Use of a Silicone-Acrylic Drape with Negative Pressure Wound Therapy with Instillation in Traumatic Wounds: A Case Series

Introduction: Cleansing wounds of debris and nonviable tissue is a crucial step in the wound healing process. Negative pressure wound therapy (NPWT) with instillation and dwelling (NPWTi-d)* of topical wound solutions is one option for reaching this goal. Typically, an acrylic adhesive drape is used to create a vacuum seal over the wound; however, a novel silicone-acrylic hybrid drape§ has been introduced as a gentler, low-tack alternative. In this case series, we describe the use of NPWTi-d with this hybrid drape in 3 patients with traumatic wounds requiring cleansing.

Methods: When necessary, debridements were performed to remove thick nonviable tissue. NPWTi-d involved instillation of normal saline, hypochlorous acid, or polyhexanide solution, with a 10-minute dwell time before application of -125 mmHg negative pressure in 3.5-hour cycles. Foam dressings with through-holes† were placed onto the wound bed and covered with the hybrid drape. Dressing changes were performed every 2-3 days. Patients were prescribed antifungal or antibiotic medication when appropriate.

Results: Patient 1 was an otherwise healthy 38-year-old male with a left arm avulsion/degloving injury involving farm machinery, which contaminated the wound with invasive fungi. NPWTi-d was applied for 14 days, until the patient was stable enough for reconstructive surgery. Patient 2 was an 80-year-old immunocompromised male with coronary artery disease and stage 3 kidney disease who was at high risk of infection. He presented with a left thigh hematoma after a motor vehicle accident. The patient received local and systemic antibiotics and NPWTi-d for 4 days, then was discharged with standard NPWT. Patient 3 was a 23-year-old male with a history of polysubstance use, who presented with a left forearm fasciotomy after suffering gunshot wounds requiring vascular repair. After 6 days of NPWTi-d, the wound was covered with healthy granulation tissue, which enabled placement of a partial thickness skin graft.

Discussion: In all 3 cases, wound healing was impaired by the presence of slough and nonviable tissues, and NPWTi-d was supportive in preparing a healthy wound bed. The low-tack hybrid drape was effective in maintaining a vacuum seal, and rapidly growth of granulation tissue was observed in all cases.