Abdominal Wound Healing Using Negative Pressure Wound Therapy With Instillation and Dwell Time in Critical Care: A Case Study

Introduction. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been shown to be a viable option in abdominal wound healing protocols. To shed additional light on NPWTi-d, the present case study describes the treatment of a large postsurgical abdominal wound. Case Report. A 50-year-old female with multiple comorbidities underwent complete colectomy, end ileostomy, and percutaneous endoscopic gastronomy tube placement and subsequently developed a 27 cm x 22 cm x 7 cm abdominal wound that was approximately 85% covered by a thick layer of necrotic fat. After multiple surgical debridements over a 4-week timeframe, with recurrent adipose necrosis and failed surgical closure, NPWTi-d was initiated using 50 mL normal saline with 10-minute dwell time followed by 3.5 hours of continuous negative pressure at -125 mm Hg. Perforated foam was used in the wound bed. The NPWT dressings were changed twice weekly, and a physical debriding pad was used during dressing changes as needed. The instillation fluid was changed to an antimicrobial when an infection developed. Over the course of 6 weeks of treatment with NPWTi-d, progressive improvement was noted in wound size and depth; the final wound measurement was 25 cm x 22 cm x 4.5 cm, and 25% of the wound bed was covered with a thinner layer of necrotic tissue. Unfortunately, the patient died due to her underlying illness. Conclusions. Despite the patient’s overall failure to thrive, poor nutrition, and persistent high acuity, this wound improved dramatically with attention to the complexities of stoma care and the use of NPWTi-d.

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