Complex Wound Management Using Negative Pressure Wound Therapy with Instillation and Dwell Time in a Cancer Care Setting

Introduction: Wound management represents a major healthcare cost and with inadequate intervention has a significant impact on patient quality of life. Oncological wounds have a delayed reaction in the wound healing cascade due to chemotherapy and radiation. These treatments are therapeutic to the destruction of cancer cells but have an adverse effect on tissue integrity and wound healing. An acute wound can easily progress to a chronic phase with inadequate wound care management.¹ To address this problem at this cancer center, the unit-based wound ostomy nurse has utilized negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d) for treatment of 6 patients with complex wounds and multiple comorbidities.  

Methods: NPWTi-d was initiated with instillation of normal saline or 0.125% hypochlorous solution, which was allowed to dwell for 3-20 minutes, followed by 2-3.5 hours of -125 mmHg negative pressure. Dressing changes were performed every 2-3 days. Debridements, incision and drainage, and antibiotics were used as necessary.

Results: One female and five males with an average age of 62 (range: 53-78 years) presented with the following wounds: surgical dehiscence (n=3), pressure injury (n=1), chronic seroma (n=1), and abdominal wall abscess (n=1). Malignancy was not detectable in any wounds. Patient comorbidities included diabetes, hypertension, and past treatment for cancers. NPWTi-d was applied for 1-2 weeks, after which the wounds exhibited a reduction in slough and an improvement in granulation tissue. Wounds were closed with a flap or transitioned to conventional NPWT prior to discharge home or to a rehabilitation clinic for outpatient recovery.

Conclusion: NPWTi-d is beneficial in the delivery, soak, and removal of topical solutions to cleanse the wound bed, thus creating a moist, closed wound environment conducive to healing.² Using NPWTi-d supported the formation of a healthy wound bed and contributed to rapid, positive outcomes in this patient population.