Application of Negative Pressure Wound Therapy with Intermittent Instillation of Normal Saline in the Acute Care Setting

Over the past decade, negative pressure wound therapy (NPWT) has been used to promote a wound healing environment in complex wounds. NPWT has evolved to include instillation and dwell time (NPWTi-d). Previous porcine studies have shown that NPWTi-d with saline promotes granulation tissue formation¹ and removes debris and infectious material.^2,3 We present the use of NPWTi-d in 3 cases with complex wounds treated in an acute care setting. All cases were treated with 10-20mL of 0.9% normal saline with a 10 minute dwell time followed by 3.5 hours of NPWT at -125mmHg and systemic antibiotics. Dressing changes occurred 3 times per week. Case 1 was a 26-year-old female admitted for necrotizing soft tissue infection of the mons pubis and lower abdominal area. Co-morbidities included obesity (BMI>30kg/m²), diabetes, and obstructive sleep apnea. Debridement and NPWT were initiated. NPWT failed due to body habitus. NPWTi-d was initiated and continued for 5 days. The patient was discharged 19 days after admission. Case 2, a 19-year-old male, was admitted for an infected right anterior thigh donor site following tongue reconstruction surgery. Comorbidities included congenital dyskeratosis, aplastic anemia, bone marrow transplant, bilateral lung transplant, hepatic fibrosis, squamous-cell carcinoma, and tongue resection. The patient had previously undergone several rounds of debridement and systemic antibiotics at an outside facility. NPWTi-d was initiated and continued for 3 days. The patient was discharged 4 days after admittance with intravenous antibiotics. Case 3 was a 57-year-old male admitted for a stage 4 pressure ulceration of the coccyx. Comorbidities included paraplegia, spinal infarction, diabetes, and colostomy. Sharp debridement was performed followed by NPWTi-d. The patient was discharged 20 days after admittance. All patients were discharged to long-term care facilities for follow-up. The patients reported no pain during the dressing changes and each wound showed improvement following adjunctive treatment with NPWTi-d.