Background: In our hospital, we have used negative pressure wound therapy (NPWT) with instillation and dwelling (NPWTi-d)* of topical wound solutions to solubilize and remove debris from the wound bed. Recently, we have begun applying NPWTi-d with a hybrid silicone-acrylic drape† that can be repositioned as needed when creating a vacuum seal.
Purpose: We report our experience using the hybrid drape in 3 patients with large slough-covered wounds.
Methods: During NPWTi-d, normal saline or hypochlorous acid solution was instilled, followed by a 5-minute dwell time and 2 hours of -75 to -125 mmHg. Dressings included reticulated open-cell foam dressing with through-holes‡, which were covered by the hybrid drape to create a vacuum seal. Dressings were changed every 3-4 days.
Results: Case 1 was an 84-year-old female with hypertension, bilateral metatarsalgia and hammer toe, and a previous C. difficile infection, presenting with a 40x30x1.2 cm3 wound after undergoing debridement for necrotizing fasciitis. Case 2 was a 59-year-old female with latent tuberculosis, hypertension, pre-diabetes, and obesity, presenting with an infected abdominal wall seroma requiring debridement, resulting in a 25x25x6 cm3 wound with extensive undermining. Case 3 was a 50-year-old female with morbid obesity and primary osteoarthritis of the right knee. After undergoing right knee reconstructive surgery, she developed a dehiscence measuring 9x6.5x3 cm3 with periwound skin breakdown. In these patients, NPWTi-d was utilized for 21, 14, and 10 days, respectively. In all cases, slough was decreased after NPWTi-d, allowing transition to conventional NPWT. Use of the hybrid drape allowed for greater repositionability and reduced irritation of sensitive periwound skin.
Conclusion: This new hybrid drape enabled us to heal the adjacent skin while providing NPWTi-d. All patients felt the new drape was more comfortable for day-to-day wear, providing more flexibility. Patients reported less pain with removal and repositioning.
*V.A.C. VERAFLO™ Therapy, †DERMATAC™ Drape, ‡V.A.C. VERAFLO CLEANSE CHOICE™ Dressings; 3M Company; San Antonio, TX