Novel Use of Doxycycline in Continuous-Instillation Negative Pressure Wound Therapy as "Wound Chemotherapy"

Scimeca, Christy L.; Bharara, Manish; Fisher, Timothy K.; Giovinco, Nicholas A.; Armstrong, David G.

doi:10.1177/1938640010371121

Cited by 18 publications

(12 citation statements)

References 8 publications

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“…Once all tubing was in place, the V.A.C.ULTA™ Therapy System was turned on and set to −125 mmHg, which caused the dressing/drape to collapse within the agar wound model. After a complete seal was achieved and NPWT applied, the peristaltic pump was turned on and set to a rate of 30 cc/hour as previously published (4,5). At the end of 3·5 hours of therapy, the peristaltic pump was turned off and the V.A.C.® Advanced Drape and V.A.C.…”

Section: Methodsmentioning

confidence: 99%

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Distribution assessment comparing continuous and periodic wound instillation in conjunction with negative pressure wound therapy using an agar‐based model

Rycerz

Slack

McNulty

2012

International Wound Journal

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Negative pressure wound therapy (NPWT) is a widely accepted and effective treatment for various wound types, including complex wounds. Negative pressure with instillation was initially used as a gravity-fed system whereby reticulated, open-cell foam in the wound bed was periodically exposed to cycles of soaking with instillation solution followed by NPWT. Recent publications have alluded to positive outcomes with continuous instillation, where fluid is delivered simultaneously with negative pressure. To evaluate the distribution of instillation solutions to wound beds in conjunction with negative pressure, agar-based models were developed and exposed to coloured instillation solutions to identify exposure intensity via agar staining. This model allowed comparison of continuous- versus periodic-instillation therapy with negative pressure. Continuous instillation at a rate of 30 cc/hour with negative pressure showed isolated exposure of instillation fluid to wound beds in agar wound models with and without undermining and tunnelling. In contrast, periodic instillation illustrated uniform exposure of the additive to the entire wound bed including undermined and tunnel areas, with increased staining with each instillation cycle. These findings suggest that periodic instillation facilitates more uniform exposure throughout the wound, including tunnels and undermining, to instillation solutions, thereby providing therapy consistent with the clinician-ordered treatment.

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Section: Methodsmentioning

confidence: 99%

“…Recently, publications have alluded to positive outcomes with the implementation of continuous instillation with the application of NPWT occurring simultaneously (5,6). This method eliminates the typical soak times that are imparted using the traditional NPWTi with periodic‐instillation therapy.…”

Section: Introductionmentioning

confidence: 99%

Distribution assessment comparing continuous and periodic wound instillation in conjunction with negative pressure wound therapy using an agar‐based model

Rycerz

Slack

McNulty

2012

International Wound Journal

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“…New devices allow infusion and fluid removal with the simultaneous application of local negative pressure [25] . Several kinds of fluids can be applied, mainly antiseptic, topical antibiotic, insulin saline solution [26][27][28] . This system could be useful, especially for contaminated or infected wounds.…”

Section: Wound Chemotherapy With Npwtmentioning

confidence: 99%

Management of negative pressure wound therapy in the treatment of diabetic foot ulcers

Meloni

Izzo

Vainieri

et al. 2015

WJO

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Diabetic foot (DF) is a common complication of diabetes and the first cause of hospital admission in diabetic patients. In recent years several guidelines have been proposed to reinforce the the management of DF with a notable increase in diabetes knowledge and an overall reduction of amputations. Significant improvements have been reached in the treatment of diabetic foot ulcers (DFUs) and nowadays clinicians have several advanced medications to apply for the best local therapy. Among these, negative pressure wound therapy (NPWT) is a useful adjunct in the management of chronic and complex wounds to promote healing and wound bed preparation for surgical procedures such as skin grafts and flap surgery. NPWT has shown remarkable results although its mechanisms of action are not completely understood. In this paper, we offer a complete overview of this medication and its implication in the clinical setting. We have examined literature related to NPWT concerning human, animal and in vitro studies, and we have summarized why, when and how we can use NPWT to treat DFUs. Further we have associated our clinical experience to scientific evidence in the field of diabetic foot to identify a defined strategy that could guide clinician in the use of NPWT approaching to DFUs. Core tip: This paper represents a summary of the mechanism of action of negative pressure wound therapy and its effectiveness. Further, according to scientific findings and our experience, we propose a flow chart about its use addressed to the field of diabetic foot.Meloni M, Izzo V, Vainieri E, Giurato L, Ruotolo V, Uccioli L. Management of negative pressure wound therapy in the treatment of diabetic foot ulcers.

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“…73 Scimeca et al using NPWTi with insulin in a case report confirmed the efficacy for the treatment of chronic wounds due to emergency amputation at the midfoot level. 34 …”

Section: F Insulinmentioning

confidence: 99%

“…Independently Lessing et al and Scimeca et al demonstrated the effectiveness of continuous instillation even though both used different instilled fluids: saline solution and doxycycline, respectively. 30,34 Argenta and Morykwas presented the benefits resulting from the use of intermittent therapy in standard NPWT, emphasizing the better perfusion of both the wound tissue and surrounding tissues. 3,35 The element of intermittent therapy in NPWTi is unequivocally part of the administered therapy composed of instilled phase with the following dwell time phase, and then with a formation and maintenance of negative pressure.…”

Section: Continuous-versus Periodic-instillationmentioning

confidence: 99%

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

Bobkiewicz

Studniarek

Drews

et al. 2016

NPWTJ

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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.

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Novel Use of Doxycycline in Continuous-Instillation Negative Pressure Wound Therapy as "Wound Chemotherapy"

Cited by 18 publications

References 8 publications

Distribution assessment comparing continuous and periodic wound instillation in conjunction with negative pressure wound therapy using an agar‐based model

Distribution assessment comparing continuous and periodic wound instillation in conjunction with negative pressure wound therapy using an agar‐based model

Management of negative pressure wound therapy in the treatment of diabetic foot ulcers

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

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