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.