A Case Report: Coupling Negative Pressure Wound Therapy with Instillation and Split Thickness Skin Graft for a Large Chronic Venous Leg Ulceration

Purpose: There is no case report coupling NPWTi* (Negative Pressure Wound Therapy with Instillation) and STSG (Split Thickness Skin Graft) for chronic venous ulceration. The purpose of this case report is to highlight a case of a chronic venous ulceration located at the anteromedial ankle that healed in 2 months using NPWTi and STSG Case Study: A 64-year-old female with a history of chronic venous insufficiency who sustained a wound to left medial ankle that was down to the subcutaneous tissue, with severe malodor and peri-wound erythema. The wound was present for 2 years with failed outpatient treatment. Over the past few weeks her wound significantly worsened and she was started on Levaquin. She was sent to the hospital for further treatment. The wound initially measured to be 9.5cm x 6.5 cm x 0.3 cm. The wound was treated with NPWTi with HOCl soaks† instilled into the NPWTi for 2 days. The patient was then taken to the OR for hydro surgical debridement° and re-application of NPWTi therapy with Vashe installation for 3 days. After which patient was taken to the OR for a split thickness graft. After 2 months the wound fully closed. ­­­

Procedures: Ulcer debridement through subcutaneous tissue, application of NPWT with instillation, application of STSGResults: After hydro surgical debridement, NPWTi and STSG the chronic wound fully healed in 2 months.

Analysis & Discussions: Venous ulcerations are difficult to heel, specifically large ones. They can take months to obtain closure and can drastically affect a patient’s life. Benefits of STSG may include good rates of ulcer healing, pain reduction, earlier time for mobilization, decreased outpatient visits, and reduced need for dressings. NPWTi increased granulation tissue, improved tissue oxygenation, and clears debris wound debris. Furthermore, NPWTi has showed promise in wound preparation prior to STSG. We believe that the combination of surgical debridement with NPWTi and STSG is viable method to treat venous ulcerations.