Evaluating Extended Usage of Closed Incision Negative Pressure Therapy Over Closed Flap Incisions in Pressure Ulcer Management

Introduction: Closed incision negative pressure therapy (ciNPT*) administers constant subatmospheric pressure1, helps hold incision edges together, removes fluid and infectious materials, affords a barrier against external contamination, and sealing the area of the peri-surgical site. Here, 3 male patients (aged 53-74 years) with pressure injuries received extended ciNPT* usage across closed flap incisions. Methods: For wound cleansing, patients received negative pressure wound therapy with instillation and dwell-time (NPWTi-d†), which instilled dilute hypochlorous acid followed by NPWT for 2 hours. NPWTi-d dressings were changed every 48-72 hours. Staged debridements or ulcer excisions were performed in the operating room. Perioperative antibiotics were administered. Each patients’ defects received viable human amnion membrane allograft particulate§ for optimizing tissue regeneration and healing. Dermal matrix‡ provided scaffolding for soft tissue replacement. Flaps provided defect coverage. Staples or sutures fastened incisional edges, and drains were installed pro re nata. ciNPT dressings** were placed over closed flap incisions and ciNPT (-125 mmHg) was initiated. Dressing replacement occurred every 7 days. Results: Patients’ medical histories included: diabetes mellitus, prostate cancer, deep vein thrombosis, transient ischemic attacks, and malnutrition. Patient 1, a 66-year-old with paraplegia secondary to transverse myelitis secondary to COVID-19, was admitted for acute infection and pressure ulcers after protracted hospitalization. Patient 2, a 53-year-old with incomplete quadriplegia and recrudescent pressure injuries developed a right hip ulcer with osteomyelitis. Patient 3, an ambulatory 74-year-old, sustained a stage 4 sacral ulcer associated with protracted hospitalization for sepsis. One patient underwent partial ostectomy. Two patients received NPWTi-d prior to flap closure, and dermal matrix provided scaffolding for soft tissue replacement in 2 patients. In 2 patients, ciNPT dressings were replaced after 7 days and ciNPT was administered for an additional 7 days. After 14 days of ciNPT, one patient had a second dressing change with replacement and ciNPT for 7 days post discharge. Inpatient stays were between 4 and 14 days. Discussion: In these patients, extended ciNPT use facilitated positive incision healing outcomes and flap success following pressure injury management.