Use of Negative Pressure Wound Therapy with Instillation and Closed Incision Negative Pressure Therapy for Complex, At-risk Colorectal Patients: A Case Series

Abstract Body: Introduction: Complex open infected wounds of varying etiology are benefiting from negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d†) using a reticulated open-cell foam dressing with through holes (ROCF-CC††), in conjunction with debridement and antibiotic therapy. There are growing numbers of cases for using NPWTi-d with ROCF-CC dressing for complex wounds when debridement is not appropriate/readily available.1  Colorectal surgical procedures are impacted by high rates of surgical site infections, (as high as 45%).2 Recent randomized control trials within this population set are showing reduction in complications when closed incision negative pressure therapy (ciNPT‡) is applied to closed incisions. Method:  Three at-risk patients (ages: 58, 78, 89; two MRSA positive) presenting with wound infection, comorbidities and need for debridement, received NPWTi-d using ROCF-CC (instillation of saline with 5-minute dwell time, followed by 2-3 hours of NPWT) over a 10-14-day period with dressing changes 3 times a week.  These patients received antibiotics but were unable to undergo debridement. Three other at-risk patients with rectal cancer (ages: 63, 84, 94) received continuous ciNPT (-125mmHg) over their closed surgical incision lines of the perineal region.  Antibiotics were administered as needed in these patients. Results:  Wound bed preparation and removal of infectious material, including devitalized tissue, occurred in three cases with 90% granulation tissue noted before switching to portable NPWT. All closed incisions in perineal region remained approximated and closed permanently following 7 days of ciNPT. Health practitioners are challenged with patients who have multiple comorbidities and large wounds that require debridement. Conclusion: Consideration should be given to incorporate advance technologies such as NPWTi-d using ROCF-CC that help cleanse the wound bed and move the trajectory of wound healing to the proliferative phase. Additionally, use of ciNPT over closed incisions for patients at risk for dehiscence should be incorporated into patient care in the surgical setting.