Treatment modalities of lower extremity wounds are crucial for reducing lower limb amputations. The treatment of chronic wounds has an estimated economic impact of more than $25 billion annually in the United States, and chronic wounds of the lower extremities have been estimated to represent 30% to 40% of all wounds.
Wound healing can be impaired by systemic factors, such as advanced age, diabetes, obesity, and malnutrition, and local factors, such as slough and necrotic tissue in the wound bed. The removal of slough generally occurs through debridement.
The negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a reticulated open cell foam with through holes (ROCF-CC) has been developed to assist with wound cleansing.
A retrospective assessment of 10 patients (N = 10) with complex lower extremity wounds treated with either advanced wound dressings (control group; n = 5) or NPWTi-d using ROCF-CC dressings (treatment group; n = 5) was performed by a single podiatrist between June 2015 and October 2017.
Surgical debridement of the wound was performed in both groups. For patients in the control group, advanced wound dressings were applied to wounds and changed 1 to 3 times per week.
Negative pressure wound therapy with instillation and dwell time is a recent technological advancement to negative pressure wound therapy (NPWT) that includes the periodic instillation of a topical solution into the wound bed.
Patients in the treatment group had normal saline instilled into the chronic wounds (V.A.C. VERAFLO Therapy; 3M+KCI) with a dwell time of 20 minutes, followed by continuous negative pressure (-125 mm Hg) for 2 hours. NPWTi-d helped reduce bioburden in infected wounds.
Patients in the treatment group had significantly fewer wound complications and underwent significantly fewer surgical debridement, compared with patients in the control group. All wounds in the treatment group healed without complications,
This study was limited concerning several aspects of the methodology. First, the cases represent the experience of a single podiatrist at a single institution over a relatively short period of time (about 2.5 years).
Authors: Windy Cole
Newspaper: Wounds 2020;32(6):159–163. Epub 2020 March 31