Use of Reticulated Open Cell Foam Dressings With Through Holes During Negative Pressure Wound Therapy With Instillation and Dwell Time

A Large Case Study

Luis G. Fernández, MD, FACS, FASAS, FCCP, FCCM, FICS; Marc R. Matthews, MD, MS, MC, FACS; Cynthia Ellman, RN, BSN, CWOCN; Patricia Jackson, BSN, RN, CWOCN; David H. Villarreal, MD, FACS; Scott Norwood, MD, FACS, FCCM

Disclosures

Wounds. 2020;32(10):279-282. 

In This Article

Results

Of the 19 treated patients, there were 10 males and 9 females, with an average age of 58.2 ± 15.1 years. Common patient comorbidities included hypertension, diabetes, obesity, and paraplegia. The treated wound types included pressure injuries, traumatic wounds, and surgical wounds (Table). The average length of NPWTi-d use with ROCF-CC was 9.5 ± 4.1 days.

In all patients, the wound beds showed the development of healthy granulation tissue and reduction of slough and thick exudate following NPWTi-d use with ROCF-CC dressings within 72 hours. None of the patients developed treatment-related adverse events. All patients were discharged from care to another hospital facility, a skilled nursing facility, a long-term acute care facility, or home, depending on clinical prognosis and recommendations from the physical therapy and rehabilitative team.

The following 2 cases are representative of the 19 case studies of complex wounds that were treated using NPWTi-d with ROCF-CC dressings.

Case 1

A 65-year-old female presented to the hospital with groin pain (pain scale, 7/10). Previous medical history included coronary artery disease, percutaneous coronary angioplasty, breast cancer, diabetes mellitus, hypercholesterolemia, hypertension, a myocardial infarction, diabetic neuropathy, tobacco use, and an iliac artery stent. A computerized tomography scan of the abdominopelvic region revealed muscle stranding. The patient was diagnosed with a left lower extremity ischemia with occluded right superficial femoral and popliteal arteries. The patient underwent a femoral thrombectomy to resolve the occlusions. The patient underwent incision and drainage to remove an abscess (Figure 1A) 4 days after hospital admission. Cellulitis was present, and IV broad-spectrum antibiotics (piperacillin and tazobactam, 4.5 mg IV every 6 hours; linezolid, 500 mg orally twice daily) were given for a period of 14 days. Bacterial cultures were positive for Escherichia coli and demonstrated specific sensitivity to cefazolin; the antibiotic therapy was changed accordingly. Negative pressure wound therapy with instillation and dwell time with ROCF-CC dressings was applied 7 days after admission. A hypochlorous acid wound cleansing solution (30 mL, Vashe Wound Cleansing Solution; Urgo Medical North America) was instilled into the wound bed with a dwell time of 10 minutes, followed by continuous negative pressure for 3 hours at -125 mm Hg. After 3 days, increased granulation tissue development was observed in the wound (Figure 1B). Negative pressure wound therapy with instillation and dwell time was discontinued, and the patient was discharged to a skilled nursing facility with NPWT (V.A.C. Therapy; KCI, now part of 3M Company).

Figure 1.

Left groin wound. (A) Wound following incision and drainage; the yellow box indicates the wound location. (B) Wound after 3 days of using negative pressure wound therapy with instillation and dwell time with reticulated open cell foam dressing with through holes.

Case 2

A 33-year-old male presented to the hospital with an infection in his above-the-knee amputation stump following a fall (Figure 2A). Previous medical history included tobacco use, anemia, and methicillin-resistant Staphylococcus aureus infection. Conservative sharp debridement was performed at the bedside, and an oral antibiotic (linezolid, 500 mg orally twice daily) was administered for 14 days. Negative pressure wound therapy with instillation and dwell time with ROCF-CC dressings was started, instilling 80 mL to 100 mL of hypochlorous acid solution with a 10-minute dwell time, followed by 2 hours of negative pressure at -125 mm Hg. Dressing changes occurred every 3 days. After the first dressing change at 3 days post-initial application, granulation tissue development was observed in the wound bed (Figure 2B). Further granulation tissue development and reduction of slough was observed after 6 and 9 days of NPWTi-d with ROCF-CC dressing use (Figure 2C, 2D). After 9 days of NPWTi-d with ROCF-CC dressing use, NPWTi-d was discontinued and NPWT initiated with continuous negative pressure at -125 mm Hg. After 1 day of NPWT, the wound bed was 98% covered with healthy granulation tissue (Figure 2E). The patient was discharged to a long-term acute care facility 12 days after admission to the hospital.

Figure 2.

Traumatic wound of an above-the-knee amputation stump. (A) Wound at presentation; (B) wound after 3 days of negative pressure wound therapy with instillation and dwell time (NPWTi-d) with use of reticulated open cell foam dressing with through holes (ROCF-CC); (C) wound after 6 days of NPWTi-d with ROCF-CC dressing use; (D) wound after 9 days of NPWTi-d with ROCF-CC dressing use; and (E) wound after 1 day of negative pressure wound therapy.

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