Analysis of Rinsing Fluid during Negative Pressure Wound Therapy with Instillation: A Potential Monitoring Tool in Acute and Chronic Wound Treatment. A Pilot Study

Abstract

Background: During negative pressure wound therapy (NPWT), open wounds are draped with a nontransparent sponge, making daily wound evaluation impossible. Sometimes, late or undetected bacterial infections and postoperative bleeding result in repetitive surgery, thus prolonging inpatient time. With the introduction of additional fluid instillation (NPWTi), the wound surface is rinsed, and bacteria, proteins and biomarkers are flushed into a collecting canister, which is later discarded. Methods: The aim of this pilot study was to analyze rinsing fluid samples (0.9% sodium chloride) from the NPWTi device in patients with acute and chronic wounds. In 31 consecutive patients a standardized laboratory analysis was performed to evaluate cellular composition and potassium, phosphate, lactate dehydrooxygenase, pH and total protein levels. Results: While there was an increase in the total cellular amount and the number of polymorphonuclear cells, the number of red blood cells (RBC) decreased after surgery. Potassium and pH showed no significant changes in the first three postoperative days, whereas total protein showed an undulant and partially significant course. Conclusion: We were able to quantify cellular metabolites by analyzing the rinsing fluid of NPWTi. We propose the analysis of this material as a novel and potentially promising tool to monitor wound status without removal of the dressing. The establishment of reference values might help to improve the NPWTi therapy.

Cryo-Induced Cellulose-Based Nanogel from Elaeis guineensis for Antibiotic Delivery Platform

“…Even though the pH of human skin surface ranges between 5.4 and 5.9, it was found to gradually increase with skin depth, and a pH close to neutral (pH 7.4) was observed after skin destruction in an acute wound [ 55 ]. The wound as scar tissue becomes acidic during healing and reestablishing the intact stratum corneum [ 56 ].…”

Management of complex pelvic-perineal soft tissue infection in open pelvic fractures: Comparison between conventional and modified instillation negative-pressure wound therapy

“…NPWT stabilises the wound bed, promotes granulation, and improves local perfusion. Recently, it has been reported that NPWT promotes mechanical rinsing for bacterial decontamination through instillation [17][18][19][21][22][23][24]. However, deep and organ space infection of the pelvic cavity is anatomically di cult to access.…”

“…Recently, mechanical rinsing for bacterial decontamination through instillation has been developed [17][18][19][21][22][23][24]. However, it is di cult to treat the soft tissue damage of an open pelvic fracture that is anatomically di cult to access, has many bends, and is located close to contamination sources, such as the anorectum [21].…”

Negative Pressure Wound Therapy with Instillation: Analysis of the Rinsing Fluid as a Monitoring Tool and Approach to the Inflammatory Process: A Pilot Study

“…Recent studies have shown that wound fluid contains locally produced and absorbed products, which provide insight into the wound-healing cascade [ 15 , 16 , 17 ]. Conventional negative pressure therapy in open abdominal wounds showed distinct clearance patterns of cytokines when compared with serum levels, thus allowing the investigation of abdominal sepsis [ 18 ].…”

“…Conventional negative pressure therapy in open abdominal wounds showed distinct clearance patterns of cytokines when compared with serum levels, thus allowing the investigation of abdominal sepsis [ 18 ]. Other studies evaluated the rinsing fluid of NPWT(i) devices and found that basic laboratory markers such as pH, electrolytes, and flow cytometry could safely be determined [ 16 ]. Increasing levels of polymorph nuclear cells marked the beginning of the inflammatory healing phase, and increased potassium values resembled cell destruction after surgical debridement [ 16 ].…”