Using Negative Pressure Wound Therapy With Instillation to Cleanse Lower Extremity Wounds: Assessing Potential Cost Savings

Abstract

Background: Use of negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d*) to deliver, dwell, and remove topical wound solutions from the wound bed can assist clinicians in preparing a clean surface for successful closure. By promoting wound healing, NPWT technologies have the potential to reduce the total treatment-associated costs over conventional therapies, despite having a higher unit price.1-3

Purpose: We present our experience using NPWTi-d* to manage lower extremity wounds in 3 patients and discuss the feasibility of improving cost efficiency.

Methods: NPWTi-d was applied in the operating room (OR). Normal saline was instilled with an 8 to 10-minute dwell time, followed by 3-3.5 hours of -125 mmHg. Therapy continued for 6-7 days with dressing changes every 2-3 days.

Results: Patients were all male, aged 24, 51, and 83 years old. Wound etiologies included deep tissue laceration, contusion with soft tissue necrosis, and chemical burn. All wounds were covered with non-viable tissue or fibrinogen, requiring cleansing. Prior to NPWTi-d, patients underwent surgical debridement and received antibiotics as necessary. After NPWTi-d, the wounds showed growth of healthy granulation tissue and reduced wound size, allowing for discharge to outpatient care. Patients transitioned to standard NPWT for 2-3 weeks before final closure. Upon follow-up 2-6 months later, no patients experienced wound complications or required readmission to the OR, potentially saving on time and cost. Returns for OR debridement and each additional day spent in the hospital are estimated to cost $3,393 and $2,842, respectively.2,4

Conclusion: In these patients, use of NPWTi-d assisted in cleansing the wound surface and producing a positive healing outcome. Despite higher initial costs of NPWTi-d over standard dressings, a wound management protocol including NPWTi-d may help mitigate expenses incurred by delayed healing.

*V.A.C. VERAFLO™ Therapy; 3M Company; San Antonio, TX

References

  1. Deleyto, E., Garcia-Ruano, A., Gonzalez-Lopez, J.R. Negative pressure wound therapy with instillation, a cost-effective treatment for abdominal mesh exposure. Hernia. 2017.
  2. Gabriel, A., Kahn, K., Karmy-Jones, R. Use of negative pressure wound therapy with automated, volumetric instillation for the treatment of extremity and trunk wounds: clinical outcomes and potential cost-effectiveness. Eplasty. 2014; 14: e41.
  3. Driver, V.R., Eckert, K.A., Carter, M.J., French, M.A. Cost-effectiveness of negative pressure wound therapy in patients with many comorbidities and severe wounds of various etiology. Wound Repair Regen. 2016; 24: 6, 1041-1058.
  4. Health Forum, 1999 - 2018 AHA Annual Survey. In: AHA Hospital Statistics™. 2019.

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