A Case Review Series of Christiana Care Health System’s Experience with Negative Pressure Wound Therapy Instillation

Abstract

Acute and chronic wounds afflict a multitude of patients to varying degrees. Wound care treatment modalities span the spectrum of technological advancement and with that differ greatly in cost. Negative pressure wound therapy (NPWT) can now be combined with instillation and dwell time (NPWTi-d). This case review series of 11 patients in a community hospital setting provides support for the utilization of NPWTi-d. Additionally, current literature on the use of NPWTi-d in comparison to NPWT will be reviewed. We highlight three specific cases. The first case is a 16-year-old male who was shot in the left leg. He suffered a pseudoaneurysm and resultant compartment syndrome. This required a fasciotomy and delayed primary closure. To facilitate this, NPWTi-d was employed and resulted in a total of four operative procedures before closure 13 days after admission. Next, a 61-year-old uncontrolled diabetic female presented with necrotizing fasciitis of the lower abdomen and pelvis. She underwent extensive debridement and placement of NPWTi-d with Dakin’s solution. A total of four operative procedures were performed including delayed primary closure six days after admission. Finally, a 48-year-old female suffered a crush injury with internal degloving. NPWTi-d with saline was utilized until discharge home on postoperative day 12.NPWTi-d, when compared to NPWT, has been reported to lead to a decrease in time to operative closure, hospital length of stay, as well as operative procedures required. The cost-benefit analysis in one retrospective review noted a $1,400 savings when these factors were taken into account.This mode of wound care therapy has significant benefits that warrant the development of a prospective randomized controlled trial to further define the improvement in quality-of-life provided to the patient and the reduction of potential overall healthcare costs.

Negative Pressure Wound Therapy for Necrotizing Fasciitis and Compartment Syndrome of the Upper Extremity — a case report

“…Necrotizing fasciitis is a life-threatening severe infection characterized by extensive soft tissue necrosis along fascial planes involving the subcutaneous region and skin. [1][2][3][4][5]11 NF can appear on various body regions, but most often on the extremities. 3, 4, 11 It is often caused by monobacterial (Streptococcus pyogenes) infection but polymicrobial or fungal origins are not rare either.…”

“…3, 4, 11 It is often caused by monobacterial (Streptococcus pyogenes) infection but polymicrobial or fungal origins are not rare either. [2][3][4][6][7][8] Thrombocytopenia, advanced age, liver diseases, acute renal failure, low serum albumin level, and smoking are risk factors for NF and increase mortality rate. 4,6 The clinical complaints are the pain, swelling, erythema, tenderness and due to the generalization of the local infection fever and signs of sepsis.…”

“…In advanced cases, skin bullae and necrosis can develop. [2][3][4]11 In advanced cases, anxiety can develop as a sign of generalized septic-toxic signs. 8 When the disease is localized in the extremities, concomitant compartment syndrome is often observed.…”

“…[1][2][3][4][5] It has monobacterial (β-hemolytic Streptococcus), polymicrobial or fungal etiology. 1,4,[6][7][8] Local symptoms are pain, erythema, tenderness, swelling, induration, and crepitation. 2,3,6 In advanced cases, skin bullae and necrosis can develop.…”

“…1,10 In the last decade, the use of NPWT has become the gold standard in the treatment of NF. 1,3,4,6,9 We present a successful negative pressure wound therapy in case of extended necrotizing fasciitis and compartment syndrome of the right upper extremity.…”