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Discussion: Update on Negative-Pressure Wound Therapy

W particularly chronic wounds, are common, frequently complex, and costly. This tripartite trend of prevalence, complexity, and fiscal impact grows more burdensome with each passing year. This is why this special issue of Plastic and Reconstructive Surgery in general and Orgill and Bayer’s article in particular are so refreshing. Interrogating and drawing attention to this problem can only improve care. To that end, when working with one of the myriad wound healing pharmaceuticals and modalities now available, I think the thinking clinician might pause to ask: “What am I trying to accomplish?” and “How do I define success?” When focusing on negative-pressure wound therapy specifically, this question becomes very salient. The authors of this article provide an elegant overview of the literature and provide an equally thought-provoking review of the physics and proposed mechanism of action of negative-pressure wound therapy.1 What they come up with in both of these analyses (in not so many words) is that in our efforts to gauge success with this technology specifically (and many others in general), we may be overly simplistic. Although “wound healing” is a laudable goal—just as “prevention of sudden cardiac death” may be a laudable goal in cardiovascular medicine—negative-pressure wound therapy does not seem to be a “wound healing device”; rather, in so far as it assists in reducing depth and complexity of defects, it is what one might call a “wound simplification device.” In cardiovascular medicine, the well-intentioned clinician researcher would never think to initially test an antihypertensive or a statin using sudden cardiac death as a primary endpoint. Rather, one would want to know how well these two drugs reduced blood pressure or managed lipids. Such is the problem facing wound healing at present. Everything is studied to the ultimate endpoint,1 even though good care often mandates that different classes of wound healing modalities (and different procedures) be used throughout the timeline. This is a problem we and others have encountered in a number of studies.2,3 However, how do we define “wound simplification”? I would argue that well-intentioned clinicians, researchers, policymakers, and industry personnel need to come together to better identify other surrogate markers of success in this rapidly developing space. I believe we will be greatly assisted by a host of wound diagnostics and socalled theragnostics that are rapidly becoming available that will allow for (potentially) rapid bedside and chairside assessment of wounds. Orgill and Bayer succeeded in outlining a modality that has had a major impact on this field. It is particularly noteworthy that they have done this even amid such therapeutic taxonomic and syntactical ambiguity. Here is to improving our medical and linguistic vocabulary and to continuing to make a difference in this most challenging but ultimately rewarding area.