Negative pressure wound therapy with instillation (NPWTi): Current status, recommendations and perspectives in the context of modern wound therapy.

Abstract

REVIEWAbstract-Introduction of negative pressure wound therapy (NPWT) revolutionized the conception of wound healing. Currently, increasing number of studies confirmed the high efficiency of this therapy in many clinical scenarios. Moreover, some innovations have been introduced in recent years to improve the management of complex and chronic wounds. NPWT with instillation (NPWTi) combines traditional NPWT with application of topical irrigation solutions within the bed of the wound. Bioburden reduction, decreases time to wound closure, promotes granulation and tissue formation. Fewer operative visits are required when using NPWTi compared to standard NPWT. However, there are still questioned aspects of the NPWTi and thus its superiority over standard NPWT has not been fully indicated. Moreover, based on current studies no firm conclusions have been taken concerning the type of instilled solution preferably used, range of dwell-time phase, range of negative pressure and others. The main goal of the publication is to overview and summarize the current state of art concerning NPWTi. Moreover, mechanisms of action, review of the most commonly used instilled solutions are discussed and clinical evidence of NPWTi are described.

The utilisation of a negative pressure wound therapy clinical decision tree in an acute care setting tissue viability service

“…NPWT has become widely used in the management of complex wounds for both inpatient and outpatient care 20 and has been described as an effective treatment for wounds of multiple aetiologies. 6,21 NPWT was initially introduced in hospital care for acute, traumatic and or post-surgical wounds.…”

Instillation-TIME (iTIME) as a rationale amendment for TIME conception. Is there enough evidence for the efficiency of negative pressure wound therapy with instillation (iNPWT) to announce a breakthrough idea for wound treatment?

“…12 Moreover, further comprehensive reviews were published to define the use, settings and instilled solutions for optimal utility of iNPWT indicating the increased value of iNPWT in the field of wound healing. [13][14][15] Currently, iNPWT is used as a method of choice in open fracture, pressure ulcer and nonhealing, complex postoperative wounds with a high rate of wound closure. 11,16,17 In the recent multi-center prospective observational study, iNPWT was used for implant-associated infection following a knee or hip implant placement confirmed with the eradication of the wound infection in 75% of patients.…”

Negative Pressure Wound Therapy (NPWT) in Breast Surgery

“…Such formation of biofilm is considered to be one of the main factors impairing the wound healing process. 7 Stoeckel et al retrospectively analyzed the data of 18 patients who had post-operative breast wound complications treated with NPWT. 15 of the patients underwent surgery for breast cancer, two had reduction mammoplasty, and one was treated for a recurrent primary breast abscess.…”