When All Else Fails Vac It: A Case Report on the Efficacy of Negative Pressure Wound Therapy as a Singular Modality to Accelerate Wound Healing for Limb Salvage

The purpose of this case study is to investigate the efficacy of negative pressure wound therapy as a singular modality for limb salvage status-post extensive sharp debridement of the foot. In this case, a 68-year-old diabetic with peripheral neuropathy Caucasian male with a past medical history of below-knee amputation of the left lower extremity, peripheral arterial disease, atrial fibrillation on oral anticoagulation therapy, diabetic peripheral neuropathy presented to our inpatient services with a right foot wound

On admission, X-rays were obtained which revealed soft tissue ulcer of the lateral midfoot with underlying osteomyelitis of the fifth metatarsal base and questionable involvement of the lateral aspect of the cuboid. MRI was also ordered which revealed soft tissue ulceration on the lateral margin of the midfoot with underlying osteomyelitis of the cuboid and fifth metatarsal. The patient underwent serial debridement (5th metatarsoectomy, partial cuboid resection) to salvage his right limb with the application of negative pressure wound therapy due to the presence of a large soft tissue deficient. After receiving Vancomycin and Zosyn during his inpatient stay he was discharged on Doxycycline 100mg twice daily and Levofloxacin 750mg daily.

During his outpatient care he underwent negative pressure wound therapy dressing changes three times a week, which closed by 76% at 83 days. The remaining closure was achieved by dermal template dressings at 120 days. This case study is a strong demonstration of the efficacy of negative pressure wound therapy for extensive wounds during limb salvage protocol by achieving an accelerated closure rate in less 90 days. 

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