Comparing Negative Pressure Wound Therapy with Instillation and Advanced Wound Dressings for Management of Complex Lower Extremity Wounds

Purpose: In this study, we compared NPWTi-d with ROCF-CC (ie, treatment group) to advanced wound dressings (ie, control group) for lower extremity wounds.

Methods: The treatment group consisted of 5 patients with a mean age of 70.4 ± 10.2 years, whereas the control group comprised 5 patients with a mean age of 69.2 ± 14.1 years. Wound types (eg, diabetic ulcers) and comorbidities (eg, diabetes and perivascular disease) were similar between groups. After an initial debridement, normal saline was instilled onto wounds of the treatment group with a dwell time of 20 minutes followed by negative pressure (-125 mmHg) for 2 hours (with dressing changes every 2-3 days); advanced wound dressings (eg, alginate or collagen dressings) were applied to wounds in the control group and changed 1-3 times per week.

Results: Patients in the treatment group required fewer debridements and had a shorter time to wound closure when compared to control patients. After transitioning from NPWTi-d to acellular fish skin grafts or other advanced wound therapies, all treatment-group wounds were closed within 1.5 to 5 months without requiring hospital or operating room readmission. In contrast, only 2 of 5 control wounds healed, and each patient in the control group required readmission for additional surgery. One patient in the control group ultimately underwent a below knee amputation and another was lost to follow up after 2 years.

Conclusion: These data further support the use of NPWTi-d with ROCF-CC to help manage complex wounds of the lower limb. Further studies are necessary to compare NPWTi-d with ROCF-CC to other wound care modalities, including NPWT, for this wound type.

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