Background: Traditionally, negative pressure wound therapy with instillation and dwell (NPWTi-d*) is applied to the wound using foam dressings and an adhesive acrylic drape. However, the traditional drape is not able to be repositioned following initial placement and can be painful to remove at dressing changes. A new hybrid polyurethane drape with acrylic adhesive and a silicone perforated layer (HA-drape†) has been developed for use. This 3-patient case series describes the initial use of NPWTi-d and HA-drape.
Methods: Three patients presented for care. Sharp debridement was performed, and intravenous antibiotics were given, as necessary. Delicate structures were protected prior to NPWTi-d with HA-drape application. NPWTi-d dressings‡ were applied followed by HA-drape application. Acetic acid or normal saline was instilled into the wound bed with a dwell time of 5-10 minutes, followed by 3 hours of negative pressure (-100 mmHg to -125 mmHg). Dressings were changed every 2-3 days. Wound healing and periwound skin condition were monitored.
Results: The patients presented with exploratory laparotomy for necrotizing pancreatitis, transmetatarsal amputation wound dehiscence, or necrotizing fasciitis. The HA-drape was able to be repositioned following the initial placement. No negative pressure or instillation solution leaks were observed with HA-drape usage. HA-drape removal was easy with no patient-reported pain at dressing changes compared to previous experience with traditional drape. Increased development of healthy granulation tissue was observed in the wound beds of all 3 patients. No periwound skin irritation was observed in any patient.
Conclusions: The HA-drape application and removal was easier compared to previous experiences with traditional drape. In these 3 patients, use of NPWTi-d with HA-drape resulted in increased development of granulation tissue in the wound bed without the loss of negative pressure seal, instillation solution leaks, or periwound skin irritation.
*V.A.C. VERAFLO™ Therapy, †DERMATAC™ Drape, ‡V.A.C. VERAFLO™ Dressing or V.A.C. VERAFLO CLEANSE CHOICE™ Dressing (KCI, now part of 3M Company, San Antonio, TX)