Negative Pressure Wound Therapy (NPWT) -- Leadership for a Global Consensus

St. Mary’s Surgeon Represents United States on Expert Panel for Wound Care


News Release:   SAN FRANCISCO, Calif. Feb. 5, 2009 – Dr. Charles K. Lee, Director of the San Francisco Wound Care and Reconstructive Surgery Center, located at St. Mary’s Medical Center, will represent the United States at an international conference on Negative Pressure Wound Therapy (NWPT). NPWT has revolutionized the world of wound management and reconstructive surgery for the past ten years and has been applied on millions of patients worldwide to successfully treat wounds of all types.  “Serving on this panel is a great honor and responsibility. Our challenge is to bring a together a global consensus on the benefits and limitations of NPWT and to further set guidelines on its use in every type of clinical scenario, ranging from medianstinitis to pressure ulcers.” said Dr. Charles K. Lee, Medical Director of Microsurgery and of the San Francisco Wound Care and Reconstructive Surgery Center.  The NWPT expert panel consists of 22 leading, independent physicians from many clinical specialties that use NWPT for patient treatment. The panel will convene in Hamburg, Germany and panelists will attend workshops on wounds. At the end of the workshop, the panel will vote on treatments to identify best practices for wound care. The panel recommendations will be posted on the panel website,  http://www.npwtexperts.com/ on February 8, 2010.

     Dr. Lee is an expert plastic and reconstructive surgeon, treating patients who suffer from chronic and acute wounds. He and his staff use a collaborative, multi-specialty approach to their wound care treatment and the center uses the latest most advanced wound dressing and surgical techniques to fully heal any type of wound. Dr. Lee has been using NWPT for the past 12 years to treat more than a thousand patients successfully.   “NPWT can be the primary treatment in some cases of wounds, but it is mainly an adjunct in my practice.   The most important thing to know about NPWT is when to recognize when NPWT is not working and needs an expert evaluation to make a new determination about further options in treatment. A wound should be seriously assessed every two weeks to determine if NPWT is working, has stopped, or needs a higher level of reconstructive treatment,” says Dr. Lee.
     NPWT is a wound healing technique used to treat both acute and chronic wounds. A vacuum source is used to create sub-atmospheric pressure in conjunction with wound filler (foam or gauze) in the local wound environment to remove fluid and enhance wound healing. It is a simple, but ingenious way to advance wound healing while also improving patient comfort and outcomes.

ABOUT THE SAN FRANCISCO WOUND CARE AND RECONSTRUCTIVE SURGERY CENTER

The San Francisco Wound Care and Reconstructive Surgery Center is dedicated to one goal – providing patients top-notch treatment of all wounds, including: diabetic and venous ulcers, chronic wounds, lymphedema, acute trauma and osteomyelitis. The well-trained multidisciplinary staff includes three reconstructive plastic surgeons who are experts in wound care and reconstructive surgery as well as general and vascular surgeons, endocrinologists, infectious disease specialists, a podiatrist and a wound care nurse practitioner. The comprehensive set-up of the clinic offers patients continuity of care all in one location.

What is the difference between a graft or a flap?

There appears to be a lot of confusion between these two terms as I have often heard my medical and nursing colleagues use these words interchangeably. In many respects, they are related, however, they are completely different in their intrinsic properties and surgical technique.

A graft or a flap can be made up of the exact same tissue type-- that is, it can be skin, fat, tendon, bone, nerve, etc. The key difference is that a flap has its own blood supply, and that a graft does not, and therefore requires a good vascular bed for it to survive. We have often heard of the terms skin graft, or bone graft. These tissues are harvested from their specific locations which can afford to give up a part of their architecture. The place that the area has "donated" its tissue is called the donor site. Once the donor site has been harvested, the skin or the bone can be placed in the new area for the body to accept this tissue and eventually grow into it with new blood vessels and adjacent cells. This is why the bed, the accepting area for the graft, is so important to be prepared well. The graft can only survive well when it can be nourished by a good blood supply.

A flap has the additional advantage that it has its own intrinsic blood supply, allowing it to be transferred or transplanted to another area of the body with much less reliance upon the surrounding tissue bed. This does not mean that the surrounding bed should not be well prepared, ie debrided. It simply means that the accepting area will unlikely lead to graft survival and that designing tissue with its own blood supply is the only way for that tissue type to actually survive in the area. Because a flap has its own blood supply, the surgical technique to harvest and to move this tissue is much more complex. The surgeon has to dissect not only the block of tissue to be moved, but also the blood vessels (artery,vein) that feed the tissue block. This makes the flap an extremely powerful tool in reconstructive surgery. It is also a tool that requires significantly more surgical technique, planning, and time to make it successful.

It is understandable why there might be confusion between these two concepts because of their relationship to each other. However, the complexity and time factor between these two concepts is so significantly different that we should not pass over this as simple semantics.