Complex Lower Limb Wound Cleansing With Negative Pressure Wound Therapy With Instillation and Dwell Time

Background

• Negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d*) facilitates the delivery, dwelling, and removal of topical wound solutions at the wound bed.
• Use of NPWTi-d on complex wounds can assist health care practitioners in preparing a clean wound bed for successful closure.
• NPWTi-d is paired with a polyurethane reticulated open cell foam dressing with through holes (ROCF-CC†) or a standard instillation dressing (ROCF-V‡), which are designed to remove infectious materials and wound debris.

Purpose

• We present our experience using NPWTi-d with ROCF-V (n=4) or ROCF-CC (n=2) on 6 complex lower limb wounds.

Methods

• NPWTi-d was initiated by instilling normal saline, 0.125% hypochlorous acid, or a polyhexanide solution, which dwelled in the wound bed for 5-10 minutes, followed by 3-3.5 hours of continuous -125 mmHg negative pressure (Table 1).
• Dressing changes were performed every 2-3 days.
• Patients received parenteral antibiotics when necessary, and debridements were performed when possible.

Results

• Six patients (aged 46-83 years) were treated with NPWTi-d with ROCF-V (n=4) or ROCF-CC (n=2).
• Wounds included bone resection for osteomyelitis, post-amputation flap dehiscence, a venous leg ulcer, major right foot reconstruction, and compartment syndrome sequela (Table 2).
• Patient comorbidities included diabetes, previous diabetic foot ulcers, and a history of smoking. For all wounds, the appropriate foam dressing was placed in contact with the wound bed and covered with an adherent drape.
• Treatment with NPWTi-d continued for a median of 6 days (range: 6-28 days).
• After treatment with NPWTi-d, the wounds showed continuous improvement until treatment could be stepped down to conventional NPWT or the wound could be successfully closed.
• Two representative cases are shown in Figure 1 and 2.

Conclusions

• In these patients, use of NPWTi-d with ROCF-V or ROCF-CC assisted in cleansing these complex lower limb wounds and producing a positive healing outcome.

Acknowledgements

• Nicholas A. Cheney, DO provided initial surgical care for 2 cases.
• The wound and ostomy nurses and clinical and administrative staff at St. Ann’s Hospital Wound Clinic and Licking Memorial Hospital Wound Clinic provided health care support.