This is less a list of bans than a list of things that must be found before the device goes on. It starts with a requirement rather than exclusions: a thorough wound assessment must be carried out before starting negative pressure wound therapy (NPWT).
Exposed structures are the first item, and the instruction is to adapt rather than to refuse. Any exposed blood vessels, bowel, or other vulnerable structures should be identified. When NPWT is used in wounds with exposed anatomy that could be injured by negative pressure, dressing materials and pressure settings should be modified accordingly. For example, protective dressings may be placed between the foam and bowel, and lower pressure settings may be selected.
A fistula — an abnormal passage between two parts of the body — carries a specific warning. Applying NPWT directly over a fistula may result in excessive fluid extraction or tissue injury, potentially leading to dehydration and damage to nearby vital structures.
Two conditions are about sequence rather than exclusion. All dead or devitalized tissue should be adequately debrided, and active infection treated, before NPWT is applied. Dead tissue and untreated infection are not reasons the therapy can never be used; they are things that have to be dealt with first.
Two more are stated as limits. On bone infection: although case reports have described the use of NPWT in wound beds with active osteomyelitis without bad outcomes, this approach is not considered standard of care. On cancer: an underlying malignancy is also considered a contraindication to NPWT due to the theoretical risk of tumor seeding.
This is a decision list for whoever prescribes the therapy. It is here so you can recognize the questions, not so you can rule yourself in or out of treatment. If something on it applies to you and a device is already running, the move is to ask whether it was taken into account — not to switch anything off.