Negative Pressure Wound Therapy With Instillation and a Reticulated Open Cell Foam With Through Holes Used for the Early-Stage Management of Complex Lower Extremity Wounds

Abstract

Patients with non-healing lower limb wounds often present with the presence of slough and/or non-viable tissue. Negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d*) utilizes periodic instillation of topical wound solutions and negative pressure for wound cleansing and removal of infectious materials.1-4 More recently, NPWTi-d using a novel reticulated open cell foam dressing with through holes (ROCF-CC†) was reported to aid in the loosening and removal of thick exudate from wounds.5 In this study, we describe our experience using NPWTi-d with a ROCF-CC dressing for the early-stage management of four patients that presented with lower extremity wounds with exudate and infectious material. Three male and one female patients ranging in age from 60 to 86 years presented with wounds resulting from a traumatic hematoma, a venous leg ulcer, a diabetic ulcer, and a pressure ulcer. Comorbidities included diabetes mellitus, peripheral vascular disease, and edema. Two patients underwent surgical debridement, and two patients underwent surgical incision and drainage procedures. A ROCF-CC dressing was then placed and NPWTi-d was applied. Sterile normal saline was intermittently instilled with a dwell time of 20 minutes, followed by continuous negative pressure at -125mmHg for two hours. The total duration of NPWTi-d ranged from four to seven days, with ROCF-CC dressing changes occurring every two to three days. In each case, exudate and infectious materials were tremendously reduced after application of NPWTi-d with ROCF-CC, and wound healing had progressed to a point where the patient could be discharged and transitioned to other wound care modalities (eg, conventional NPWT therapy or placement of an oxidized regenerated cellulose dressing containing silver). These cases help support the use of NPWTi-d with ROCF-CC as a viable option for wound care providers in the early-stage cleansing of complex wounds of the lower limb.
___________________________________________________________
*V.A.C. VERAFLOTM Therapy and †V.A.C. VERAFLO CLEANSE CHOICETM Dressing (KCI, an ACELITY Company, San Antonio, TX)

References
(1) Gupta S, Gabriel A, Lantis J, Teot L. Clinical recommendations and practical guide for negative pressure wound therapy with instillation. Int Wound J 2016;13:159-174.
(2) Kim PJ, Attinger CE, Steinberg JS et al. The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study. Plast Reconstr Surg 2014;133:709-716.
(3) Wolvos T. The evolution of negative pressure wound therapy: negative pressure wound therapy with instillation. J Wound Care 2015;24:15-20.
(4) Kim PJ, Attinger CE, Steinberg JS, Evans KK. Negative pressure wound therapy with instillation: past, present, and future. Surgical Technology International 2015;26:51-56.
(5) Teot L, Boissiere F, Fluieraru S. Novel foam dressing using negative pressure wound therapy with instillation to remove thick exudate. Int Wound J 2017;14:842-848.