Negative Pressure Wound Therapy With Instillation and Dwell Time Used to Treat Pyoderma Gangrenosum

A Case Report

Stephanie L. Woelfel, PT, DPT, CWS

Disclosures

Wounds. 2020;32(12):E59-E61. 

In This Article

Abstract and Introduction

Abstract

Introduction: Pyoderma gangrenosum (PG) is a rare, ulcerative dermatosis that is part of a systemic auto-inflammatory process. The overall incidence of PG is 5.8 per 100 000 individuals and it is associated with an increased mortality rate compared with the general population. Due to the pathergy phenomenon—present in 20% to 30% of cases—traumatic events, such as debridement or surgery, are often avoided in these patients. This report is on the use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) combined with a reticulated open cell foam dressing with through holes (ROCF-CC) to achieve debridement and granulation in a lower extremity PG wound.

Case Report: A known patient with history of neuropathic arthritis, systemic lupus erythematosus, and cryoglobulinemic vasculitis presented with worsening of his lower extremity wound including new onset pain, odor, and purulent discharge. Negative pressure wound therapy with instillation and dwell time using a hypochlorous acid solution and a ROCF-CC was initiated. Significant decrease in necrotic tissue was noted by day 4, with improved granulation tissue growth by day 25. No pathergy occurred in this case.

Conclusions: The use of NPWTi-d with ROCF-CC demonstrated positive debridement effects on this PG wound.

Introduction

Pyoderma gangrenosum (PG) is a rare, ulcerative dermatosis that is part of a systemic auto-inflammatory process. The overall incidence of PG is 5.8 per 100 000 individuals and it is associated with an increased mortality rate compared with the general population.[1] Treatment of PG focuses on pharmacotherapy, typically with use of systemic steroids and other anti-inflammatory medications, and wound care. Gentle cleansing combined with topical antimicrobials (as indicated) and maintaining a moist wound environment are basic tenets of wound care for this population.[1] Sharp debridement and surgery are often avoided in these patients due to the risk of pathergy, which occurs in 20% to 30% of cases.[2]

Negative pressure wound therapy with instillation and dwell time (NPWTi-d) allows topical wound solutions to dwell directly on the wound bed. This assists in cleansing the wound bed, while the subsequent NPWT cycle removes slough and other devitalized tissue, as well as solubilized contaminants.[3] Specialized dressings have been developed for use with NPWTi-d. A reticulated open cell foam dressing with through holes (ROCF-CC) is one option that can remove infectious materials and thick wound exudate. This may be especially helpful in wounds where debridement is not possible or needs to be delayed.[4]

Hypochlorous acid is a topical wound cleansing solution that is non-cytotoxic and provides an antimicrobial effect.[5] It may assist in treating wounds that are critically colonized or infected.

This case report presents the use of NPWTi-d (V.A.C. VERAFLO; 3M + KCI) with a ROCF-CC dressing (V.A.C. VERAFLO CLEANSE CHOICE DRESSING; 3M+KCI) and a hypochlorous acid wound solution (Vashe Wound Solution; URGO Medical) to treat a lower extremity PG wound.

Comments

3090D553-9492-4563-8681-AD288FA52ACE

processing....