Use of negative pressure wound therapy with instillation and a reticulated open cell foam dressing with through holes in the acute care setting

Negative pressure wound therapy with instillation and a dwell time (NPWTi-d) is an automated and controlled system used to deliver, dwell, and remove topical wound solutions from the wound bed. Recently, a polyurethane reticulated open cell foam instillation dressing (ROCF-CC) has been developed, which helps remove thick wound exudate and infectious materials. We present our experience using NPWTi-d with ROCF-CC on complex wounds when surgical debridement was not appropriate due to medical instability, recurrent nonviable tissue, or palliative treatment plan. For all wounds presented in this study, the contact layer with through holes was placed in the wound bed, followed by the cover layer (without holes). Both foam layers were covered with a non-adherent drape, and NPWTi-d was initiated by instilling fluid, such as normal saline, acetic acid, or a hypochlorous solution with 2-10 minutes of dwell time, followed by 30 minutes to 4 hours of negative pressure at -125 mmHg. Dressing changes were performed every 2-3 days. Duration of NPWTi-d with ROCF-CC was determined by the treating clinician, and it was discontinued upon sufficient wound improvement or at the time surgical debridement could be performed. Standard NPWT was also sometimes used before and after NPWTi-d. There were 14 patients (7 males and 7 females; average age: 63 years) treated, and all patients received systemic antibiotics. Patient comorbidities included obesity, diabetes, hypothyroidism, hypertension, and peripheral vascular disease. Wound types included diabetic foot ulcers, necrotizing fasciitis, dehisced wounds, and pressure injuries. Duration of NPWTi-d with ROCF-CC ranged from 1-15 days, and positive outcomes were measured by wounds showing improved color, less malodor, less surrounding erythema, and demarcation of healthy skin from devitalized tissue. Based on these patients, adjunctive use of NPWTi-d with ROCF-CC provided an option for improving tissue quality in wounds for patients where surgical debridement was not possible.