Negative Pressure Wound Therapy With Instillation After Total Knee Arthroplasty: Initial Use of a Novel Silicone-Acrylic Drape
Background: When a patient presents with a wound covered with non-viable tissue and fibrinogen, wound cleansing becomes an essential step in the treatment protocol. In our clinic, negative pressure wound therapy with instillation and dwelling (NPWTi-d)* of topical wound solution is a key tool in this process. When applying NPWTi-d, an adhesive drape is used to create a seal over the wound.
Purpose: Recently, we have begun using a novel silicone-adhesive drape§ in place of the standard acrylic drape. We report our initial usage of this hybrid drape in conjunction with NPWTi-d on a patient with a non-healing wound subsequent to total knee arthroplasty.
Case: A 61-year-old female presented to our clinic for specialty wound care after undergoing total knee arthroplasty. Fluid collection distal to the knee required revision and incision and drainage. A non-adherent alginate dressing† was applied for 7 days. Surgical debridement and pulse lavage were performed in the operating room, followed by application of NPWTi-d with the hybrid drape. NPWTi-d consisted of instillation of normal saline with an 8-minute dwell time, followed by 3.5 hours of -125 mmHg. No fluid was instilled into the joint space. Dressings were changed on day 3. The goals of therapy were to decrease wound depth and support the growth of healthy granular tissue. After 6 days of NPWTi-d, these goals had been achieved, and the patient was discharged home with standard NPWT.
Conclusion: Application of NPWTi-d supported a quick transition to outpatient care. We observed that use of the silicone-acrylic drape adequately created a seal while allowing for easy repositioning after initial placement around anatomically difficult areas. The gentle adhesion of the drape also improved patient comfort at dressing changes and during wear time. We intend to incorporate this novel drape into our regular use of NPWTi-d for wound cleansing.
*V.A.C. VERAFLO™ Therapy, §DERMATAC™ Drape, †SILVERCEL™ NON-ADHERENT Antimicrobial Alginate Dressing; KCI, now part of 3M Company; San Antonio, TX