Negative pressure wound therapy in resource-limited environments: Review and field guide

Negative pressure wound therapy (NPWT) has emerged as a valuable tool in the management of traumatic soft tissue injuries. Negative pressure wound therapy alters the local wound environment through a variety of mechanisms at both the macroscopic and microscopic level to reduce edema, stimulate angiogenesis, decrease bacterial burden, and promote healing. In battlefield or disaster response settings, NPWT offers additional advantages including reductions in dressing changes and the skilled personnel required to complete them, as well as less exposure to the surrounding environment and associated infection risk. Despite these potential benefits, NPWT use in the austere environment can be limited by logistical and financial constraints associated with commercially available NPWT products. A variety of effective, low-cost NPWT systems have been devised to overcome these barriers. This review summarizes the existing literature on improvised NPWT systems. It also presents a detailed list of potential substitutions for the fundamental NPWT components, as well as techniques for troubleshooting and augments to consider in special scenarios. We aim to provide a concise and practical field guide for construction of an improvised NPWT system to facilitate delivery of evidenced-based wound care in austere environments with infrastructure constraints.