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The utility of negative pressure wound therapy with instillation for wound bed preparation

Authors Fernández L

Received 1 January 2019

Accepted for publication 22 May 2019

Published 1 July 2019 Volume 2019:6 Pages 51—58

DOI https://doi.org/10.2147/CWCMR.S198418

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 2

Editor who approved publication: Professor Marco Romanelli


Luis Fernández

Department of General Surgery, University of Texas Health Science Center, Tyler, TX, USA

Abstract: Negative pressure wound therapy (NPWT) with instillation and dwell-time (NPWTi-d) is an adjunctive therapy that facilitates wound cleansing via the introduction of a topical wound solution followed by the application of subatmospheric pressure. The author presents two cases to evaluate the effectiveness of NPWTi-d in the cleansing of complex and contaminated postoperative wounds. Prior postoperative surgical wounds or seromas were subject to incision and drainage and were packed with either iodoform gauze or hypochlorous acid–impregnated gauze. Infected wounds were swabbed to assay wound-resident bacteria and discern pathogenicity and the applicability of antibiotics. For each case, NPWTi-d was administered to the surgical defect, instilling a predetermined volume of hypochlorous acid wound solution (VASHE®,; SteadMed Medical, Fort Worth, TX, USA) with a 20-min dwell time followed by 2 hrs of NPWT at −125 mmHg. Patient 1, a 76-year-old female, was readmitted to the hospital for large bowel obstruction and an infected groin wound. NPWTi-d was applied to the left groin wound, and after seven days, the wound edges were drawn closer together. At discharge, the wound had almost fully reepithelialized. The patient followed up in clinic 6 days later with a completely healed wound. No complications were reported 4 months post-NPWTi-d. Patient 2, a 63-year-old male, underwent an abdominal wall reconstruction to resolve a Grade III complex incisional hernia. Two months later, the patient presented with erythema and a seroma along the incision. The seroma was opened, and NPWTi-d was applied for 3 days. After developing healthy granulation tissue, patient 2 transitioned to conventional NPWT. The wound was fully healed at 4-month follow-up. In the complex wounds for these two patients, NPWTi-d yielded positive outcomes in cleansing contaminated tissue. Randomized, controlled clinical studies should be developed to compare the effectiveness of NPWTi-d on wound healing and patient outcomes versus standard irrigation modalities.

Keywords: negative pressure wound therapy, instillation, dwell time, hernia, hypochlorous acid
 

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