The evolution of negative pressure wound therapy: negative pressure wound therapy with instillation.

Complex wounds pose a considerable burden to patients and the health-care system. The development of negative pressure wound therapy (NPWT) has revolutionised the treatment of these wounds. NPWT helps create a favourable wound healing environment by removing infectious material, decreasing oedema and promoting perfusion and granulation tissue formation. Additionally, NPWT has been reported to help reduce time to wound closure and length of hospital stay. Modifications of this foundation of wound care have added intermittent instillation with a dwell time to NPWT (NPWTi-d). This new system offers more comprehensive wound care through automated wound irrigation, allowing more control over the wound environment and the opportunity to deliver topical wound solutions directly to the affected tissues. A comparison between the two therapies, NPWT and NPWTi-d, is described, and two real-world applications of NPWTi-d are presented.

Negative pressure wound therapy with instillation: the current state of the art.

Traditional negative pressure wound therapy (NPWT) has revolutionized the treatment of complex wounds for nearly 20 years. A decade ago, a modification of the original system added intermittent automated instillation of topical wound irrigation solutions to traditional negative pressure wound therapy. This combined therapy, termed negative pressure wound therapy with instillation (NPWTi), has been shown to be effective in the treatment of a variety of complex wounds. Negative pressure wound therapy with instillation has been shown to reduce bioburden and biofilms present in wounds helping heal clinically infected wounds. It has also been used with success to jump-start stalled wounds, in relieving wound pain and treating infected foreign bodies including infected orthopedic hardware and some types of exposed abdominal wall mesh. The system includes a foam dressing placed in the wound covered by a semi-occlusive drape. A tubing placed over a hole cut in the drape connects the foam dressing to a pump run by a computerized microprocessor that delivers negative pressure to the dressing and wound. A preset volume of instillation fluid is automatically delivered via the instillation tubing to the wound. The fluid is held in the foam to bathe the wound for a predetermined time period. Negative pressure is then re-started draining the irrigation fluid and any wound exudate into a collection canister. The entire sequence is automated and consists of three phases: (1) fluid instillation; (2) holding for a period of time in the wound, which is fully expanded since the negative pressure is off during this phase; and then (3) a cycle of continuous negative pressure. The entire sequence repeats itself automatically. Typically the dressing is changed three times a week. The variables involved in treating patients with negative pressure wound therapy with instillation included: the indicated wound types; the system settings; the choice of the irrigation solution and the duration of therapy. This article will serve as a reference to help the negative through treating patients with NPWTi from patient selection, system setting to the complication of therapy.

Negative-pressure wound therapy with instillation: international consensus guidelines.

BACKGROUND: Negative-pressure wound therapy with instillation is increasingly utilized as an adjunct therapy for a wide variety of wounds. Despite its growing popularity, there is a paucity of evidence and lack of guidance to provide effective use of this therapy. METHODS: A panel of experts was convened to provide guidance regarding the appropriate use of negative-pressure wound therapy with instillation. A face-to-face meeting was held where the available evidence was discussed and individual clinical experience with this therapy was shared. Follow-up communication among the panelists continued until consensus was achieved. The final consensus recommendations were derived through more than 80 percent agreement among the panelists. RESULTS: Nine consensus statements were generated that address the appropriate use of negative-pressure wound therapy with instillation. The question of clinical effectiveness of this therapy was not directly addressed by the consensus panel. CONCLUSION: This document serves as preliminary guidelines until more robust evidence emerges that will support or modify these consensus recommendations.

Wound fluid management in wound care: the role of a hydroconductive dressing.

 A case series was conducted to evaluate the clinical experience with a new hydroconductive wound dressing, that appears to help facilitate the removal of necrotic tissue and other deterrents to wound healing while preserving healthy granulation tissue in a wound. Eight patients were treated with the dressing which has a proprietary technology that draws fluid away from the wound. The dressing was used on a variety of wound types and all wounds went on to heal by secondary intention. There were no adverse effects noted by any patient in the case series. Larger patient studies are needed to corroborate the positive clinical results that were observed in this series of patients. .

The use of negative pressure wound therapy with an automated, volumetric fluid administration: an advancement in wound care.

UNLABELLED: Introduction. This small pilot study introduces initial clinical experience with a system combining negative pressure wound therapy and negative pressure wound therapy with instillation (NPWT/NPWTi, V.A.C. ULTA™ Negative Pressure Wound Therapy, KCI USA, Inc, San Antonio, TX). MATERIALS AND METHODS: The NPWT system with instillation delivers controlled volumetric fluid instillation, and uses instillation- specific reticulated open-cell foam (ROCF) dressings: Dressing A (ROCF-V, V.A.C. VeraFlo™ Dressing, KCI USA, Inc, San Antonio, TX) or Dressing B (ROCF-VC, V.A.C. VeraFlo Cleanse™ Dressing, KCI USA, Inc, San Antonio, TX). Six patients ranging in age from 26-83 years were treated with either NPWT with instillation and Dressing A or Dressing B, and Microcyn® antiseptic solution (Oculus Innovative Sciences, Petaluma, CA) (n = 5) or quarter- strength Dakin's Solution® (Century Pharmaceuticals, Indianapolis, IN) (n = 1), as the instillate. Negative pressure wound therapy was applied in 1 patient to a single wound using Dressing C (ROCF; V.A.C.® GranuFoam™ Dressing, KCI USA, Inc, San Antonio, TX) in one half of the wound, and Dressing B in the other half. In this patient series, instillation was repeated every 2-4 hours with a 5-10 minute soak time followed by negative pressure at -100 mm Hg to -125 mm Hg. All wounds were closed by skin graft or primary, secondary, or delayed primary intention. RESULTS: For the wound treated with NPWT only, no difference in degree or quality of granulation tissue formation was observed by either dressing. CONCLUSION: The system worked well across multiple wound types in either NPWT mode or NPWT with instillation mode, and no complications were observed. Larger patient studies with controls are needed to validate the clinical observations in this patient series. .

A clinical review of infected wound treatment with Vacuum Assisted Closure (V.A.C.) therapy: experience and case series.

Over the last decade Vacuum Assisted Closure((R)) (KCI Licensing, Inc., San Antonio, TX) has been established as an effective wound care modality for managing complex acute and chronic wounds. The therapy has been widely adopted by many institutions to treat a variety of wound types. Increasingly, the therapy is being used to manage infected and critically colonized, difficult-to-treat wounds. This growing interest coupled with practitioner uncertainty in using the therapy in the presence of infection prompted the convening of an interprofessional expert advisory panel to determine appropriate use of the different modalities of negative pressure wound therapy (NPWT) as delivered by V.A.C.((R)) Therapy and V.A.C. Instill((R)) with either GranuFoam() or GranuFoam Silver() Dressings. The panel reviewed infected wound treatment methods within the context of evidence-based medicine coupled with experiential insight using V.A.C.((R)) Therapy Systems to manage a variety of infected wounds. The primary objectives of the panel were 1) to exchange state-of-practice evidence, 2) to review and evaluate the strength of existing data, and 3) to develop practice recommendations based on published evidence and clinical experience regarding use of the V.A.C.((R)) Therapy Systems in infected wounds. These recommendations are meant to identify which infected wounds will benefit from the most appropriate V.A.C.((R)) Therapy System modality and provide an infected wound treatment algorithm that may lead to a better understanding of optimal treatment strategies.

Wound instillation--the next step in negative pressure wound therapy. Lessons learned from initial experiences.

Negative pressure wound therapy uses a reticulated sponge and subatmospheric pressure to facilitate healing of a variety of wounds. The therapy appears to assist wound healing by decreasing wound bacterial burden and edema while facilitating granulation tissue formation. The latest development in negative pressure wound therapy allows clinicians to instill a solution into the wound and is indicated for use when patients receiving negative pressure wound therapy would benefit from the controlled delivery of topical wound treatment solutions and suspensions. A retrospective analysis of five cases was conducted to describe initial experiences with instillation and negative pressure wound therapy (average treatment time on negative pressure wound therapy with instillation 15 days, range 5 to 24 days). In two of the five cases where traditional negative pressure wound therapy was tried, infected wounds improved and culture results became negative following instillation of antibiotics in a saline solution. In all cases where used, instillation of a topical anesthetic appeared to effectively minimize wound pain that is occasionally associated with negative pressure wound therapy. Negative pressure wound therapy with instillation and possibly hyperbaric oxygen therapy may be initiated from the onset of treatment to manage high-risk wounds that appear severely infected and may be limb-threatening if located on an extremity. Controlled clinical studies to ascertain the efficacy and cost-effectiveness of this treatment modality are needed.