Use of Negative Pressure Wound Therapy with Instillation and Dwell Time for the Treatment of Complex Wounds: A Case Series

Recent studies have reported on clinical benefits of using adjunctive negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) on complex and/or infected wounds. Our purpose was to report on 5 patients with a variety of complex wounds that were treated with NPWTi-d using topical wound solutions (saline or polyhexanide).  All patients received systemic antibiotics and wound debridement prior to therapy.  During NPWTi-d, topical wound solutions were allowed to dwell over the wound bed ranging from 3 to 5 minutes, followed by NPWT ranging from 2-8 hours at pressures of -125mmHg or ‑150mmHg. Dressing changes occurred every 2-3 days with therapy ranging from 7 days to 6 weeks. The patients consisted of 4 males and 1 female with a mean age of 51.2 years. Common comorbidities included diabetes mellitus, hypertension, and peripheral arterial disease. Wound types included right heel full-thickness ulcer, necrotizing fasciitis on the trunk and thighs, left foot abscess, left lateral heel and plantar foot ulcers, and left heel ulcer. Methods of wound closure included rotational flap, split-thickness autologous graft, secondary intention, free flap, and regenerative tissue matrix. Increases in granulation and less non-viable tissue were observed with subsequent dressing changes using NPWTi-d. We noted decreased pain and fewer trips to operating room (OR) for debridement as compared to our previous experiences. Four wounds were closed in a timely manner; one continued local wound care due to non-compliance. All patients were discharged with no complications during follow-up visits. In thesefour patients, adjunctive NPWTi-d was successful in managing complex wounds by decreasing pain, reducing OR debridement and preparing wounds rapidly for closure, which resulted in early discharge and short length of stay for the patient and facility.