Managing Diverse Wounds in Comorbid Patients Using a Reticulated Open Cell Foam Dressing with Through Holes During Negative Pressure Wound Therapy with Instillation

Abstract

Attaining positive therapeutic objectives in wound resolution are thought to be preempted by complex, contamination or chronicity of the wounds. Negative pressure wound therapy with instillation and a dwell time (NPWTi-d*) is reported effective in the cleansing of complex and recalcitrant wounds.¹ Reticulated open cell foam dressings with through holes (ROCF-CC^†) complemented with NPWTi-d has demonstrated effective and precise removal of thick wound exudate.² Here, we evaluated NPWTi-d with ROCF-CC in the management of wounds of varying complexity in 4 patients with comorbidities and diverse wound types. If applicable, patients received antibiotics and underwent selective debridement to prepare for NPWTi-d with ROCF-CC. Wound care entailed instillation with 65-80 mL of a topical irrigant solution (hypochlorous acid solution^‡ or normal saline solution) with a 5- to 10-minute dwell time, followed by 3 to 4 hours of NPWT (-125 mmHg). Dressings were changed every 2-3 days. Two female and 2 male patients with a mean age of 62.0 ± 14.5 years were included. Comorbidities included type 2 diabetes mellitus (n=3), asthma (n=2), sepsis (n=2), hypertension (n=2), dyslipidemia (n=2), hypertension (n=2), multiple sclerosis (n=1), obesity (n=1) and gastroesophageal reflux disease (n=1). Presenting wound etiologies included pressure injury of the left lower extremity over the lateral trochanter, right necrotic neuropathic foot ulcer, post-surgical site complication resultant of back surgery, and cellulitis and abscess of the buttock situated at the right ischial tuberosity. Mean duration of NPWTi-d with ROCF-CC for these patients was 8.0 ± 2.0 days. Upon development of healthy and stable granulation tissue, healthy wound edges and wound bed preparation, all patients transitioned to conventional NPWT at discharge. In these four patients, NPWTi-d with ROCF-CC was an effective adjunctive intervention in the management of complex wounds for these patients with comorbidities.

References
1) Gupta S, Gabriel A, Lantis J, Téot L. Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int Wound J 2016;13:159-174.

2) Téot L, Boissiere F, and Fluieraru S. Novel foam dressing using negative pressure wound therapy with instillation to remove thick exudate. Int Wound J 2017; 1-7.

*V.A.C. VERAFLO^TM Therapy System, †V.A.C. VERAFLO CLEANSE CHOICETM Dressing, (KCI, an ACELITY Company, San Antonio, TX); ‡VASHE® (Urgo Medical North America, Fort Worth, TX)