Affordable negative pressure wound therapy: Bridging the gap for Complex wound management in low-resource environments

Introduction

The application of effective negative pressure wound therapy (NPWT) has revolutionized the outcome of complex wounds. By applying controlled suction over a sealed wound environment, NPWT reduces infection and accelerates healing.^1,2 This understanding, as ‘glass cupping’, was used in earlier centuries to promote healing. More efficient and effective methods were developed during the Russian–Afghan war by Nail Bagautdinov in 1985. ³ The technique and technology was subsequently pilfered and publicized from the USA without regard to its inventor,^1,2 leading to legal battles over patents and proprietary and rights. ⁴

NPWT involves placing a porous interface (usually foam or gauze) into the wound bed, sealing the wound with an adhesive drape, and applying controlled negative pressure through a vacuum source to evacuate exudate (Fig. 1). The core therapeutic mechanisms include ¹ as follows:

Macro-deformation: Bringing wound edges together.

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Figure 1.

Schematic representation of a negative pressure wound therapy (NPWT) system.

These effects translate into faster granulation, reduced dressing frequency, lower infection rates, and accelerated healing. These benefits have been documented across trauma, orthopaedic, plastic, vascular, and general surgery.^5,6 NPWT has accordingly become a go-to tool for suboptimal wounds.

However, the high cost and proprietary nature of commercial devices limit accessibility in low- and middle-income countries (LMICs) and resource-poor clinical settings. Despite strong evidence for NPWT benefits, equity of access remains a global challenge. Commercial NPWT systems (e.g. VAC systems, portable battery-powered units) are typically designed for hospital infrastructure in high-income settings and their high cost reflects the following:

Specialized engineering: Accurate pressure sensors, vacuum pumps, feedback systems, and safety alarms require precision design.

Thus, the costs of NPWT lead to prices of $1000–2000 US (with additional costs of c. $75 per change of dressing. This drastically limits use in low-resource contexts, where the burden of complex wounds is highest from trauma, infection, diabetes, and vascular disease. In such contexts, low-cost NPWT models provide a pragmatic option that preserves the clinical advantages of NPWT while overcoming financial barriers to care. Such systems follow similar principles using locally available components (Fig. 2) and cost $5-10 to make and < $5 for each dressing change. ⁷ Core components of a basic model include:

Sealed wound dressing: Sterile gauze and foam.

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Figure 2.

Locally available material to assemble negative pressure wound therapy (NPWT) system.

While commercial NPWT systems are technologically sophisticated, many of their advantages relate to automation rather than fundamentally different wound-healing science. In low-resource settings, inability to use intermittent suction, non-portability, the need to treat patients on an inpatient basis, an absence of built-in pressure sensors, alarms, or proprietary foams have all been cited as a limitation of improvised NPWT systems. ⁷ However, these limitations may be effectively mitigated through simple, low-cost strategies (Table 1).

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Table 1.

Commercial versus low-cost NPWT: Limitations and pragmatic solutions.

Feature	Commercial NPWT	Low-cost NPWT	Pragmatic strategies to overcome limitations in low-cost models
Pressure control	Precise, programmable, real-time monitoring	Approximate, dependent on suction source	Inline manometers; wall-suction regulators; predefined pressure ranges (−75 to −125 mmHg) with scheduled verification
Intermittent suction	In-built in the system	Manual control	Protocol-driven nursing checks in which continuous suction can be switched off for a short period at pre-designated time intervals
Alarm systems	Automated alerts for leaks, pressure loss, or full canisters	Typically absent	Protocol-driven nursing checks; visual seal assessment; pressure gauge markings; fixed canister-volume monitoring schedules
Foam interface	Medical-grade reticulated polyurethane	Sterile gauze and improvised foam (autoclaved)	Sterile gauze to allow uniform pressure transmission; locally available foam after appropriate sterilization
Suction source	Dedicated microprocessor-controlled vacuum pumps	Wall suction or portable suction devices	Adjustable wall suction where available; or portable suction devices with pressure gauges to maintain controlled negative pressure
Standardization	High manufacturing and quality control standards	Operator and material-dependent variability	Locally developed protocols, checklists, and staff training; standard assembly steps and dressing-change intervals
Documentation and evidence	Large multicentre trials and registries	Smaller but growing evidence base	Prospective audits, pragmatic trials, and institutional outcome reporting to strengthen context-specific evidence

NPWT: negative pressure wound therapy.

Discussion

NPWT has become an integral component of modern wound care because it addresses fundamental biological processes underpinning wound healing: removal of excess exudate, reduction of tissue oedema, mechanical stimulation of granulation tissue, and maintenance of a protected wound environment. Importantly, these mechanisms are independent of the proprietary nature of the delivery device. Commercial NPWT devices offer automation, precision engineering, and built-in safety features to reduce reliance on human monitoring. In contrast, low-cost NPWT systems intentionally trade automation for affordability, adaptability, and scalability. They illustrate how effective surgical technology can be recreated to align with the realities of resource-constrained health systems. This is a successful contextually appropriate adaptation of the same therapeutic principle for settings where commercial solutions are neither affordable nor sustainable. By prioritizing affordability, availability, and system compatibility overautomation, such an approach ensures advances in wound care are accessible, equitable, and responsive to local needs.

By using readily available materials and familiar suction sources, these systems do not require additional capital investment or specialized maintenance. ⁷ The reliance on protocol-driven monitoring rather than automated alarms further aligns with settings where human resources are available but advanced technology is not.

Low-cost NPWT limitations, when examined pragmatically, can be mitigated through simple solutions (Table 1). In such environments, process reliability can substitute for device complexity, a principle well recognized in global health delivery models.

Importantly, the growing body of observational studies, pragmatic trials, and institutional audits from LMICs suggests that low-cost NPWT can achieve outcomes comparable to commercial systems.^8,9 While large multicentre randomized trials remain limited, this reflects structural research inequities rather than lack of clinical effectiveness. Implementation-focused evidence—cost-effectiveness analyses, feasibility studies, and real-world outcome reporting—may be more relevant than traditional efficacy trials when evaluating such innovations.