Optimizing Negative Pressure Wound Therapy

Negative pressure wound therapy is widely used to expedite wound healing; however, achieving sufficient contraction in large wounds, refractory ulcers, and fasciotomy wounds following necrotizing fasciitis remains challenging, often requiring skin grafts.This study introduces a three-dimensional negative-pressure wound therapy application method that maximizes wound contraction, aiming to achieve direct closure, even for large ulcers.We applied this technique in two cases: necrotizing fasciitis of the thigh and diabetic foot gangrene due to chronic limb-threatening ischemia.Our three-step approach adapted negative-pressure wound therapy application based on wound shape-first promoting horizontal contraction while preventing early adhesion between the wound pocket and underlying tissues, then adjusting foam placement to enhance further contraction, and finally inducing vertical contraction.This method achieved effective wound closure in both cases, thereby avoiding the need for skin grafts.Additionally, in comparison to skin grafting, it reduced scarring and hospitalization duration.In the case of transmetatarsal amputation, the thick plantar skin effectively covered the weight-bearing area, lowering the risk of ulcer recurrence.This technique is simple and minimally invasive, and may offer a functionally and aesthetically superior alternative for wound closure.