Use of Reticulated Open Cell Foam Dressings With Through Holes During Negative Pressure Wound Therapy With Instillation and Dwell Time: A Large Case Study.

INTRODUCTION: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been utilized in wounds with positive clinical benefits. A reticulated open cell foam dressing with through holes (ROCF-CC) was developed to assist with wound cleansing by removing thick wound exudate and infectious materials, and it may be used when debridement is not possible or appropriate. Use of NPWTi-d with ROCF-CC dressings has been reported with positive outcomes in complex wounds. OBJECTIVE: The present study reports the authors' experience using NPWTi-d with ROCF-CC dressings in 19 patients with complex wounds. MATERIALS AND METHODS: Of the 19 patients, 8 underwent sharp debridement. Oral and/or intravenous antibiotic treatment was initiated as needed prior to NPWTi-d. All patients received NPWTi-d with ROCF-CC dressings with instillation of quarter-strength Dakin's solution, hypochlorous acid solution, or saline with a dwell time of 5 to 10 minutes, followed by 2 to 3.5 hours of continuous negative pressure at -125 mm Hg. Dressing changes occurred every 2 to 3 days. Measurements and assessments of wound progression were done as per institutional protocols. RESULTS: The 19 treated patients consisted of 10 males and 9 females, with an average age of 58.2 ± 15.1 years. Common patient comorbidities included hypertension, diabetes, obesity, and paraplegia. Wound types included pressure injuries, traumatic wounds, and surgical wounds. The average length of NPWTi-d use was 9.5 ± 4.1 days. In all of the patients, the wound beds showed development of healthy granulation tissue following NPWTi-d with ROCF-CC. All patients were discharged to one of the following: another hospital facility, skilled nursing facility, long-term acute care facility, or home. CONCLUSIONS: In the authors' clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of thick exudate and infectious materials and promoted development of granulation tissue.

Use of Negative Pressure Wound Therapy With Instillation in the Management of Complex Wounds in Critically Ill Patients.

INTRODUCTION: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) cleanses wounds with cyclic delivery, dwell, and removal of topical solutions to solubilize infectious materials and wound debris. OBJECTIVE: In this 2-patient case study, the authors report their experiences using NPWTi-d on 2 critically ill patients requiring management of large, complex wounds. MATERIALS AND METHODS: In both cases, normal saline was instilled with 10- to 20-minute dwell times, followed by 2 hours of negative pressure wound therapy (NPWT) at -125 mm Hg. RESULTS: Patient 1 was a 67-year-old woman, with a history of Roux-en-Y gastric bypass surgery, who required emergency surgery about 36 hours after ischemic efferent limb detorsion. After damage control surgery, NPWTi-d was applied for about 2 weeks. Once the wound was granulating, treatment was switched to conventional NPWT. Definitive surgery was planned for once she became physiologically optimized. Patient 2 was a 45-year-old woman presenting with septic shock and complex, necrotic wounds due to Fournier's gangrene. She received appropriate debridement, antibiotics, and adjunctive nutritional and critical care support. Then, NPWTi-d and NPWT were applied for 68 days, after which split-thickness skin grafts were used to close the right thigh, inguinal area, perineum, suprapubic area, right superior buttocks region, and back. Conventional NPWT was applied over the grafts as a bolster, and the patient was discharged to a rehabilitation center 27 days later with a 95% graft take. CONCLUSIONS: In the authors' clinical experience, NPWTi-d promoted wound healing in critically ill patients with large wounds.