Use of Negative Pressure Wound Therapy With Instillation in the Management of Complex Wounds in Critically Ill Patients.

INTRODUCTION

Negative pressure wound therapy with instillation and dwell time (NPWTi-d) cleanses wounds with cyclic delivery, dwell, and removal of topical solutions to solubilize infectious materials and wound debris.

OBJECTIVE

In this 2-patient case study, the authors report their experiences using NPWTi-d on 2 critically ill patients requiring management of large, complex wounds.

MATERIALS AND METHODS

In both cases, normal saline was instilled with 10- to 20-minute dwell times, followed by 2 hours of negative pressure wound therapy (NPWT) at -125 mm Hg.

RESULTS

Patient 1 was a 67-year-old woman, with a history of Roux-en-Y gastric bypass surgery, who required emergency surgery about 36 hours after ischemic efferent limb detorsion. After damage control surgery, NPWTi-d was applied for about 2 weeks. Once the wound was granulating, treatment was switched to conventional NPWT. Definitive surgery was planned for once she became physiologically optimized. Patient 2 was a 45-year-old woman presenting with septic shock and complex, necrotic wounds due to Fournier's gangrene. She received appropriate debridement, antibiotics, and adjunctive nutritional and critical care support. Then, NPWTi-d and NPWT were applied for 68 days, after which split-thickness skin grafts were used to close the right thigh, inguinal area, perineum, suprapubic area, right superior buttocks region, and back. Conventional NPWT was applied over the grafts as a bolster, and the patient was discharged to a rehabilitation center 27 days later with a 95% graft take.

CONCLUSIONS

In the authors' clinical experience, NPWTi-d promoted wound healing in critically ill patients with large wounds.