Management of Lower Extremity Wounds with Mechanically Powered Disposable Negative Pressure Therapy: Navigating Reinjury and Therapy Interruptions

Introduction: Lower extremity wounds in patients with multiple comorbidities or complex medical histories are important to manage adequately to prevent secondary complications such as infection or stalled healing. For small, complex wounds that persist even after standard care, the use of a mechanically powered disposable negative pressure wound therapy (dNPWT)* device can be an effective option.1 We present 4 complex cases of lower extremity wounds managed with dNPWT.

Methods: Debridement and antibiotics were utilized as necessary. dNPWT* was applied at -125 mmHg and dressings were changed 3 times per week. After dNPWT, wound closure was assisted by applications of an antimicrobial wound matrix§, alginate dressing with silver†, or autologous skin grafting.

Results: The patients were 3 males and 1 female, ages 59 to 85-years-old. Wounds included an excised hematoma, surgical incision after ankle fusion surgery, diabetic foot ulcer, and a deep abrasion. Patient comorbidities included peripheral arterial disease, smoking, diabetes, hypertension, and neuropathy. Osteomyelitis was detected in 2 patients, who received antibiotic therapy. dNPWT was applied for 3-4 weeks, although 3 patients experienced therapy interruptions due to femur fracture, ankle fusion revision, or hyperbaric oxygen therapy.

During these interruptions, 2 patients acquired additional wounds. One patient with a nearly healed wound suffered a minor contusion injury resulting in wound regression. Despite these setbacks, wound sizes decreased during dNPWT and all wounds were ultimately closed within the 10- to 58-week observation period.

Discussion: These cases represent difficult-to-treat scenarios in which dNPWT contributed to a positive healing outcome. Despite significant interruptions and wound regression unrelated to dNPWT, closure was achieved in all cases.