THIS IS NO LONGER AN ACTIVE POLICY. POLICY WAS ARCHIVED ON 03/18/2025
Medical & Reimbursement Policies
Medical Policy
D-1039-002
Policy Id
HHO-DE-MP-1039
Topic
Negative Pressure Wound Therapy in the Outpatient Setting
Section
Archived Policies
Effective Date
Jun 10, 2024
Issued Date
May 10, 2024
Last Revision Date
05/2024
Annual Review
06/2025
Prepared By
K. O'Toole
DISCLAIMER
Highmark medical policy is intended to serve only as a general reference resource regarding coverage for the services described. This policy does not constitute medical advice and is not intended to govern or otherwise influence medical decisions.
POLICY STATEMENT
This policy provides information regarding the coverage of, as determined by applicable federal and/or state legislation.
This policy is designed to address medical necessity guidelines that are appropriate for the majority of individuals with a particular disease, illness or condition. Each person’s unique clinical circumstances warrant individual consideration, based upon review of applicable medical records.
The qualifications of the policy will meet the standards of the National Committee for Quality Assurance (NCQA) and the Delaware Department of Health and Social Services (DHSS) and all applicable state and federal regulations.
Purpose
This medical policy outlines Highmark Health Options services for Negative Pressure Wound Therapy in the Outpatient Setting.
Definitions
Highmark Health Options (HHO) – Managed care organization serving vulnerable populations that have complex needs and qualify for Medicaid. Highmark Health Options members include individuals and families with low income, expecting mothers, children, and people with disabilities. Members pay nothing to very little for their health coverage. Highmark Health Options currently services Delaware Medicaid: Diamond State Health Plan (DSHP), Delaware Healthy Children Program (DHCP), and Diamond State Health Plan Plus (DSHP) LTSS members.
Exudate (drainage) – Interstitial fluid produced by the body in response to tissue damage. Exudate production is essential for moist wound healing. Normally, the production reduces overtime but there are wounds that do not heal as expected, which will produce excessive exudate or no exudate. A wound should not have extreme wetness or dryness in the healing process.
Licensed Health Care Professional – For the purposes of this policy, a licensed health care professional is a physician, physician assistant (PA), registered nurse (RN), licensed practical nurse (LPN), or physical therapist (PT). The practitioner should be licensed to assess wounds and/or administer wound care within the state where the beneficiary is receiving vacuum assisted wound closure therapy.
Vacuum Assisted Wound Closure Device – A type of medical therapy that involves the use of suction (negative pressure) underneath airtight wound dressings to promote the healing of opens wounds that have been resistant to previous treatments. Device is also known as: Wound VAC, negative pressure wound therapy (NPWT), vacuum assisted wound closure, sealed surface wound suction (SSS), sub atmospheric pressure therapy or dressing (SWT), foam suction dressing and vacuum pack technique (VPT), vacuum sealing technique (VST), incisional negative pressure wound therapy (INPWT), closed incision management (CIM) topical negative pressure therapy (TNP) and prophylactic negative pressure wound therapy (PNPWT).
Wound Healing – The improvement occurring in either surface area (length x width) or the depth of the wound.
Policy Position
Prior Authorization
Prior Authorization may be required. Please validate codes on the Prior Authorization Lookup Tool https://www.highmarkhealthoptions.com/providers/prior-auth-lookup
Procedures
Negative Pressure Wound Therapy may be considered medically necessary when the following criteria are met for all wound types:
A. The patient must be age 12 and older; AND
B. A complete wound care program has been tried which includes all of the following:
1. Documentation in the medical record by a licensed medical professional on the current and previous wound care management and wound healing progress; AND
2. The patient has a complex wound where size, depth, location, complications, exudate amount, etiology and/or other specific factors support non-feasibility of healing with moist topical dressing; AND
3. Wound care physician notes contain an initial wound measurement followed by measurements at a minimum of once a month. Documentation must show the progress of the healing wound and anticipated duration of vacuum assisted wound therapy (e.g., degree of wound healing required); AND
4. Controlling of comorbid conditions diabetes, nutritional issues, and pressure relief at wound site (Note: See Contraindications and Precautions Below); AND
5. Operative note or wound care notes if requests are for treatment in surgical and/or traumatic wounds; AND
6. If the initiation of NPWT occurred during an inpatient stay, the initial date of service is to be documented.
C. Use of vacuum assisted wound devices in the outpatient setting are considered medically necessary appropriate for the following conditions:
1. Chronic Stage III or IV pressure ulcers (>30 days) that have failed to heal despite optimal wound care when:
a. Standard dressings cannot be maintained due to anatomic factors; AND
b. The patient’s incontinence and/or moisture issues have been appropriately managed; AND
c. There has been use of group 2 or 3 support surface for pressure ulcers on the trunk or pelvis; OR
2. Neuropathic (e.g., diabetic) ulcers
a. The patient has been actively involved in a comprehensive diabetic management; AND
b. Pressure on a foot ulcer has been appropriately reduced using medically appropriate modalities; OR
3. Venous or arterial insufficiency ulcers or chronic ulcers of mixed etiology
a. Compression bandages OR garments have been applied appropriately; AND
b. Elevating the affected extremity has been maintained while the patient is sedentary; AND
c. Ambulation/leg exercises that promote circulation have been encouraged and utilized; AND
d. For initiation of vacuum assist wound device in the home setting, the ulcer must have been present for at least 30 days; OR
4. Traumatic or surgical wounds (i.e., preoperative flap or graft, exposed bones, tendons, or vessels) that need accelerated formation of granulation tissue; not achievable by other topical wound treatments (e.g., comorbid conditions of the patient that will hamper appropriate healing with other topical wound treatments) and no contraindications to negative pressure wound therapy. The following traumatic or surgical wound conditions include:
a. Wounds refractory to standard wound regimens; OR
b. Burns; OR
c. Complications of surgically created wounds (i.e., dehiscence, post-sternotomy disunion with exposed sternal bone, post-sternotomy mediastinitis, or post-operative disunion of the abdominal wall) which may include the use of skin grafts to assist in wound closure.
Note: The individual NPWT pump is able to accommodate more than one wound dressing set for multiple wounds on a patient. If more than one NPWT pump is utilized on the patient during the same period, the service will be denied as not medically necessary.
The following supplies are medically necessary for negative pressure wound therapy, including:
A. Wound care sets will be limited to up to 15 dressing kits per wound, per month. Documentation must be provided to support the medical necessity for requests in excess of limitation.
B. Canister sets will be limited to 10 per month in most cases. Documentation must be provided showing evidence that a large volume of drainage exists.
Example: Documentation must show an exudate amount greater than 90 ml of exudate per day.
Note: Vacuum assist devices are capable of accommodating more than one wound dressing set for multiple wounds on a patient. Therefore coverage for more than one pump per patient for the same time period will be considered noncovered and not medically necessary.
Continuation of Services
A. Continuation of the powered vacuum assist wound device is considered medically necessary following an initial two week therapeutic trial or a subsequent period if the treatment has resulted in documented improvements of the wound; AND
B. Coverage for the medically necessary powered vacuum assist wound device will end when the treating physician reports adequate wound healing has occurred to the degree where the device may be discontinued; AND
C. There must be documentation by the wound care physician regarding wound healing. Documentation of wound progress measurements include:
1. Decrease wound size (length, width, depth, undermining, tunneling); AND
2. Increased granulation tissue; AND
3. Increase epithelialization; AND
4. Decreased wound odor; AND
5. Decreased wound pain; AND
6. Decreased volumes of exudate; AND
D. Continued use of this therapy should be reviewed against outcome criteria at the beginning of therapy, at each dressing change or, at a minimum of every two weeks and reported on a monthly basis
E. Recent laboratory values do not demonstrate a contraindication exists.
Note: In some circumstances, the use of this treatment modality when initiated in the inpatient setting may not meet the criteria for use in the outpatient setting. A review for medical necessity determination by a Medical Director will be performed.
Contraindications
The wound being treated must be free of the following absolute contraindications for NPWT:
A. No vacuum assisted wound device has been cleared for use in infant and children. Patient size and weight should be considered when prescribing this device; OR
B. Exposed anastomotic site; OR
C. Exposed nerves; OR
D. Exposed organs; OR
E. Exposed vasculature; OR
F. Malignancy in the wound; OR
G. Necrotic tissue with eschar present; OR
H. Non-enteric and unexplored fistulas; OR
I. Untreated osteomyelitis; OR
J. Severe peripheral arterial disease: Ankle Brachial Pressure Index ≤ 0.5 needs investigation, and if appropriate, revascularization prior to commencement of vacuum assist device; OR
Precautions
A. The following factors have been identified as risks to wound healing and should be adequately addressed by the ordering provider:
1. Active smoking
2. Obesity
3. Poorly managed diabetes
4, Pulmonary disease
5. Uremia
6. Ascites
7. Anemia
8. Jaundice
9. Steroid Use
B. Malnourished patients who have not received adequate nutrition/nutritional supplements (e.g., hyperalimentation).
C. Caution should be used for patients with neuropathic or circulatory compromise.
D. Caution should be used towards non-concordant or combative patients.
E. Caution should be used towards patients with infected wounds; they may require more frequent dressing changes.
F. Patients with burns; the devitalized burned tissue must be debrided prior to application of NPWT.
G. Patients with wounds in close proximity to blood vessels, delicate fascia, vital organs or exposed tendons (ensure adequate protection with overlying fascia, tissue or other protective barriers).
H. Bone fragments or sharp edges could puncture protective barriers, vessels, or organs causing injury. Any injury could cause bleeding, which, if uncontrolled results could be fatal.
I. The dressing must be removed if defibrillation is required in the area of dressing placement. Failure to remove the dressing may inhibit transmission of electrical energy and/or patient resuscitation.
J. The therapy unit is MRI unsafe and should not be taken in the MRI environment; dressings can typically remain on the patient with minimal risk in an MRI environment.
K. Hyperbaric Oxygen Therapy (HBOT): the therapy unit is unsafe in the hyperbaric oxygen chamber and is considered a fire hazard. Care must be taken with the dressing to ensure HBO compatible.
L. Precautions need to be taken in patients receiving long-term anticoagulant therapy, hemophilia and patients with hemoglobinopathies, such as sickle cell.
The NPWT services are not covered and considered not medically necessary when:
A. The safety and effectiveness of NPWT systems in newborns, infants and children has not been established at this time and currently, there are no NPWT systems cleared for use in these populations, OR
B. In the judgment of the treating physician the adequate wound healing has occurred to the degree that NPWT may be discontinued and the wound can be anticipated to heal completely with other wound care treatments; OR
C. Any measurable degree of wound healing has failed to occur over the prior month. Wound healing is defined as improvement occurring in either surface area (length X width) or depth of the wound; OR
D. The patient/caregiver is unable/unwilling to follow the plan of care; OR
E. The wound has developed evidence of a wound complication contraindicating continued use of the device
F. NPWT that extends beyond four months (this includes NPWT applied in an inpatient setting prior to discharge to the home) is considered not medically necessary and requires Medical Director Review.
Any conditions not listed in criteria above will be considered not medically necessary since the scientific evidence has not been established. Examples of indications not covered include, but are not limited to:
- Use following cardiac surgery not meeting medical necessity criteria above;
- Use following surgical excision of pilonidal sinus and/or recurrent pilonidal disease;
- Use of device as a preventive/prophylactic intervention in patients with surgical wounds, such as a diagnosis of diabetes or obesity as risk factors, ventral hernia repair or post cesarean delivery, post knee arthroplasty or kidney transplantation;
- Use of chemotherapeutic agents in intermittent instillation with NPWT.
Use of a nonpowered vacuum assist device (e.g., SNaP® system) or a battery operated (A9272), disposable system (e.g., PICO™ system) have not been proven in peer-reviewed literature as medically effective and are not medically necessary for the treatment of acute and/or chronic wounds.
If it is determined during the course of treatment for an initial wound that the NPWT system will be applied to additional wounds, all additional wounds must meet the criteria listed in this policy to determine medical necessity.
DME
The negative pressure wound therapy device (E2402) is classified as a DME rental item and may be subject to prior authorization requirements.
Post-Payment Audit Statement
The medical record must include documentation that reflects the medical necessity criteria and is subject to audit by Highmark Health Options at any time pursuant to the terms of your provider agreement.
Place of Service
For the purposes of this policy, the place of service for vacuum assisted wound therapy is in the home setting.
Governing Bodies Approval
On December 20, 2002, the VAC device received premarket approval to include the indication of partial-thickness burns.
On November 13, 2009, the U.S. Food and Drug Administration (FDA) released a Medical Device Alert regarding the use of negative pressure wound therapy systems. The alert notified medical practitioners of possible death or serious complications due to the use of the vacuum assisted wound therapy systems. Per the FDA, it had received reports of six deaths and 77 injuries associated with this device over the two years. Major complications reported included bleeding and infection. The alert provided the recommendations to reduce risks with the device:
A. More careful selection of patients for vacuum assisted wound therapy;
B. Assure that patient monitoring is performed frequently in an appropriate care setting by a trained practitioner. To determine the frequency of monitoring, the provider must consider the patient’s condition, including wound status, wound location and comorbidities;
C. Proper training must be obtained prior to prescribing and using the device;
D. Instructions for proper home use of the vacuum assisted wound therapy device to the patient and/or caregiver must be given. This instruction is to include how to use the device, potential complications and their signs and symptoms, and management of complications.
In addition, the FDA listed the following contraindications for vacuum assisted wound therapy:
A. Necrotic tissue with eschar present
B. Untreated osteomyelitis
C. Non-enteric and unexplored fistulas
D. Malignancy (within the wound)
E. Exposed blood vessels, nerves, anastomoses, or organs
Rembursement
Participating facilities will be reimbursed per their Highmark Health Options contract.
Summary of Literature
Negative pressure wound therapy (NPWT) is a vacuum assisted wound device that has been used in clinical applications for more than five decades. The concept of applying topical negative pressure in the management of wounds emerged in the late 1980s and is increasingly used for a wide variety of wounds. The merits of vacuum assisted wound therapy in the outpatient setting for a variety of wounds such as ulcers related to pressure sores, venous or arterial insufficiency or neuropathy and other wounds have been studied in a number of clinical contexts. NPWT has triggered accelerated wound healing in the outpatient setting which has reduced wound dressing, visits to specialists, and hospitalizations (Lukasz, 2014). An additional positive result of NPWT include significant antibacterial effects by reducing subcutaneous edema (Lukasz, 2014). NPWT devices are classified as either powered (requiring electric power source) or non-powered (mechanical) or battery operated.
It is important to note that these devices are adjunctive therapy and are not intended to replace good basic wound care (i.e., daily wound measurements of dimension and depth, wet dressing applications, necrotic debridement, adequate overall nutrition, and minimization of disease activity of comorbid conditions.
Numerous for NPWT include:
- Decubitus (pressure) ulcers
- Neuropathic ulcers
- Ulcers related to venous or arterial insufficiency
- Dehisced wounds or wound with exposed hardware or bone
- Post sternotomy wound infection or mediastinitis, or
- Complications of a surgically created wound where exhibiting accelerated granulation therapy is necessary and cannot be achieved by other available topical wound treatment.
Negative pressure wound therapy (NPWT) applies a localized vacuum to draw the edges of the wound together while providing a moist environment conducive to rapid wound healing. The development of negative pressure techniques for wound healing is based on two theories: (1) the removal of excess interstitial fluid (exudate) decreases edema and concentrations of inhibitory factors and increases local blood flow; and (2) stretching and deformation of the tissue by the negative pressure is believed to disturb the extracellular matrix and introduce biochemical responses that promote wound healing.
There are concerns surrounding the quantification of exudate levels within clinical research and day-to-day treatment of wounds (Mulder, 1994). The characteristics of wound exudate vary heavily, in regard to factors such as, wound type, underlying patient conditions, wound bed description, and chronic or acute wound. These influencing factors make it difficult to standardize a specific exudate level for vacuum assisted wound therapy or any other wound therapy (Mulder, 1994). Gerit D. Mulder, the CEO of the Wound Healing Institute in Denver, Colorado produced an exudate output classification for chronic wounds, including:
- Absent (dry)
- Minimal (less than 5cc per 24 hours)
- Moderate (5-10 cc per 24 hours)
- High (more than 10 cc per 24 hours
According to the Journal of Wound Care (2014), Mulder terminology is familiar in the clinical environment but is not practical in clinical practice due to the numerous factors of wounds. Managing and decreasing exudate production is an important function within NPWT, a licensed clinical professional must assess the fluid quantity and type. A wound vacuum device removes exudate from a wound by applying the negative pressure which can be increased or decreased depending on the needs of the wound.
NPWT systems include a vacuum pump, drainage tubing, and a dressing set. The pump may be stationary or portable, may rely on AC or battery power, allows for regulation of the suction strength, has alarms to indicate loss of suction, and has a replaceable collection canister. The dressing sets may contain either foam or gauze dressing to be placed in the wound and an adhesive film drape for sealing the wound. The drainage tubes come in a variety of configurations depending on the dressings used or wound being treated.
The electric pump applies intermittent or continuous negative pressure to an open cell foam or gauze wound dressing. The dressing evenly distributes pressure to the wound surface. In early stages of healing, fluid is withdrawn by the device, removing inhibitory factors and reducing bacterial counts. In later stages, tensile forces applied to surrounding tissues by the dressing are thought to stimulate cellular proliferation and protein synthesis.
CMS partnered with the AHRQ and commissioned a review of NPWT devices. AHRQ contracted with the ECRI Institute Evidence-based Practice Center to perform the review (AHRQ, 2009). A technology assessment report on NPWT prepared for the AHRQ found that “the systematic reviews of NPWT reveal several important points about this technology. First, all of the systematic reviews noted the lack of high-quality clinical evidence supporting the advantages of NPWT compared to other wound treatments. The lack of high-quality NPWT evidence resulted in many systematic reviewers relying on low-quality retrospective studies to judge the efficacy of this technology. Second, the other systematic reviews found no studies directly comparing different NPWT devices or components have been published. Direct comparison studies are especially important in determining which dressing approach (foam or gauze) may provide the best potential for wound healing. Third, other systematic reviews concluded that NPWT must be evaluated according to wound type. Wound healing varies according to the type of wound being treated and NPWT benefits described for one wound type cannot be transferred to other wound types. Most wound types have insufficient high-quality NPWT evidence to judge if NPWT is better than standard care for specific wounds. Studies comparing foam to gauze are needed for each wound type before decisions can be made about which systems or components offer significant therapeutic distinctions.”
In 2012, the Cochrane Review conducted a systematic review of NPWT to surgical incisions using wound healing as the primary outcome of interest. Unfortunately, assessing the efficacy of NPWT by attempting to determine when a surgical incision is "completely healed" is a difficult endpoint to measure. A more clinically relevant question is how the application of NPWT affects the rate of surgical site complications.
Zhang (2014) conducted a meta-analysis to evaluate the effectiveness and safety of NPWT for diabetic ulcers. Eight qualified studies were identified with a total of 669 patients. Overall, use of the NPWT resulted in a significantly higher proportion of healed diabetic foot ulcers, reduction of ulcer area and shorter time to wound healing. Use of this therapy resulted in fewer major amputations but the rate of minor amputations was not impacted.
NPWT used in a prophylactic role has been reported in primarily observational studies. While there have been a small number of small trials, the use of prophylactic NPWT cannot be supported. Larger randomized trials are needed in order to determine health outcomes and cost effectiveness (Gestring, 2018).
Discontinuation criteria for incisional NPWT have not been clearly defined and may vary according to incision and patient factors. Reported duration of incisional therapy varies between 1 and 5 days in the literature. Reddix et al. (2009) reported discontinuation of incisional NPWT at the point when no edema fluid was evident in the device canister for 12 hours, usually 24 to 72 hours after surgery.
There are a number of non-powered, portable, disposable NPWT systems. The Smart Negative Pressure (SNaP®) Wound Care System, received 510(k) clearance from the FDA in 2009 and is designed to remove small amounts of exudate from chronic, traumatic, dehisced, acute, or subacute wounds and diabetic and pressure ulcers. The device consists of a cartridge that acts as the negative pressure source, a dressing, and a strap and can be worn under clothing. The cartridge utilizes specialized springs that generate continuous negative pressure and is preset at negative 75, 100, or 125 mmHg, weighs less than 3 ounces, and has a 60 cc capacity. The dressing is a hydrocolloid dressing with an antimicrobial gauze wound interface layer. (Powered NPWT systems usually have a foam-based interface layer.)
A single use, disposable NPWT device, the PICO™ system, received 510(k) clearance from the FDA in 2012 and is designed to remove low to moderate amounts of exudate. The system uses batteries instead of electrical power and instead of using a canister, the exudate is absorbed into the dressing. The pump is programmed to stop working after 168 hours (7 days) of use and will not restart after that time, even with new batteries.
According to one manufacturer (Smith-Nephew), optimal wound healing has occurred when:
- Initial therapy objectives have been met
- 100% granulation tissue in the wound bed
- Granulation tissue level with the surrounding skin
- Patient’s overall condition/wound is improving
- Wound bed is ready to take a skin graft/flap
- Exudate levels less than 20-50 mls per day
- No improvement/reduction in size of wound is seen in the wound bed following two consecutive dressing change
The use of the disposable, single use portable NPWT systems are not supported in scientific literature. Clinical trials fail to provide sufficient evidence to support improvement in net health outcomes compared to alternatives (Armstrong et al., 2012, Gabriel et al., 2013, and Hudson et.al. 2013)
PRESSURE ULCERS
Stage I
Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.
Stage II
Partial thickness loss of dermis presenting as a shallow open ulcer with a red-pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.
Stage III
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.
Stage IV
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often includes undermining and tunneling.
Unstageable
Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown or black) in the wound bed.
References
Pennsylvania Department of Human Services. Technology Assessment Group Coverage Decisions. Managed Care Operations Memorandum: OPS # 05/2012-005. Accessed on May 26, 2016.
Agency for Healthcare Research and Quality. Technology assessment: negative-pressure wound therapy devices. 2009. Last reviewed in October 2014. Accessed on May 26, 2016.
Food and Drug Administration (FDA) [website]. Center for Devices and Radiological Health (CDRH). 510(k) Premarket Notification Database. Accessed on May 27, 2016.
U.S. Food and Drug Administration. FDA safety communication: Update on serious complications associated with Negative Pressure Wound Therapy Systems. 2011 Feb 24. Accessed on June 13, 2016.
Food and Drug Administration (FDA) [website]. Preventing Bleeding with Vacuum-assisted Wound Closure. FDA Patient Safety News: Show #45. November, 2008. Accessed on June 13, 2016.
Centers for Medicare & Medicaid Services. National Coverage Determinations (NCDs). Accessed on June 3, 2016.
Armstrong DG et al. Comparative effectiveness of mechanically and electrically powered negative pressure wound therapy devices: a multicenter randomized controlled trial. Wound Repair Regen 2012 May; 20(3):332-41. Accessed on May 27, 2016.
Lerman B et al. The SNaP™ Wound Care System: a case series using a novel ultraportable negative pressure wound therapy device for the treatment of diabetic lower extremity wounds. J Diabetes Sci Technol. 2010; 4(4):825-830. Accessed on May 27, 2016.
National Institute for Health and Clinical Excellence (NICE). (2009, December). Negative pressure wound therapy for the open abdomen. Accessed on May 27, 2016.
Agency for Healthcare Research and Quality. (2009 November). Negative pressure wound therapy devices. Accessed on May 27, 2016.
Agency for Healthcare Research and Quality. Negative pressure wound therapy technologies for chronic wound care in the home setting. Technology Assessment Report, Project ID: WNDT0913. September 15, 2014. Accessed on June 6, 2016.
Smith & Nephew Company. Clinical Guidelines for NPWT therapy. Accessed on June 3, 2016.
Putnis S, Khan WS, & Wong James ML. Negative pressure wound therapy – a review of its uses in orthopedic trauma. The Open Orthopedics Jour, 2014 8, (Suppl: M2) 142-147. Accessed on June 13, 2016.
Howell RD, Hadley S, Strauss E, Pelham FR. Blister formation with negative pressure dressings after total knee arthroplasty. Curr Orthop Pract. 2011; 22(2):176–9. Accessed on June 13, 2016.
Reddix RN Jr, Tyler HK, Kulp B, Webb LX. Incisional vacuum-assisted wound closure in morbidly obese patients undergoing acetabular fracture surgery. Am J Orthop 2009; 38:32–5. Accessed on June 13, 2016.
Stannard JP, Atkins BZ, O’Malley D, Singh H, Bernstein B, Fahey M, Masden D, Attinger CE. Use of negative pressure therapy on closed surgical incisions: a case series. Ostomy Wound Manage 2009; 55:58–66. Accessed on June 13, 2016.
Gomoll AH, Lin A, Harris MB. Incisional vacuum-assisted closure therapy. J Orthop Trauma 2006; 20:705–9. Accessed on June 13, 2016.
Colli A. First experience with a new negative pressure incision management system on surgical incisions after cardiac surgery in high risk patients. J Cardiothorac Surg 2011; 6:160. Accessed on June 13, 2016.
Grauhan O, Navasardyan A, Hofmann M, et al. Prevention of post sternotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg. May 2013; 145(5):1387-1392. Accessed on June 13, 2016.
Masden D, Goldstein J, Endara M, et al. Negative pressure wound therapy for at-risk surgical closures in patients with multiple comorbidities: a prospective randomized controlled study. Ann Surg. Jun 2012; 255(6):1043-1047. Accessed on June 13, 2016.
Webster J, Scuffham P, Stankiewicz M, et al. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev. 2014; 10:CD009261. PMID 25287701. Accessed on June 13, 2016.
Runkel N, Krug E, Berg L, et al. Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus. Injury. Feb 2011; 42 Suppl 1:s1-12. Accessed on June 13, 2016.
Zhang J, Hu ZC, Chen D, Zhu JY, Tang B. Effectiveness and safety of negative-pressure wound therapy for diabetic foot ulcers: a meta-analysis. Plast Recontr Surg. 2014; 134(1): 141-151. Accessed on June 13, 2016.
DME MAC Jurisdiction A. Negative Pressure Wound Therapy Pumps (L33821). Effective 10/1/2015. Accessed on June 13, 2016.
DME MAC Jurisdiction A, A52511 10/1/2015. Accessed on June 13, 2016.
Medicare NHIC. Local Coverage Determination (LCD): Negative Pressure Wound Therapy Pumps (L11500). October 1, 2011. Accessed on June 13, 2016.
Mulder, G.D. Quantifying wound fluids for clinician and researcher. Ostomy/Wound Management; October 1994, Volume 40, No. 8. Accessed on 02/10/2017.
World Union of Wound Healing Societies (WUWHS). Principles of best practice: Wound exudate and the role of dressings. A consensus document. London: MEP Ltd, 2007. Accessed on 02/10/2017.
Dealey, C., Cameron, J., and Arrowsmith, J. A study comparing two objective methods of quantifying the production of wound exudate. Journal of Wound Care 2006 15:4, 149-153. Accessed on 02/10/2017.
Highmark Commercial Medical Policy. Non-powered negative pressure wound therapy system. October 30, 2017. Accessed on December 12, 2017.
Hutton DW, Sheehan P. Comparative effectiveness of the SNaP Wound Care System. Int Wound J. Apr 2011; 8(2):196-205. Abstract accessed on December 12, 2017.
Hudson DA, Adams KG, Huyssteen AV, Martin R, Huddleston EM. Simplified negative pressure wound therapy: clinical evaluation of an ultraportable, no-canister system. Int Wound J. 2013 May 7. Accessed on December 12, 2017.
Gabriel A, Thimmappa B, Rubano C, Storm-Dickerson T. Evaluation of an ultra-lightweight, single-patient-use negative pressure wound therapy system over dermal regeneration template and skin grafts. Int Wound J. 2013 Aug; 10(4):418-24. Abstract accessed on December 12, 2017.
Armstrong DG, Marston WA, Reyzelman AM, Kirsner RS. Comparison of negative pressure wound therapy with an ultraportable mechanically powered device vs. traditional electrically powered device for the treatment of chronic lower extremity ulcers: a multicenter randomized-controlled trial. Wound Repair Regen. 2011 Mar-Apr; 19(2):173-80. Abstract accessed on December 12, 2017.
