ReconstructionWound careOPCS S57
Negative pressure wound therapy (NPWT)
NPWT · vacuum-assisted closure (VAC™) · topical negative pressure (TNP)
Negative pressure wound therapy applies subatmospheric pressure (typically −80 to −125 mmHg) to a wound through a sealed dressing connected to a vacuum pump and canister. It removes excess interstitial fluid, mechanically deforms the wound edge, and promotes granulation, perfusion and angiogenesis. In skin oncology its main uses are as a bolster over skin grafts, salvage of dehisced reconstruction, downstaging of complex defects pending definitive reconstruction, and management of post-lymphadenectomy seroma / drainage.
CurrentLast reviewed 16 May 2026
Mechanism
- Subatmospheric pressure (typically −80 to −125 mmHg) at the wound bed.
- Macrostrain: contraction of the wound bed; reduces volume of large defects.
- Microstrain: mechanical deformation of cells → mechanotransduction-driven proliferation and angiogenesis.
- Removal of exudate and interstitial oedema.
- Reduction of bacterial bioburden (limited evidence; not a substitute for surgical debridement).
- Stabilisation of the wound bed → improved graft / flap take.
Indications in skin oncology
- Skin-graft bolster: over uneven, large or contoured beds (lower limb, scalp, perineal); reduces shear and seroma. NPWT bolster typically applied for 5-7 days.
- Salvage of dehisced wounds or seroma after lymphadenectomy.
- Temporary closure of large defects awaiting Mohs / permanent paraffin margin clearance.
- Post-operative seroma prevention after groin / axillary block dissection — supported by RCTs in melanoma and other oncologic dissections.
- Dehiscence over irradiated beds; complex pressure-injury management in advanced disease.
- Bridging therapy between staged reconstructions.
Parameters and dressings
- Pressure: usually −125 mmHg continuous for adults; −75 to −100 mmHg over fragile / elderly skin or grafts; −50 to −75 mmHg for paediatric and ischaemic limbs.
- Mode: continuous (most common); intermittent (3-minutes-on / 2-minutes-off) cycles may promote granulation but discomfort limits use.
- Foam: black polyurethane (open-cell, hydrophobic — most aggressive granulation); white polyvinyl alcohol (denser, less granulation, used over tendons / fragile tissue).
- Gauze NPWT: alternative; less aggressive granulation; favoured by some over exposed structures.
- Instillation NPWT (NPWT-i): cyclical instillation of saline / antiseptic between negative-pressure periods; useful in heavily contaminated / infected wounds.
- Dressing change every 2-3 days for foam systems.
Contraindications and complications
Contraindications:
- Untreated osteomyelitis.
- Necrotic tissue with eschar (debride first).
- Malignancy in the wound bed (relative; oncology team decision).
- Exposed major vessels / vascular anastomosis without protective barrier.
- Coagulopathy / active bleeding.
- Allergy to dressing components.
Complications:
- Pain on initiation (consider warming saline soak or pressure step-down).
- Periwound dermatitis; skin maceration.
- Bleeding (rare but reported — especially after anticoagulation, infection, vessel exposure).
- Retained foam.
- Tissue ingrowth — use non-adherent contact layer over fragile tissues, friable grafts, or paediatric skin.
Evidence and UK practice
- Skin grafts: meta-analyses show improved graft take and reduced complications with NPWT bolster (vs conventional bolster) — particularly for lower-limb and meshed grafts.
- Lymphadenectomy seroma: RCTs of prophylactic NPWT after groin / axillary dissection in melanoma show ~40-50% reduction in seroma rate.
- NICE: HTG509 (formerly MTG43; PICO single-use NPWT for closed surgical incisions) supports prophylactic use over high-risk closed incisions.
- NPWT is incorporated in BAPRAS / NHS major-trauma and complex skin-cancer reconstruction pathways.
References
- Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38:563-577.
- Webster J et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2019;3:CD009261.
- Schaverien MV et al. Negative pressure wound therapy following inguinal lymphadenectomy: a systematic review and meta-analysis. J Surg Oncol. 2020;121:846-855.
- NICE HTG509. PICO negative pressure wound dressings for closed surgical incisions. London: NICE; 2019 (formerly MTG43; last reviewed 29 February 2024).
- WUWHS. Consensus document: closed surgical incision management. London: Wounds International; 2016.
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