Negative pressure wound therapy (NPWT) combined with instillation and dwelling (NPWTi-d) of a topical solution onto the wound bed enables the solubilization and removal of exudate and infectious debris. Combined with a polyurethane reticulated open cell foam dressing with through holes (ROCF-CC), NPWTi-d can stimulate the loosening of thick slough and fibrinous materials, cleansing the wound bed with alternating cycles of instillation and negative pressure. We present our experience using NPWTi-d with ROCF-CC on patients with multiple high-risk comorbidities.
For all wounds, the ROCF-CC dressings were placed onto the wound bed, then covered with an adherent drape‡ to create a seal. NPWTi-d was initiated with an instillation of 0.03% hypochlorous acid, a dwell time of 5–20 minutes, and a NPWT cycle for 1–2 hours at -125 or -150 mmHg. Dressing changes were performed every 2–3 days, and debridements and antibiotics were utilized as necessary. There were four patients (two males and two females; average age of 62.5 years) receiving treatment for Fournier’s gangrene (n=2), wound dehiscence (n=1), and chronic lower extremity wound (n=1). Patient comorbidities included diabetes, hypertension, peripheral vascular disease, hyperlipidemia, quadriplegia, and history of tobacco use. Bacterial cultures were positive in three wounds. Duration of NPWTi-d with ROCF-CC was on average 11 days (range: 6–16 days).
NPWTi-d promoted the growth of granulation tissue and loosened and removed slough, allowing for easier debridements that could be performed at bedside. After discontinuation of NPWTi-d, two patients transitioned to conventional NPWT application at home, one patient was discharged to a long-term acute care facility, and one patient received a partial incision closure followed by a muscle flap with skin graft. In these four patients, NPWTi-d was a valuable tool for wound bed preparation, enabling the use of less-invasive procedures and supporting the wound-healing process.