Initial Experience Using Negative Pressure Wound Therapy with Instillation and an Open Reticulated Cell Foam with Large Through Holes for Managing Complex Wounds

Negative pressure wound therapy (NPWT) is an advanced wound care therapy commonly used in chronic and complex wounds. In recent years, NPWT has evolved to include the ability to instill topical wound solutions, which are then allowed to dwell (NPWTi-d) directly onto the wounds. NPWTi-d provides wound cleansing and loosens wound debris.  Recently, an open reticulated cell foam dressing with large through holes (ROCF-CC) that helps facilitate the removal of thick exudate and infectious material has become available for use with NPWTi-d, which may be helpful when surgical debridement is not possible or appropriate at time of treatment. We present our first experiences using NPWTi-d with ROCF-CC in 4 patients with complex wounds. Surgical debridements were not possible or appropriate in these patients. All patients were treated with NPWTi-d using the ROCF-CC dressings and instillation of 10 to 22mL of normal saline or 10mL of polyhexanide and betaine. Solution dwell times ranged from 1 to 5 minutes, followed by 30 minutes to 2 hours of continuous negative pressure (-125mmHg or -150mmHg). Three females and one male with an age range of 63 to 87 years old were treated. Patient comorbidities included diabetes mellitus, coronary heart disease, hypertension, chronic paraplegia, obesity, and peripheral vascular disease. Wound types included surgical dehiscence (n=1), pressure ulcer (n=2), and traumatic wound (n=1). Three patients were switched to NPWT following NPWTi-d with ROCF-CC; 2 of these patients were discharged to a skilled nursing facility. In these 4 patients, NPWTi-d with ROCF-CC removed thick wound exudate and infectious materials and promoted granulation tissue formation in complex wounds in which surgical debridement was not possible or appropriate at time of treatment.