Statement of Problem: Inadequate surgical debridement of an infected abdominal surgical wound delays wound healing and puts patients at risk for continued infection. Since negative pressure wound therapy (NPWT) is recommended to be used in wounds with < 25% necrosis, then use of it with a wound containing greater than 75% necrosis is considered off-label use.

Rationale: Combined debridement methods were utilized to optimize the wound bed in preparation for secondary healing.

Methodology: A variety of debriding modalities were used in conjunction with negative pressure wound therapy to expedite the removal of necrotic tissue. Twenty-four hours after sub-optimal surgical debridement, 30-grams of papain urea debriding ointment was employed under NPWT to promote synergistic debridement. On three subsequent wound care visits, bedside pulsed lavage, conservative sharp debridement (CSD) and papain-urea debriding ointment were utilized. The next four dressing changes required decreasing doses of the papain-urea debriding ointment as the necrotic tissue emulsified. Copious wound exudate (500-1000cc per day) was attributed to necrotic tissue breakdown using the papain urea debriding ointment under the NPWT.

Results: Using a variety of debriding methods (mechanical, enzymatic, sharp, & autolytic) along with negative pressure wound therapy provided a synergistic effect in cleaning the wound base and preparing the bed for granulation, contraction and epithelialization. The patient experienced less pain with non-sharp debridement methods.

Conclusion: Combining debridement methods/therapies can provide a synergistic effect of promoting orderly wound healing by expediting wound debridement, promoting faster granulation and wound contraction.