EWMA Council

Prof. Christine Moffatt
EWMA Position
Document Editor
Director,
Centre for Research
and Implementation
of Clinical Practice
Christine.Moffatt@
exchange.tvu.ac.uk
Correspondence to:
Kathy Day
MEP Ltd,
53 Hargrave Road,
London N19 5SH
kday@mepltd.co.uk
EWMA Position Document 2007:
Topical Negative Pressure
in Wound Management
More than a decade after pioneering
researchers experimented with crude
suction apparatus to promote wound
healing, topical negative pressure (TNP) therapy
has revolutionised the field of wound management.
TNP therapy substantially broadens the
scope of treatment and has rapidly become a
first-line intervention for a wide range of complex
wounds. This important development in wound
care is being shown in a growing number of randomised
controlled trials, as well as case studies,
to produce dramatic improvements in clinical
outcomes such as healing rates, hospitalisations
and, in the case of mediastinitis and the open abdomen,
mortality.
The indications and advantages of TNP therapy
have been reviewed extensively (Box 1), however
there remains a crucial need for a better understanding
of when and how to effectively integrate
this therapy into clinical practice.
Box 1
Studies using TNP therapy in various wound types
n Burn wounds 1
n Chronic leg ulcers 2
n Diabetic foot ulcers 3
n Open abdomen including
management of fistulae 4
n Pressure ulcers 5
n Securing a skin graft 6
n Sternal wound infections 7
n Surgical, non-healing wounds 8
n Trauma 9
With these issues in mind, the 2007 EWMA position
document – Topical negative pressure in
wound management – presents a European perspective
on the pathophysiological effects and the
technical and practical issues involved in using
TNP therapy. The aim is to provide insights into
the use of the intervention in the clinical setting,
and to enable healthcare professionals to select
and apply therapy safely. The document is published
in five languages (Figure 1) and is available
online at: www.ewma.org.
It should be noted that most clinical trials of TNP
therapy have used the vacuum assisted closure
(V.A.C. ® Therapy) system and therefore it is this
specific device that is described throughout the
document.
In the first of the four papers presented, Gustafsson,
Sjögren and Ingemansson set the scene
by outlining the historical development of TNP
therapy and describing the key components of
the VAC system.
Although TNP therapy has obvious clinical advantages,
it is often considered expensive compared
with alternative options and this may have been
a barrier to its use, particularly in community set-
Figure 1. The 2007 EWMA position document is available
in five languages.
EWMA Journal 2007 vol 7 no 2