Department of Podiatry, Sengkang General Hospital, Singapore.
Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore.
Wounds. 2020 Dec;32(12):E120-E125.
Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an integrated system that combines conventional NPWT with an irrigation feature. Wound size and location of diabetic foot wounds may make NPWTi-d utilization difficult, commonly resulting in leakages and blockages.
This study evaluates the effectiveness of a novel waterfall technique, a modification of the usual bridging used during NPWTi-d application, to facilitate the channeling of instillation fluid into diabetic foot wounds with small entry points.
A literature review of NPWTi-d use in the treatment of infected diabetic foot wounds and a case series of 9 patients with infected diabetic foot wounds who were admitted to a tertiary health care institution from September 2019 to May 2020 were carried out.
Six patients were male and 3 were female, with a median age of 56 years (range, 45-67 years). All patients underwent a surgical procedure of the infected foot wounds (7 minor ray amputations, 2 wound debridements). All resultant wounds were ray amputation wounds over the metatarsals, except for one wound over the plantar midfoot. Wound sizes ranged from 2 cm x 4 cm x 4 cm to 11 cm x 4 cm x 8 cm. Median duration from surgery to initialization of NPWTi-d was 2 days (range, 1-22 days). Only 1 case reported a leak in NPWTi-d, which was resolved with minor adjustments and without changing the dressing in its entirety; no incidents of blockage were encountered. None of the patients required repeat surgical debridement during index hospitalization, and full epithelialization was achieved in 88.9% of patients.
The waterfall technique ensures placement of the NPWTi-d tubing pad in a dependent position to improve flow of instillation fluid with minimal risk of leakage or blockage.
负压伤口治疗联合灌洗和驻留时间（NPWTi-d）是一种集成系统，它将传统的负压伤口疗法与冲洗功能相结合。糖尿病足伤口的大小和位置可能使 NPWTi-d 的使用变得困难，通常会导致泄漏和堵塞。
本研究评估了一种新型瀑布技术的有效性，该技术是 NPWTi-d 应用中常用桥接方法的改进，以促进将冲洗液输送到具有小入口点的糖尿病足伤口。
对 NPWTi-d 治疗感染性糖尿病足伤口的应用进行文献回顾，并对 2019 年 9 月至 2020 年 5 月期间在一家三级医疗机构收治的 9 例感染性糖尿病足伤口患者进行了病例系列研究。
6 例为男性，3 例为女性，中位年龄为 56 岁（范围，45-67 岁）。所有患者均接受了感染足部伤口的手术治疗（7 例小跖骨截肢，2 例伤口清创术）。所有的伤口均为跖骨间的截肢伤口，除了一例足底中足的伤口。伤口大小从 2 cm x 4 cm x 4 cm 到 11 cm x 4 cm x 8 cm 不等。从手术到开始 NPWTi-d 的中位时间为 2 天（范围，1-22 天）。只有 1 例报告 NPWTi-d 发生泄漏，但通过轻微调整解决，而无需完全更换敷料；未发生堵塞事件。在指数住院期间，没有患者需要再次进行手术清创，88.9%的患者完全上皮化。
瀑布技术确保 NPWTi-d 管垫置于依赖位置，以在最小的泄漏或堵塞风险下改善冲洗液的流动。
