Use of Negative Pressure Wound Therapy With Instillation and a Novel Silicone Hybrid Drape in Complex Wounds

Introduction: Negative pressure wound therapy (NPWT) with instillation and dwell (NPWTi-d*) is applied using an adhesive acrylic drape. However, traditional drape can be painful upon removal. A new hybrid polyurethane drape with acrylic adhesive and a silicone perforated layer (hybrid drape†) has been developed for use. Use of NPWTi-d with hybrid drape in 3 patients with complex wounds is presented.

Methods: Patients underwent surgical debridement, followed by application of NPWTi-d with hybrid drape. Traditional drape was initially used in one patient but switched to hybrid drape due to pain and irritation. Normal saline or 0.125% hypochlorous acid solution was instilled with a 20-minute dwell time, followed by 2 hours of continuous negative pressure. Dressing changes occurred every 2-3 days. Once healthy granulation tissue was observed, dermal matrix or skin graft placements were performed. NPWT‡ was used as a bolster over the dermal matrix or skin grafts with dressing changes every 3-7 days.

Results: Three patients (average age 64.0 ± 12.1 years) presented for care. Previous medical history included myelofibrosis, diabetes, sarcoma, and venous ablation. Wound types included wounds secondary to graft versus host disease, non-healing surgical excision, and venous leg ulcers. No negative pressure or instillation solution leaks occurred. Hybrid drape was well tolerated with no pain during drape removal and no periwound skin irritation. In the patient that switched to hybrid drape, pain relief and resolution of periwound skin irritation was noted. All patients underwent dermal matrix or skin graft placement. Two patients were discharged to the outpatient clinic for follow-up care. The remaining patient elected to undergo palliative care.

Conclusions: Use of NPWTi-d with hybrid drape in these 3 patients resulted in patient comfort and granulation tissue development in the wound bed without negative pressure seal loss, instillation solution leaks, periwound skin irritation, or pain during dressing changes.