Management of Complex Wounds Using Negative Pressure Wound Therapy with Instillation and a Reticulated Open Cell Foam Dressing with Through Holes

Background: Negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d), which combines periodic instillation of a topical wound solution with NPWT, can be used as part of a treatment strategy for both acute and chronic wounds. In addition, NPWTi-d using a reticulated open cell foam dressing with through holes (ROCF-CC) has been shown to assist in removing exudate and infectious materials. 

Purpose: We describe our experience using NPWTi-d with ROCF-CC to help manage 7 patients with complex wounds.

Methods: Six of the 7 patients were male, with an average age of 61.7 years (range: 45-78 years). Comorbidities were diabetes (n=6), coronary artery disease (n=3), peripheral vascular disease (n=3), surgery for abdominal aortic aneurysm (n=2), and renal disease with dialysis (n=1). Wound types were varied and included a pharyngeal abscess that developed an extensive disseminated infection involving the left breast, soft tissue avulsions with exposed tibias without periosteum, bilateral open fasciotomy leg wounds, and a right groin exposed graft with infection. Bacterial cultures were positive in 3 patients, and antibiotics were administered as appropriate. Debridements were performed as needed in 4 patients. In each case, NPWTi-d was initiated by instilling saline with a 1-second dwell time, followed by 2 hours of NPWT (-125 mmHg). NPWTi-d ranged from 5 to 27 days, with dressing changes every 2-3 days.

Results: After sufficient granulation tissue growth, NPWTi-d was discontinued and the wounds were primarily closed with sutures, flaps, or skin grafts. In one patient, closed incision negative pressure therapy‡ was used to support suture closure.

Conclusion: The positive outcomes from these cases further support the use of NPWTi-d with ROCF-CC as a viable option for assisting in the management of complex wounds.