Evaluation of Advanced Wound Care Modalities to Manage Complex Wounds in the Acute and Post-Acute Settings

Recent studies have reported on clinical benefits of using adjunctive negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) on complex wounds. We present a case series demonstrating successful outcomes using advanced wound care modalities. Patient 1, a 63-year-old morbidly obese female, presented with an infected right thigh excision of a massive localized lobule. Following surgical debridement of an infected hematoma, local wound packing using 0.25% acetic acid soaked gauze was applied. After insufficient wound improvement, NPWTi-d (instillation of 0.25% acetic acid solution with 5-minute dwell time, followed by 6 hours of NPWT) was used for 1 week, followed by 3 weeks of NPWT. A split-thickness skin graft (STSG) was applied. NPWT was used to bolster the STSG for 1 week, and the patient was discharged with a healed wound. Patient 2, a 58-year-old male, presented with a chronic lower extremity wound with exposed hardware. After hardware removal and surgical debridement, NPWT was applied for 2 days, followed by NPWTi-d (instillation of saline with 10-minute dwell time, followed by continuous NPWT every 3.5 hours) for 21 days. Treatment was changed to local silver packing and topical antibiotic. The wound healed, and patient was discharged 57 days after surgery. Patient 3, a 71-year-old female, presented with right hand swelling and pain secondary to a soft tissue infection. Following antibiotic treatment and several tenosynevectomy procedures, NPWTi-d (saline instillation with 2-minute dwell time, followed by 2 hours of NPWT) was applied for 5 days. After the wound displayed significant granulation tissue formation, the patient was discharged home with NPWT. Wound closure was observed 4 weeks post NPWT application. In all three cases, combined use of advanced wound care treatments resulted in positive clinical outcomes.