Comparison of Standard Negative Pressure Wound Therapy to Negative Pressure Wound Therapy with Instillation of Saline

Background: Negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) is an advancement to NPWT that includes the periodic instillation of topical solution into the wound. Normal saline has been recommended as a first-line solution for NPWTi-d; however, the comparative effectiveness of NPWTi-d using saline versus standard NPWT has not been adequately assessed in previous studies. 

Purpose: Our objective was to evaluate potential differences in wound outcomes in patients receiving NPWT to patients receiving NPWTi-d with saline.

Methods: An analysis was performed to compare patient characteristics and clinical outcomes of infected wounds, which were reported in two independent studies from a single investigator and institution. Outcomes included the number of operations, time to final surgery, length of hospital stay, wound closure, and percentage of wounds that remained closed at 1 month. Patient demographics and comorbidities, wound etiologies, and anatomical locations of wounds were similar between groups, although a significantly higher percentage of NPWT-treated patients had end-stage renal disease (P = .0119).

Results: Compared with patients treated with standard NPWT, NPWTi-d-treated patients had a significantly lower number of operations (P = .0048), shorter length of hospital stay (P = .0443), shorter time to final surgical procedure (P = .0001), higher percentage of closed wounds (P = .0004), and a higher percentage of wounds that remained closed at 1 month (P = .0001).

Conclusions: The results of this analysis suggest that management of infected wounds with NPWTi-d using saline leads to favorable wound outcomes when compared to those managed with NPWT.