Managing Complex Wounds Using Negative Pressure Wound Therapy with Instillation

Purpose: To evaluate negative pressure wound therapy with instillation (NPWTi) using polyhexanide solution¹ in treatment of complex, Stage 4 pressure injuries (PI) in spinal cord injury (SCI) patients.

Background: Chronic, Stage 4 PI are challenging to manage, especially in SCI patients. They are often associated with prolonged hospital stays and infections that place patients at high risk of complication despite modern treatment with antibiotics and surgical debridement². 

Methods: This case study looks at 5 SCI patients admitted for management of complex unstageable PI. The patients consisted of 1 female and 4 males with median age of 61.8 years. All 5 patients received systemic antibiotics and debridement at bedside prior to therapy and 4 of the patients were candidates for flap surgery. During the NPWTi treatment, polyhexanide topical wound solution was allowed to dwell over the wound bed from 5 to 10 minutes, followed by NPWT ranging from 3 to 5 hours at pressure of 125mmHg. Dressing changes occurred 2 to 3 times a week with therapy range from unstageable to Stage 4 to fully granulated in an average of 2.7 months. Comorbidities include diabetes mellitus, hypertension, chronic renal insufficiency, congestive heart failure and chronic obstructive pulmonary disease.

Significance: We noted fewer trips to the operating room for surgical debridement as compared to our previous experience with complex, unstageable PI. Increase in granulation tissue and decrease in non-viable tissue was noted with each subsequent dressing change. All wounds improved in a timely manner, so much so that the 4 patients who were admitted for flap surgery did not require surgical intervention to close the wound. 

Conclusion: In these 5 patients, the use of NPWTi with polyhexanide solution was successful in managing complex PI by decreasing trips to the operating room for surgical debridement and preparing the wound beds for closure.