Clinical recommendations and practical guide for negative pressure wound therapy with instillation

Abstract

Effective wound management involves a comprehensive assessment of the patient and the wound to determine an optimal wound treatment plan. It is critical to identify and address factors that may impair wound healing, prior to selecting the most appropriate therapy for each patient. Negative pressure wound therapy (NPWT) is a well-established advanced therapy that has been successful in adjunctive management of acute and chronic wounds. In recent years, the introduction of topical wound solution delivery in combination with NPWT has provided further benefits to wound healing. A commercially available system now offers automated, volumetric control of instilled topical wound solutions with a dwell time in combination with NPWT (NPWTi-d; V.A.C. VeraFlo™ Therapy, KCI, an Acelity company, San Antonio, TX). This NPWTi-d system differs from other instillation systems in that a timed, predetermined volume of topical wound solution is intermittently delivered (versus continuously fed) and allowed to dwell in the wound bed (without NPWT), for a user-selected period of time before NPWT is resumed. This added accuracy and process simplification of solution delivery in tandem with NPWT have prompted use of NPWTi-d as first-line therapy in a wider subset of complex wounds. However, considerably more research is required to validate efficacy of NPWTi-d in various wound types. The purpose of this review is to provide a relevant overview of wound healing, describe current literature supporting the adjunctive use of NPWTi-d, propose a clinical approach for appropriate application of NPWTi-d and conclude with case studies demonstrating successful use of NPWTi-d. Based on this review, we conclude that either a large case series examining effects of NPWTi-d on different wound types or possibly a large prospective registry evaluating NPWTi-d with real-world topical wound solutions versus immediate debridement and closure would be valuable to the medical community in evaluating the efficacy of this promising therapy.

A Case Review of Necrotizing Soft Tissue Infection of the Abdomen Utilizing Negative Pressure Wound Therapy with Instillation and Novel Reticulated Open Cell Foam Dressing

“…This instillation creates a controlled, protected environment for flushing and cleansing wounds by the proposed mechanism of loosening the contaminants in the wound bed [2]. ROCF-CC is a reticulated open cell foam dressing that includes through holes to facilitate the removal of thick exudate and infectious materials.…”

“…Effective wound management involves a comprehensive assessment of the patient and of the wound to determine an optimal treatment plan. Wounds at risk for delayed healing include those with extensive tissue loss, critical colonization and/or infection, high levels of exudate, or exposed critical structures [2]. …”

Treating Fasciotomy Wounds with Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWTi-d)

“…However, in compromised patients, these wounds can develop an infection (especially osteomyelitis). Depending on therapy goals, NPWTi-d can be used to cleanse the wound, promote granulation tissue formation, or a combination of both [10]. …”

Peroxy Pyruvic Acid-Containing Topical Anti-Infective: A Potential Candidate for a Wound Instillation Solution

“…Saline alone has demonstrated to be an effective instillation solution. However, microbial bioburden is not necessarily eliminated with NPWT, 10 and therefore, the inclusion of a microcidal instillation solution is an advantage.…”