The use of controlled subatmospheric pressure to promote wound healing in preparation for split-thickness skin grafting in a fourth degree burn.

Subatmospheric pressure application to acute and chronic wounds has been shown to increase local wound blood flow, increase the rate of formation of granulation tissue, and enhance bacterial clearance. The mechanical forces applied to the wound enhance the rate of granulation tissue formation by the increase intracellular messengers regulating protein production and turnover. This method of wound care is particularly useful for larger wounds that could not be readily closed by local methods, but may also be useful for chronic wounds in debilitated patients who may not be ideal surgical candidates. Further basic scientific research is needed to discern the exact mechanisms of action of subatmospheric pressure, and more clinical experience is needed to establish guidelines for its application. Further clinical studies with larger subject populations in a randomized prospective study would lend support to the utility of this wound management protocol.