Evaluation of Negative Pressure Wound Therapy With Instillation and a Novel Reticulated Open Cell Foam Instillation Dressing With Through Holes at a Wound Care Center: A Case Series

Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an automated system used to deliver a topical wound solution and allowed to dwell over the wound bed for a user-specified time before removal via negative pressure. Previous NPWTi-d studies have reported positive outcomes in patients with complex wounds.^1-3 Recently, a polyurethane reticulated open cell foam instillation dressing (ROCF-CC) has been developed that includes a contact layer with through holes and a cover layer that facilitates removal of thick wound exudate and infectious materials that can be considered when surgical debridement is not available or appropriate.⁴ We present our experience using NPWTi-d with ROCF-CC on complex wounds with devitalized tissue that were not suitable for immediate surgical debridement. Four patients received antibiotics and debridement when applicable. For all wounds, the contact layer with through holes was cut to size and placed in the wound bed. The thin cover layer (without holes) was placed over the contact layer in order to fill the undermined areas of the wound. Both foam layers were covered with a non-adherent drape, and NPWTi-d was initiated by instilling saline or a hypochlorous solution with a 5-10 minute dwell time, followed by 2-3.5 hours of negative pressure (-125mmHg). Patient comorbidities included obesity, diabetes, and hypertension. Mean patient age was 55.5 years (range: 36-78). Dressing changes were performed every 2-3 days. After an average of 9.5 days of therapy (range: 4-15), all wounds treated with NPWTi-d with ROCF-CC displayed less malodor, less devitalized tissue, and improved granulation tissue formation. In all 4 cases, adjunctive use of NPWTi-d with ROCF-CC contributed to removal of fibrinous material and slough that was present in the wound bed and led to positive clinical outcomes.