Rotation Flap Closure of Pressure Ulcers After Using Negative Pressure Wound Therapy with Instillation for Wound Cleansing

Introduction: Proper wound cleansing is an integral part of early-stage wound management that is essential in facilitating the transition to therapies that (i) promote granulation tissue formation and epithelialization, or (ii) provide wound coverage or closure. To this end, negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) includes the periodic instillation of a topical solution onto the wound bed and negative pressure for wound cleansing and the removal of infectious materials. In this study, we describe our experiences using NPWTi-d to help cleanse 11 pressure injury wounds (e.g., ischial ulcers and sacral ulcers) in six hospitalized patients before transitioning to primary closure using rotation flaps.

Method: Patients ranged in age from 34 to 78 years, and comorbidities included paraplegia, diabetes mellitus, rheumatoid arthritis, and deep vein thrombosis. After an initial debridement of each wound, NPWTi-d was applied by instilling normal saline (40–80 mL) onto the wound with a dwell time of 20 minutes followed by negative pressure at -125 mmHg for two hours. NPWTi-d was applied for 3–4 days with dressing changes every 48 hours. In four of the five patients, rotation flap closures were performed without immediate postoperative complications, and they were discharged from the hospital within 72 hours. In one patient, an unrelated medical condition delayed closure of an ischial ulcer, and the patient underwent a colostomy to prevent further soilage/contamination. After the colostomy, the patient returned for flap coverage. Additionally, one patient was re-hospitalized for seven days due to non-compliance.

Results: These cases help further support the use of NPWTi-d as a suitable option for wound care providers in the cleansing of complex wounds. These cases also suggest that wound cleansing using NPWTi-d may facilitate an expedited transition to rotation flap closure for this wound type.