The Hanikoda Method: 3-layered Negative Pressure Wound Therapy in Wound Bed Preparation

Ian Chik, MD; Enda G Kelly, BSc, MBBch BAO, MRCSI, MCh; Razman Jarmin, MD, MS; Farrah-Hani Imran, MB BCh BAO, MRCS, MS


Wounds. 2016;28(10):360-368. 

In This Article


While no component of the HM is new, the combination of the 3 dressings are used as a novel technique in preparing the wound bed for definitive wound closure. This form of therapy is thought to work primarily via macrodeformation, microdeformation, fluid removal, and alteration of the wound environment.[1] It also produces secondary effects such as removing infiltrating leucocytes while simultaneously inducing inflammation, which encourages angiogenesis and stimulates peripheral nerve response.[1]

The first layer involved in this technique is hydrogel, the second is a paraffin gauze dressing, and the third is NPWT. Each layer has a specific indication and helps prepare the wound bed for secondary healing or for the STSG (Table 1).

The combination of dressings used in the HM were chosen to help facilitate debridement while simultaneously reducing the bacterial load and size of the wound. Hydrogel is primarily used in debridement[3] by keeping the wound relatively moist, but not overly wet so as to cause maceration. Hydrogel functions by encouraging autolysis of necrotic tissue by water absorption.[4] The paraffin tulle is placed to keep the hydrogel in place and help avoid suctioning it out when attached to the wall suction. Theoretically, the HM prepares the wound bed without requiring any mechanical debridement. Negative pressure wound therapy is also important in reducing overall exudate, which may delay the healing process.[5]

Joseph et al[6] had previously described a decrease in wound volume over 6 weeks by 78% on NPWT compared to 30% on moist saline gauze (P = 0.038). However, there was no significant difference in time of healing. Negative pressure wound therapy is important in wound bed preparation especially in cases of noted skin loss, as reduction in wound size may require tissue or skin closure.

In reporting on this new technique, the authors present 8 patients who had sustained wounds due to trauma or tumor. All patients were at various stages of debridement when referred to the Wound Care Team. The challenges in each case were similar: reduce the size of the wound, obliterate cavities, eradicate infection, and cover exposed bones, tendons, or vessels with healthy granulation tissue. The hydrogel layer moisturizes the wound bed with excellent wound surface contact due to its conformability and provides an element of autolytic debridement; the paraffin tulle layer secures the hydrogel in place while providing wound permeability; the NPWT acts on macroscopic and microscopic levels. The aim was to achieve this while respecting patients' wishes for conservative measures and working around lack of available time in the operating room. Once a healthy planar wound bed was achieved, the wound was either allowed to contract and epithelialize or had an STSG procedure performed.