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Negative pressure wound therapy with instillation (NPWTi) uses reticulated open-cell foam dressings which are less hydrophobic and thus enhance fluid distribution within the wound bed. The therapy is provided with a controlled, automated delivery of solutions over the wound bed.
Porcine studies demonstrate increased granulation tissue with wounds treated with NPWTi with saline, compared to traditional NPWT(1). There was a statistically significant (p<.05) 43% increase in granulation tissue thickness compared to wounds treated with standard therapy.
A retrospective study comparing NPWT versus NPWTi (2) demonstrated a statistically significant decrease in the number of OR visits. There was a tendency to decreased length of stay and an improvement in bacterial cultures. They concluded that instillation shows promise for adjunctive treatments of infected wounds that require hospital admission.
The V.A.C. Ulta Therapy Unit combines NPWT with automated instillation features. Its application will be discussed in the following presentation including 6 surgical patients and their wounds.The international consensus guidelines on the use of NPWTi , were incorporated for application(3). Photos detailing before and following initiation of therapy are provided, all demonstrating significant rapid response of increased granulation tissue. Parameters including type and volume of solution, soak time and frequency are presented. Patient feedback during therapy is also shared.
As NPWTi remains a relatively new tool for the wound care practitioner and yet there remains a paucity of evidence for its use, this presentation will hopefully initiate dialogue and provide information related to the types of patients who are eligible for NPWTi, as well as provide details with regards to application. The responses of these patients indicate NPWTi holds promise in the treatment of the difficult wound.