds has been to place a tail of the sponge into the cavity. This technique can lead to sponge retention within the depths of the wound.…”