Management of Complex Wounds in Critically Ill Patients Using Multiple Modalities of Negative Pressure Wound Therapy

Background: Negative pressure wound therapy (NPWT) is a versatile wound management tool that can be used to help support wound healing in patients who are at risk of complications. While NPWT alone provides benefits that support wound healing, it can also be combined with the instillation and dwelling (NPWTi-d) of topical solutions onto the wound bed. Use of NPWTi-d with standard reticulated open cell foam dressings or specialized dressings with through holes (ROCF-CC) enables wound cleansing via the solubilization and removal of infectious materials from the wound surface.

Purpose: We present our experience using multiple NPWT modalities on complex wounds in critically ill patients.

Methods: Patient 1 was a 60-year-old female with a history of hypertension, hypothyroidism, venous leg ulcers, and ambulatory dysfunction. She presented with symptoms of septic shock and a large lower leg ulcer covered with fibrotic slough. Patient 2 was a 36-year-old male who presented with abdominal pain, vomiting, and diarrhea. A computed tomography scan revealed signs of necrotizing fasciitis, which was confirmed during excisional debridement. Patient 3 was a 62-year-old female with a history of remote colon and endometrial cancers, chronic obstructions, colocutaneous fistula, diabetes, hypertension, and atrial fibrillation. She presented with cellulitis of the pannus with superficial epidermal blistering and necrosis. In all cases, patients received intravenous antibiotics and debridements were performed as necessary. Patients 2 and 3 were initially treated with NPWT with standard or polyvinyl alcohol dressings. All patients were treated with NPWTi-d, instilling 0.125% hypochlorous solution or normal saline, as needed. Instillation solutions were dwelled for 10 minutes, followed by 1-3.5 hours of -125 mmHg negative pressure. In areas with thick exudate or high amounts of slough, ROCF-CC dressings were used. Dressings were changed every 2-3 days.

Results: Use of multiple NPWT modalities in the management of these complex wounds supported wound healing in these patients.