Poster CS-108

Negative Pressure Wound Therapy With Instillation and a Reticulated Open Cell Foam With Through Holes Use When Surgical Debridement is Delayed

Michael N. Desvigne , MD, FACS, CWS, FACCWS

Presented at Symposium on Advanced Wound Care Spring 2022

INTRODUCTION: Patients with complex wounds may not be able to undergo immediate surgical debridement. Negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d*) using a reticulated open-cell foam dressing with through holes (ROCF-CC†) has been reported to help solubilize and soften non-viable tissue, wound debris, infectious materials, and thick exudate.1-4 The use of NPWTi-d with ROCF-CC dressings in wounds of 4 complex patients, when immediate surgical debridement was delayed, is presented.

METHODS: Antibiotics were initiated if necessary. NPWTi-d using ROCF-CC dressings was utilized. Normal saline or 0.125% hypochlorous acid solution was instilled into the wound bed with a 20-minute dwell time, followed by 2 hours of continuous negative pressure. Dressing changes occurred every 24 to 72 hours. Patients then underwent targeted surgical debridement. 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 to 7 days.

RESULTS: Four patients (average age 57.5 ± 16.6 years) were treated. Previous medical history included peripheral vascular disease, obesity, and anticoagulant medication usage. Wound types included necrotizing infection, non-healing surgical wound, and abdominal wall wounds. Use of NPWTi-d with ROCF-CC dressings resulted in softening of non-viable tissue, allowed for targeted surgical debridement, and reduced the number of planned operating room visits. Development of healthy granulation tissue was observed in all 5 wounds. Three wounds underwent successful dermal matrix or autologous skin graft placement for wound closure. In the remaining patient, one wound was fully closed by secondary intention, while the second abdominal wound was further managed in the wound care clinic.

DISCUSSION: Use of NPWTi-d with ROCF-CC dressings allowed for targeted surgical debridement of non-viable tissue and reduced planned OR visits in these 4 complex patients.

References

1. Teot L, Boissiere F, Fluieraru S. Novel foam dressing using negative pressure wound therapy with instillation to remove thick exudate. International Wound Journal. 2017;14(5):842-848.2. Ben-Nakhi ME, Eltayeb HI. First Middle East Experience with Novel Foam Dressing Together with Negative Pressure Wound Therapy and Instillation. Cureus. 2018;10(10):e3415.3. Fernandez LG, Matthews MR, Ellman C, Jackson P, Villareal DH, Norwood S. Use of reticulated open cell foam dressings with through holes during negative pressure wound therapy with instillaton and dwell time: A large case study. Wounds. 2020;32(10):279-282.4. Blalock L. Use of Negative Pressure Wound Therapy With Instillation and a Novel Reticulated Open-cell Foam Dressing With Through Holes at a Level 2 Trauma Center. Wounds. 2019;31(2):55-58.