Initial Experience Using Negative Pressure Wound Therapy With Instillation and a Dressing with Through Holes as an Option for Complex Wound Management

An early-stage decision that clinicians often make in the management of complex wounds is which method of wound preparation will be appropriate for the patient. This decision can be affected by numerous wound and patient risk factors, including but not limited to age, obesity, wound infection, and radiation therapy, that complicate and delay wound healing.¹ These risk factors present challenges and may make surgical debridement difficult in patients with complex wounds. Recently, negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a novel reticulated open cell foam dressing with through holes (ROCF-CC) was shown to aid in the loosening and removal of thick exudate and non-viable tissue from wounds.² We present our experiences using NPWTi-d with ROCF-CC, along with rationales for wound care decisions. Patients received antibiotics and debridement when appropriate. Therapy selection and parameters were based on a decision tree model for wound care management that takes into consideration patient and wound information. Most patients received NPWTi-d with ROCF-CC for a duration of 5-8 days; however, one patient received NPWTi-d with ROCF-CC for over 30 days due to the wound extent and severity. Therapy consisted of instilling saline or quarter strength sodium hypochlorite solution with dwell times of 3-10 minutes, followed by 2 hours or 3.5 hours of NPWT either at -100 mmHg or -125 mmHg. There were 5 patients (2 males and 3 females; average age: 58 years) treated; wound types included 2 pressure ulcers, a necrotizing soft tissue infection, a perianal abscess, and a large abdominal wound. Patient comorbidities included obesity, type 2 diabetes, and radiation therapy. In all cases, progression of wound healing was observed with no complications. These cases help support the use of NPWTi-d with ROCF-CC as a viable option for wound care providers in the early-stage management of complex wounds.