Efficacy of Negative Pressure Wound Therapy With Instillation and Dwell Time for the Treatment of a Complex Chronic Venous Leg Ulcer

Carlotta Scarpa, MD, PhD; Eleonora de Antoni, MD; Vincenzo Vindigni, MD, PhD; Franco Bassetto, MD

Disclosures

Wounds. 2020;32(12):372-374. 

In This Article

Abstract and Introduction

Abstract

Introduction: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) of topical solutions is a useful method for managing difficult-to-heal wounds, particularly for contaminated chronic ulcers. Most patients with chronic ulcers are affected by several pathologies that systemically impair wound healing; local slough and bacteria further increase the risk of treatment failure.

Case Report: A 57-year-old male with obesity, diabetes, and heart disease presented with infected venous leg ulcers of 2 years' duration. The patient came to the authors' attention after unsuccessful treatment with advanced wound care dressings. The patient underwent surgical debridement and application of NPWTi-d with saline solution (settings: -100 mm Hg, 32 mL of instilled volume, 10-minute dwell time, and 2-hour cycle length) for 16 days. This resulted in good granulation tissue formation on the wound bed, so a meshed skin graft was used to cover the wound. In order to improve the skin graft take, the authors dressed it with polyvinyl alcohol foam connected to a traditional NPWT device (settings: -75 mm Hg, continuous pressure) for 1 week. After this period, complete wound healing was achieved, and the wound remained closed and stable upon follow-up.

Conclusions: In the authors' opinion, NPWTi-d of topical solutions can be very useful in order to enhance debridement and reduce bacterial load. This kind of treatment allowed the authors to obtain a very good wound bed, and its application was very quick and easy to use, with no adverse events.

Introduction

Both the complexity and features of a wound affect local healing and determine the possible success of wound closure. Older age, cardiovascular/pulmonary disease, obesity or poor nutritional status, renal failure, diabetes, local colonization/infection, large-sized wounds, slough, and high levels of exudate are some of the main risk factors in the management of chronic wounds. Undoubtedly, systemic treatment is fundamental. However, good wound bed preparation, using either advanced dressings or surgical treatment, is necessary to stimulate the initiation of wound healing.[1]

The purpose of this case study was to verify if negative pressure wound therapy (NPWT) could gently remove exudate and edema and promote granulation as a result of subatmospheric pressure, which acts both macroscopically and on cellular activity.[2] Particularly, the authors wanted to determine if a newer NPWT device with instillation and dwell time (NPWTi-d) could stop viscous slough disposal and reduce bacterial load and contaminant/infection, maintaining the acute phase and moving the chronic wound towards healing.

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