Application of Negative Pressure Wound Therapy with Instillation and Dwell Time of the Open Abdomen: Initial Experience

Abstract

Recent therapeutic advances in the management of severe abdominal sepsis (SAS) have improved patient mortality and morbidity. However, SAS and its impact on multiple organ failure remain a serious, life-threatening condition with a high mortality rate. The open abdomen (OA) technique has become an effective alternative to repeat laparotomy. The use of OA negative pressure wound therapy (OA NPWT) has been a significant advancement in the management of the open abdomen. Similarly, negative pressure wound therapy (NPWT) with instillation and dwell time (NPWT-i) has been used in patients with multiple comorbidities, with an American Society of Anesthesiology Classification ≥ 2, severe traumatic wounds, diabetic foot infections, and wounds complicated by invasive infection or extensive biofilm. Controlled instillation of saline during NPWT-i may further enhance healing by facilitating automatic and contained volumetric wound irrigation and cleansing and diluting local levels of inflammatory cytokines, improving the local as well as the systemic response to infection. Although the soft tissue and intra-abdominal compartments differ anatomically, they share very similar biologic responses to infections. Therefore, from a biologic and physiologic aspect, intraperitoneal instillation therapy may play a role as an adjunctive treatment of abdominal compartment inflammation from trauma or infection. The addition of saline solution instillation to OA NPWT (OAI) in a programmed, controlled manner may offer the clinician an effective adjunctive therapy for the treatment of the complex septic abdomen. The technical aspects of instillation into the OA and a pooled multicenter case study cohort utilizing OAI with saline solution, bacitracin, or hypochlorous acid in the management of the septic abdomen is presented.

The Association of Coloproctology of Great Britain and Ireland consensus guidelines in emergency colorectal surgery

“…Newer proprietary systems have been developed that also allow for the instillation of fluids with or without antibiotics into the peritoneal cavity [ 580 , 581 , 582 ]. This may reduce the requirement to return to theatre to perform peritoneal lavage for heavily contaminated abdomens but currently there is insufficient evidence to recommend their routine use.…”

Utilizing Instilling Negative Pressure Wound Therapy with Vashe Wound Solution for an Infected Sternal Dehiscence: A Case Report

“…The application of NPWTi has been reported to decrease the bioburden in wound beds, decrease length of hospitalization, and decrease overall healthcare costs [9] [10] [11] [12] [13] [15]. Instilling through open abdomen NPWT devices (ABTEHRA ADVANCE TM Open Abdomen Dressing, 3M, Minneapolis, MN) has been described without concomitant hypothermia [16] [17] [18]. In a series of reports, the authors (MM, LF) have instilled hypochlorous acid (Vashe Wound Solution, Urgo Medical North America, Fort Worth, TX) in the septic abdomen due to its reported antimicrobial effect and found no adverse outcomes [19] [20] [21] [22].…”

Does negative pressure wound therapy with saline instillation improve wound healing compared to conventional negative pressure wound therapy? - A randomized controlled trial in patients with extremity ulcers

“…These factors make the granulation tissue fragile, reduce fibroblast number and collagen production which ultimately impair wound healing [ 9 ]. To attenuate these effects, NS, antimicrobials and antiseptics have been proposed as potentially effective instillation solution for treating heavily infected wounds and when combined with NPWT promote better wound healing [ 8 , 10 , 11 ].…”