Use of Negative Pressure Wound Therapy With Instillation to Cleanse Lower Extremity Wounds

Introduction: Use of negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d*) to deliver, dwell, and remove topical wound solutions from the wound bed can assist clinicians in preparing a clean surface for successful closure.1-3 We present our experience using NPWTi-d* to manage lower extremity wounds in 5 patients and discuss the feasibility of improving cost efficiency.

Methods: Prior to NPWTi-d, patients underwent surgical debridement and received antibiotics as necessary. NPWTi-d was applied in the operating room. Normal saline or 0.125% sodium hypochlorite solution was instilled with a 5 to 10-minute dwell time, followed by 3-3.5 hours of -125 mmHg. No fluid was ever instilled into an open cavity or joint space. Therapy continued for 6-7 days with dressing changes every 2-3 days.

Results: Patients were 3 males and 2 females, aged 24 to 83 years old. Wound etiologies included deep tissue laceration, contusion with soft tissue necrosis, chemical burn, recurrent vascular ulcer, and an incised abscess after knee arthroplasty revision. All wounds were covered with non-viable tissue or fibrinogen, requiring cleansing. NPWTi-d was applied for 6-7 days. After NPWTi-d, the wounds showed growth of healthy granulation tissue and reduced wound size, allowing for discharge to outpatient care. Four patients transitioned to standard NPWT for 2-3 weeks before final closure. One patient was managed with alginate dressing with silver§ until closure 3 weeks later.

Discussion: In these patients, use of NPWTi-d assisted in cleansing the wound surface and supported a healthy, granulating wound. The improved wound status enabled a quick transition to outpatient care and a positive healing outcome in all 5 cases.