Outpatient Management of Lower Extremity Wounds Using a Mechanically Powered Negative Pressure Wound Therapy Device

Abstract

Background

  • Patients discharging from the hospital after a lower extremity surgical procedure should be accompanied with an appropriate treatment plan to reduce the risk of amputation and to preserve patient mobility.
  • Mechanically powered, disposable negative pressure wound therapy (dNPWT*) devices are small, wearable units that are well-suited for delivering negative pressure to lowexudating lower extremity wounds in the outpatient setting.
  • The versatility of dNPWT minimizes interference with patient mobility when placed on a lower limb wound.

Purpose

  • This case series presents 6 patients receiving dNPWT for lower extremity wound management.

Methods

  • Disposable NPWT was applied at a -125 mmHg setting.
  • Dressings were changed every 2-3 days.
  • After application of dNPWT, the wounds were either closed or therapy was switched to conventional NPWT.†
  • Where necessary, parenteral antibiotics were used to control infection and debridements were performed to remove non-viable tissue.
  • In one patient, wound closure was achieved using epidermal grafting. In this case, an epidermal harvesting system‡ was utilized to obtain the epidermal graft.

Results

  • All 6 patients were male, with an average age of 60.3 (range: 44-74) years.
  • Wound types included surgical dehiscence and surgical incision after bone resection or reconstruction (Table 1).
  • Patient comorbidities included diabetes, arthritis, neuropathy, and previous foot surgeries (Table 1).
  • Disposable NPWT was applied for an average of 2.5 weeks.
  • Closure was achieved in 5 of 6 patients via secondary intention; in one patient the wound was closed with epidermal grafting.
  • Three representative cases are shown in Figures 1, 2, and 3.

Conclusions

  • In these patients, the application of dNPWT was part of the postoperative outpatient treatment plan and helped bridge the transition to wound closure.

Acknowledgements

  • Nicholas A. Cheney, DO provided initial surgical care for cases 2, 3, and 6.
  • Jeffrey E. Gittins, DO provided initial surgical care for cases 1 and 4.
  • Health care support was provided by wound and ostomy nurses and clinical and administrative staff at St. Ann’s Hospital Wound Clinic and Licking Memorial Hospital Wound Clinic.