THE ROLE AND PLACE OF NPWT IN THE MULTIDISCIPLINARY SURGICAL MANAGEMENT OF GUNSHOT AND BLAST LIMB INJURIES
DOI:
https://doi.org/10.32345/USMYJ.3(164).2026.154-162Keywords:
NPWT, negative pressure, blast injury, limb gunshot wound, Damage ControlAbstract
Introduction. Modern armed conflicts are characterized by a high proportion of blast injuries to the limbs (up to 80%), accompanied by massive tissue defects and the formation of a zone of secondary necrosis. Traditional drainage methods are often insufficient for stabilizing such wounds, necessitating the search for more effective technologies, among which Negative Pressure Wound Therapy (NPWT) holds a leading position.
Aim. The aim of the study was to systematize and analyze the findings of current research regarding the efficacy, pathophysiological mechanisms, and safety of NPWT in the multidisciplinary management of blast limb injuries.
Materials and methods. An analysis of scientific sources from PubMed, Scopus, and Google Scholar databases, as well as national clinical guidelines dedicated to combat trauma management for the period 1997-2025, was conducted.
Results. It was established that NPWT exerts its effects through mechanisms of macro- and microdeformation, active exudate removal, and stimulation of angiogenesis, which allows for the stabilization of the "molecular shock" zone. It was determined that "early NPWT" (24-72 hours after radical primary surgical debridement) within the Damage Control concept is optimal. This method accelerates wound preparation for closure by 25-40%, reduces the incidence of infectious complications by 15-20%, and decreases the rate of delayed amputations. Particular attention is paid to safety: the necessity of using protective interfaces in cases of major vessel damage to prevent bleeding.
Conclusions. NPWT is a pathophysiologically sound and widely applied component of multidisciplinary treatment of blast wounds, providing active management of the wound process and creating conditions for successful reconstructive surgery. Personalization of pressure regimes and microbiological monitoring of biofilms under vacuum represent a promising direction for future research.
References
1. Giannou C, Balden M, Molde Å. War Surgery: Working With Limited Resources in Armed Conflict and Other Situations of Violence (Volume 2). Ann R Coll Surg Engl. 2014;96(3):251. https://doi.org/10.1308/rcsann.2014.96.3.251
2. Owens BD, Kragh JF, Wenke JC, Macaitis J, Wade CE, Holcomb JB. Combat Wounds in Operation Iraqi Freedom and Operation Enduring Freedom. J Trauma. 2008;64(2):295-299. https://doi.org/10.1097/ta.0b013e318163b875
3. Mathieu L, Choufani C, Andro C, de l’Escalopier N. Management of combat-related extremity injuries in modern armed conflicts. Orthop Traumatol Surg Res. 2024:104055. [suspicious link removed]
4. Tarasenko V, Kuchmistova O, Solomennyi A, Pidlisnyi O. Characteristics structuring and consequences of battle trauma of armed forces members. Ukr J Mil Med. 2019;19(4):111-117. https://ujmm.org.ua/index.php/journal/article/view/41
5. Zarutskyi YaL, Bilenkyi VA, et al. Military field surgery: a textbook. Kyiv: Phoenix. 2022.
6. Ignatiadis IA, Mavrogenis AF, Igoumenou VG, Polyzois VD, Tsiampa VA, Arapoglou DK, Spyridonos S. Gunshot and blast injuries of the extremities: a review of 45 cases. Eur J Orthop Surg Traumatol. 2018;29(2):295-305. https://doi.org/10.1007/s00590-018-2350-4
7. Maurya S, Srinath N, Bhandari PS. Negative pressure wound therapy in the management of mine blast injuries of lower limbs: Lessons learnt at a tertiary care center. Med J Armed Forces India. 2017;73(4):321-327. https://doi.org/10.1016/j.mjafi.2016.06.002
8. Glass GE, Murphy GF, Esmaeili A, Lai LM, Nanchahal J. Systematic review of molecular mechanism of action of negative-pressure wound therapy. Br J Surg. 2014;101(13):1627-1636. https://doi.org/10.1002/bjs.9636
9. Liu H, Zhang G, Wei A, Xing H, Han C, Chang Z. Effect of negative pressure wound therapy on the incidence of deep surgical site infections after orthopedic surgery: a meta-analysis and systematic review. J Orthop Surg Res. 2024;19(1). https://doi.org/10.1186/s13018-024-05038-7
10. Yuan S, Zhang T, Zhang D, He Q, Du M, Zeng F. Impact of negative pressure wound treatment on incidence of surgical site infection in varied orthopedic surgeries: A systematic review and meta-analysis. Int Wound J. 2022. https://doi.org/10.1111/iwj.14043
11. Leininger BE, Rasmussen TE, Smith DL, Jenkins DH, Coppola C. Experience With Wound VAC and Delayed Primary Closure of Contaminated Soft Tissue Injuries in Iraq. J Trauma. 2006;61(5):1207-1211. https://doi.org/10.1097/01.ta.0000241150.15342.da
12. Arti H, Khorami M, Ebrahimi-Nejad VE. Comparison of Negative Pressure Wound Therapy (NPWT) and Conventional Wound Dressings in the Open Fracture Wounds. Pak J Med Sci. 2016;32(1):247-251. https://doi.org/10.12669/pjms.321.8568
13. Li Z, Yu Q, Wang S, Wang G, Li T, Tang P, Liu D. Impact of negative‐pressure wound therapy on bacterial behaviour and bioburden in a contaminated full‐thickness wound. Int Wound J. 2019;16(5):1214-1221. https://doi.org/10.1111/iwj.13197
14. Fries CA, Jeffery SL, Kay AR. Topical negative pressure and military wounds—A review of the evidence. Injury. 2011;42(5):436-440. https://doi.org/10.1016/j.injury.2010.02.027
15. Argenta LC, Morykwas MJ. Vacuum-Assisted Closure: A New Method for Wound Control and Treatment. Ann Plast Surg. 1997;38(6):563-577. https://doi.org/10.1097/00000637-199706000-00002
16. Maurya S, Bhandari PS. Negative Pressure Wound Therapy in the Management of Combat Wounds: A Critical Review. Adv Wound Care. 2016;5(9):379-389. https://doi.org/10.1089/wound.2014.0624
17. Hinck D, Franke A, Gatzka F. Use of Vacuum-Assisted Closure Negative Pressure Wound Therapy in Combat-Related Injuries—Literature Review. Mil Med. 2010;175(3):173-181. https://doi.org/10.7205/milmed-d-09-00075
18. Ruberg RL. Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: Steps towards an international consensus. Yearb Plast Aesthet Surg. 2012;2012:224-225. https://doi.org/10.1016/j.yprs.2011.07.004
19. Van Rysselberghe NL, Gonzalez CA, Calderon C, Mansour A, Oquendo YA, Gardner MJ. Negative Pressure Wound Therapy for Extremity Open Wound Management: A Review of the Literature. J Orthop Trauma. 2022;36(4):S6-S11. https://doi.org/10.1097/bot.0000000000002430
20. Sivash II, Koval BM. Negative pressure wound therapy for combat-related extremity vascular injuries: clinical experience from the war in Ukraine. Scand J Trauma Resusc Emerg Med. 2025;33(1). https://doi.org/10.1186/s13049-025-01502-3
21. Upton D, Andrews A. Pain and trauma in negative pressure wound therapy: a review. Int Wound J. 2013;12(1):100-105. https://doi.org/10.1111/iwj.12059
22. Gabriel A. The clinical use of negative pressure wound therapy with instillation in surgical wound healing. In: Surgical Wound Healing and Management. CRC Press. 2012:104-109. https://doi.org/10.3109/9781841849270-13
23. Roberts DJ, Bobrovitz N, Zygun DA, Kirkpatrick AW, Ball CG, Faris PD, Stelfox HT. Evidence for use of damage control surgery and damage control interventions in civilian trauma patients: a systematic review. World J Emerg Surg. 2021;16(1). https://doi.org/10.1186/s13017-021-00352-5
24. Ratnicka I, Kondej K, Jończyk J, Graczyk M, Chrzanowska B, Jankau J. Negative pressure wound therapy as a "bridge" for the final reconstruction of tissue defect following a degloving injury of the forearm – a case report. Negat Press Ther J. 2019;6(3):4-7. https://doi.org/10.18487/npwtj.v6i3.52
25. Mamun AA, Shao C, Geng P, Wang S, Xiao J. Recent advances in molecular mechanisms of skin wound healing and its treatments. Front Immunol. 2024;15. https://doi.org/10.3389/fimmu.2024.1395479
26. Martsynkovskyi IP, Stashchuk RP, Ordatii AV, Bohush HL, Kryvoruchko VO, Korobko VA, et al. Experience of using VAC-therapy in the complex treatment of gunshot wounds. Visn Ortop Travmatol Protez. 2022;(3):12-18. https://dspace.vnmu.edu.ua/handle/123456789/6157
27. Loskutov OYe, Zherdev II, Domanskyi AM, Korol SO. Surgical tactics for the treatment of gunshot wounds of the limbs in a multidisciplinary hospital. Trauma. 2022;17(3):169-172. https://doi.org/10.22141/1608-1706.3.17.2016.75804
28. Zhang J, Xu R, Qian J, Cai X. Closed incision management with negative pressure wound therapy: a systematic review and meta-analysis of orthopedic trauma outcomes. BMC Musculoskelet Disord. 2025;26(1). https://doi.org/10.1186/s12891-025-08986-1
29. Qian H, Lei T, Hu Y. Negative pressure wound therapy versus gauze dressings in managing open fracture wound of lower limbs: A meta-analysis of randomized controlled trials.Foot Ankle Surg. 2022. https://doi.org/10.1016/j.fas.2022.03.012
30. Costa ML, Achten J, Bruce J, Tutton E, Petrou S, Lamb SE, Parsons NR. Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb. JAMA. 2018;319(22):2280. https://doi.org/10.1001/jama.2018.6452
31. Sivash II, Koval BM. NPWT in Complex Surgical Management of Combat Vascular Injuries of the Limbs: Fundamentals of Safe Application and Clinical Experience. Ukr J Cardiovasc Surg. 2025;33(4):136-146. https://doi.org/10.63181/ujcvs.2025.33(4).136-146
32. Téot L, Boissiere F, Fluieraru S. Novel foam dressing using negative pressure wound therapy with instillation to remove thick exudate. Int Wound J. 2017;14(5):842-848. https://doi.org/10.1111/iwj.12719
33. Ng S, Lok E, Oe T. Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopaedic Setting. Adv Wound Care. 2024. https://doi.org/10.1089/wound.2023.0133
34. Burhan A, Ali Khusein NB, Sebayang SM. Effectiveness of negative pressure wound therapy on chronic wound healing: A systematic review and meta-analysis. Belitung Nurs J. 2022;8(6):470-480. https://doi.org/10.33546/bnj.2220
35. Liu X, Zhang H, Cen S, Huang F. Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: A systematic review and meta-analysis. Int J Surg. 2018;53:72-79. https://doi.org/10.1016/j.ijsu.2018.02.064
36. Gabriel A, Shores J, Heinrich C, Baqai W, Kalina S, Sogioka N, Gupta S. Negative pressure wound therapy with instillation: a pilot study describing a new method for treating infected wounds. Int Wound J. 2008;5(3):399-413. https://doi.org/10.1111/j.1742-481x.2007.00423.x
37. Derakhshandeh H, Kashaf SS, Aghabaglou F, Ghanavati IO, Tamayol A. Smart Bandages: The Future of Wound Care. Biotechnol. 2018;36(12):1259-1274. https://doi.org/10.1016/j.tibtech.2018.07.007
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