Negative Pressure Wound Therapy (VAC)

NPWT is used whenever a wound is too large, too deep, or too contaminated to heal reliably on its own with standard dressings. It is often chosen after other wound-care methods have stalled, or as a planned first step for complex wounds right after surgery or injury.

• Diabetic foot ulcers (open sores on the feet caused by diabetes-related nerve and blood-vessel damage)
• Pressure injuries (also called bedsores or decubitus ulcers), especially stage III and stage IV
• Surgical wounds that have opened up or become infected after an operation (dehiscence)
• Traumatic wounds, including open fractures and degloving injuries (where skin is stripped from the tissue below)
• Burns and skin-graft sites, to help the graft attach and survive

NPWT is generally well tolerated, but like any wound treatment it carries some recognised risks, listed from most to least common.

• Pain or discomfort when the dressing is removed and replaced, usually every 48 to 72 hours
• Skin irritation or breakdown around the sealed film edges
• Bleeding from fragile wound tissue, especially in patients who take blood thinners
• Retained foam: small pieces of dressing material left in the wound if not carefully counted
• Infection continuing or worsening despite therapy, particularly if bacteria are highly resistant

Preparation for NPWT depends on where it is being set up. When it starts in an operating theatre (for example, right after debridement, which is surgical cleaning of the wound), standard pre-operative fasting applies: nothing to eat for at least six hours and nothing to drink for at least two hours before the scheduled time. If the device is being fitted at the bedside or in a clinic without anaesthesia (numbing of the whole body), fasting is usually not required.

Blood-thinning medications are reviewed by the doctor before the device is placed, because active bleeding inside the wound can be worsened by suction. Smoking constricts the small blood vessels that NPWT tries to stimulate, so the wound-care team will usually encourage stopping or reducing smoking before and during the course of treatment. Alcohol can also impair healing and interact with any pain relief given during dressing changes.

Before starting NPWT, the medical team typically runs a set of baseline tests to understand the wound and the patient's overall health.

• Blood tests: full blood count to check for anaemia (low red blood cell levels) and signs of infection, and blood sugar control tests for diabetic patients
• Wound swab or tissue culture: a sample taken from the wound to identify any bacteria present and choose the right antibiotics if needed
• Imaging such as ultrasound or MRI to check whether infection has spread to bone (osteomyelitis) or deeper structures

Recovery with NPWT is ongoing rather than a single event: the device stays in place continuously, and care focuses on keeping the seal intact, managing pain during dressing changes, and watching for signs of healing or complications. Whether the patient is in hospital or at home with a portable pump, the same basic principles apply.

• Dressing changes: the foam or gauze is removed and replaced by a trained nurse or clinician, usually every 48 to 72 hours, or more often if the wound is infected.
• Pain management: a pain reliever is typically offered before each dressing change, as removal of adherent foam can be uncomfortable.
• Mobility: many patients with a portable pump can move around, shower with a sealed waterproof cover, and sometimes even go home, depending on wound severity and the doctor's assessment.
• Monitoring the canister: the collection canister must be checked regularly and emptied or replaced when full, following the nurse's or manufacturer's instructions.
• Wound progress checks: the clinical team examines the wound at each dressing change, looking for new pink tissue (granulation) as a sign that healing is advancing.

The cost of NPWT varies widely because the treatment is not a single procedure with a fixed price; it is a continuous therapy that can last days, weeks, or even months, and the final bill reflects how long the device runs, how complex the wound is, and the healthcare system in which it is delivered.

• Wound complexity and stage: a small post-surgical wound requiring a single short course of NPWT costs far less than a deep, infected diabetic foot ulcer or an open abdomen that needs weeks of continuous suction.
• Frequency of dressing changes: more frequent changes (for infected or heavily draining wounds) mean more nursing time, more foam dressings, and more canisters.
• Pump type: single-use disposable pumps have a different cost structure than reusable hospital-grade pumps with rented consumables.
• Inpatient versus outpatient setting: hospital admission, ICU level care, or specialist surgical wards all carry different daily charges that add to the therapy's base cost.
• Hospital class and country: a private tertiary hospital in a high-income country charges substantially more than an equivalent facility in a country with lower operating costs.