A procedure to help hospitals heal people left with open wounds in their abdomen has been given the all-clear by the National Institute for Health and Care Excellence (NICE). Updated guidance says the technique - called Negative Pressure Wound Therapy - can be used with ‘normal arrangements' for clinical governance, patient consent and audit[i]. This is an upgrade on previous guidance which, in 2009, kick-started a national audit of the use of the technique after safety concerns were raised by a specialist unit.

When a person has major abdominal surgery or injury, the wound cannot always be closed by conventional techniques. When this happens, the wound may be left open temporarily if they are likely to need further surgery. Negative Pressure Wound Therapy can be used to cover the wound, help nursing care and aid healing.

The procedure involves a ‘vacuum system' being applied to the open abdominal wound and surrounding area. The equipment generates a gentle vacuum, which helps to remove any excess blood or fluid and keeps the wound clean. This aims to reduce the risk of infection.

Professor Bruce Campbell, Chair of the Interventional Procedures Advisory Committee, said: “The decision to leave a patient with an open abdomen - a procedure sometimes called a laparostomy - is not one that is taken lightly by surgeons. It may be considered after emergency surgery if there is too much swelling to close the abdomen or when there is very serious infection inside the abdomen and closure would be unwise.

“We originally reviewed the technique in 2009 after concerns were raised by a specialist unit that Negative Pressure Wound Therapy might increase a patient's risk of developing intestinal fistulae. This is a hole in the bowel wall which leaks bowel contents and may not heal. At the time the Committee concluded there was insufficient evidence to recommend the procedure and called for a national clinical audit to take place into the management of the open abdomen.

“As a direct result of that research, we have been able to conclude that the procedure is safe and effective, and should be considered for routine use in the NHS across the whole of the UK.”

The updated guidance is available to view on the NICE website. NHS Trusts are expected to consider the advice when deciding whether or not to fund the procedure locally.

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Notes to Editors

About the guidance

A copy of the interventional procedures guidance, Negative pressure wound therapy for the open abdomen, is available from Wednesday 27 November 2013.

A laparostomy is a relatively uncommon clinical procedure in which a patient's abdomen is not immediately sealed following surgery, thereby exposing the intestine and other intraperitoneal organs. It can be performed for a variety of reasons, for example when there is severe infection or when closing the abdominal wound would create too high pressure internally. NICE estimates that intensive care units in the UK will treat a maximum of ten patients a year for this.

About NICE's Interventional Procedures guidance

NICE's Interventional Procedures guidance is applicable for NHS healthcare settings in England, Wales, Scotland and Northern Ireland. The guidance makes recommendations on the safety of a procedure and how well it works. By providing guidance on how safe procedures are and how well they work, NICE makes it possible for new treatments and tests to be introduced into the NHS in a responsible way.

Interventional procedures guidance is developed for NICE by an independent committee of experts. The committee assesses all the available evidence and will generally make one of the following main recommendations for use of the procedure:

• Use with normal arrangements for clinical governance, consent and audit.
• Use with special arrangements for clinical governance, consent and audit or research.
• Use only in research.
• Do not use.

An interventional procedure is a test, treatment or surgery that involves a cut or puncture of the skin, or an endoscope to look inside the body, or energy sources such as X-rays, heat or ultrasound. The guidance does not cover whether or not the NHS should fund a procedure. Decisions about funding are taken by local NHS bodies (primary care trusts and hospital trusts) after considering how well the procedure works and whether it represents value for money for the NHS.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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