Use of Sequential Wound Management in Three Patients with Lower Extremity Wounds

Introduction: Chronic and complex wounds often require a combination of treatment methods tailored to the needs of the wound and the patient. Advanced wound therapies and dressings such as negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d*), standard NPWT†, and oxidized regenerated cellulose (ORC)/collagen/silver-ORC dressing‡ can be used in sequential order to help manage the wound as it progresses toward healing. The use of NPWTi-d, NPWT, and ORC/collagen/silver-ORC dressings in 3 patients is described.

Methods: All patients received antibiotics and underwent amputation or bone resection due to the presence of osteomyelitis. Two patients received NPWTi-d with 7-14 mL of normal saline using a 2 to 10-minute dwell time, followed by 2.5 to 3.5 hours of continuous negative pressure at -125 mmHg. All patients received NPWT at -125 mmHg. Dressing changes for both NPWTi-d and NPWT were performed every 2-3 days. After the discontinuation of NPWT, all patients received ORC/collagen/silver-ORC dressings. Dressing applications occurred every 2-3 days.

Results: Three patients with lower extremity wounds underwent care (age range: 53-74 years). Patient comorbidities included diabetes, hypertension, critical limb ischemia, and degenerative joint disease. Wound types included Wagner grade 3 diabetic foot ulcer, surgical dehiscence, and infected diabetic foot. Two patients received NPWTi-d following surgery. After 6 days, NPWTi-d was discontinued and NPWT initiated. NPWT was discontinued after 21-30 days and treatment was switched to ORC/collagen/silver-ORC dressings. All wounds were fully healed 70-79 days after presentation.

Discussion: In these three patients, the use of sequential wound management along with good clinical practice including amputation and antibiotics resulted in full healing of all 3 wounds.