Wound Bed Preparation of Lower Extremity Wounds Using Negative Pressure Wound Therapy with Instillation: Taking Cost into Consideration

Abstract Body: Use of negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) to deliver, dwell, and remove topical solutions from the wound bed can assist health care practitioners in preparing a clean surface for successful closure. By promoting wound healing, NPWT technologies have the potential to help reduce the total treatment-associated costs over conventional therapies, despite having a higher unit price.1-3 We present our experience using NPWTi-d* to manage lower extremity wounds in 3 patients and discuss the feasibility of improving cost efficiency. In each case, extensive wound bed preparation was required and may otherwise have been achieved via serial debridements and prolonged hospital stay. Patient 1 was an otherwise healthy 83-year-old male with a contusion resulting in a large, gelatinous hematoma and soft tissue necrosis of the right medial calf. Patient 2 was a 51-year-old male with multiple sclerosis and profound lower extremity lymphedema, who presented with a deep tissue injury of the right medial calf. Patient 3 was a 65-year-old female with recurrent right foot diabetic ulcers with progressive vasculopathy, who suffered a dehisced incision 2 weeks after below knee amputation. All patients underwent surgical debridement and partial closure with sutures, followed by 6-7 days of NPWTi-d. Normal saline was instilled into the wounds, with a dwell time of 5-10 minutes, followed by a 3.5-hour NPWT cycle at -125 mmHg. Dressings were changed every 2-3 days. Upon discharge from the clinic, Patients 1 and 2 were transitioned to conventional NPWT† for 3 weeks; Patient 3 underwent primary closure. Upon follow-up 2-6 months later, all wounds were closed with no signs of complication. In these patients, use of NPWTi-d assisted in cleansing the wound surface and produced a positive healing outcome. Each patient underwent a single operation, and none required readmission, potentially saving on time and cost.