Cleansing Chronic Lower Limb Wounds Using Negative Pressure Wound Therapy With Instillation and Dwelling of Normal Saline
Chronic podiatric wounds are common sources of morbidity and mortality in elderly patients, requiring adequate removal of nonviable tissues paired with active management of the wound healing environment. Negative pressure wound therapy (NPWT) with the instillation and dwelling (NPWTi-d) of cleansing topical solutions is a versatile tool for solubilizing slough and creating micro-deformations on the wound surface. In this case series, we report on the use of NPWTi-d for 3 chronic wounds in elderly patients with multiple comorbidities. Patient 1 was a 65-year-old obese female with peripheral vascular disease, chronic venous insufficiency, hyperthyroidism, chronic obstructive pulmonary disease, fibromyalgia, and lymphedema, who had a dehisced wound on her right foot that was non-healing after 90 days. Patient 2 was a 78-year-old female with peripheral neuropathy, hypertension, and osteoarthritis, who presented with a 300-day neuropathic ulcer on her left foot. Patient 3 was a 75-year-old obese, diabetic male with coronary heart disease, peripheral vascular disease, stage 4 chronic kidney disease, hyperlipidemia, chronic obstructive pulmonary disease, gastroesophageal reflux disease, neuropathy, osteomyelitis, and a past myocardial infarction. He presented with a 210-day Wagner grade 3 diabetic foot ulcer of the right lateral malleolus. Each patient had undergone lower limb procedures within the past 2 years, and previous treatments included conventional NPWT, enzymatic debridement, and excisional debridement. NPWTi-d was initiated to wash the wounds with saline, soaking for 1 minute, followed by 3-hour cycles of continuous -125 mmHg. After a period of 7 to 33 days, NPWTi-d was discontinued, and care was transitioned to advanced wound dressings. All 3 wounds responded positively to therapy, exhibiting reduced slough, growing granulation tissue, and reducing in size. In these patients with chronic wounds, NPWTi-d was effective in creating an environment that promoted wound healing and prepared the wound for eventual closure.