What Qualifies a Wound for NPWT? Clinical Indications Guide
What qualifies a wound for a wound vac?
The Quick Answer
**NPWT (wound VAC) is indicated for**: diabetic foot ulcers, stage 3–4 pressure injuries, dehisced surgical wounds, traumatic wounds with tissue loss, burns (partial-thickness), skin graft/flap fixation, and wounds failing conventional therapy after 2–4 weeks. Contraindications include untreated osteomyelitis, necrotic tissue without debridement, malignancy in wound bed, or exposed vessels/organs without protective coverage.
Why We Ask This
Clinicians either overutilize NPWT for simple wounds where standard dressings suffice (wasting resources) or underutilize it for complex wounds where early NPWT could prevent amputation—both extremes driven by unclear qualification criteria and insurance authorization hurdles.
The Practical Science
Evidence-based indications follow wound characteristics: depth >0.5cm, moderate-to-heavy exudate, non-viable tissue requiring frequent debridement, or need for mechanical approximation of wound edges. NPWT accelerates granulation by 30–50% through fluid removal, bacterial reduction, and mechanotransduction stimulating cellular proliferation.
In Clinical Practice
A patient with a 4cm×3cm diabetic foot ulcer with exposed tendon receives NPWT after sharp debridement—foam cut to wound dimensions fills dead space while -100 mmHg suction removes exudate and stimulates granulation. Within 3 weeks, granulation tissue covers the tendon, enabling split-thickness grafting versus amputation.
References & Context
Vacuum assisted closure (VAC)/negative pressure wound ..."Indications of VAC includes diabetic foot ulcers, bed sores, skin graft fixation, flap salvage, burns, crush injuries, sternal/abdominal wound dehiscence, fasciotomy wounds, extravasation wounds and animal bites/frostbite.Jun 20, 2019"