Long‐term follow‐up of negative pressure wound therapy with instillation: a limb salvage procedure?

Abstract

Negative pressure wound therapy (NPWT) is a treatment to reduce oedema, stimulate granulation tissue formation, remove wound exudate and diminish wound area, thus preparing it for secondary healing, skin grafting or coverage with flaps. The association of instillation to NPWT (NPWTi) is a new method for treating severe wounds, in particular, limb lesions at high risk for amputation. This therapy helps to deliver instillation fluid automatically into the contaminated wound, before application of negative pressure. These steps, repeated cyclically, help to remove infectious material, leading to a better moist environment, a necessary condition for wound healing. We report our experience of treating three patients with complex wounds and associated noble structure exposition conservatively with NPWTi and flap coverage. In a long-term follow-up (5 years), we were able to achieve a stable surgery reconstruction on preserved limbs, without evidence of chronic infection and other sequelae or complications. Despite the fact that our experience is limited , as it is based on only a few cases, it suggests how NPWTi could be considered useful in a conservative approach to the treatment of acute complex wounds of the lower extremities. In these patients with high risk of amputation, a long-term follow-up becomes fundamental in order to evaluate wound bed status after NPTWi.

Challenges in the Treatment of Chronic Wounds

“…More recently, these electrically powered devices have added the ability to instill saline or other antimicrobial agents to assist in the cleansing of the wounds concurrent with providing the aforementioned benefits of NPWT. 128,[136][137][138] A mechanically powered, ultralight, and portable NPWT device has also been introduced in recent years. 135,139,140 Two articles comparing this device with the traditional electrically powered device in a prospective RCT have shown equivalent DFU healing outcomes with faster application times and a high degree of patient satisfaction.…”

Peroxy Pyruvic Acid-Containing Topical Anti-Infective: A Potential Candidate for a Wound Instillation Solution

“…Dermabacter hominis, Citrobacter freundii, Bacillus cereus, Candida albicans, Serratia marcescens, and G. morbillorum were each found in one dressing in the current study and account together for 15% (6) of all the patient dressings. Recently, D. hominis was extracted with S. epidermis and both have been implicated in the formation of biofilms.…”

“…These solutions have included iodine or normal saline, biguanides (polyhexanide), hypochlorite-based solutions, sulfur-based compounds (sulfonamides), cationic solutions (benzalkonium chloride), acetic acid, octenidine dihydrochloride, povidone-iodine, and silver compounds (e.g., silver nitrate). 4,[6][7][8][9] These solutions have been perceived as agents that can facilitate the use of NPWT. Saline alone has demonstrated to be an effective instillation solution.…”

“…8 However, as this current study demonstrates, wounds that have become chronic are likely to be polymicrobial and require further broad-spectrum antibiotic treatment. 6,9,45 Furthermore, increasing resistance among both gram-positive and gram-negative bacteria greatly complicates empirical treatment decision-making, and the number of currently available appropriate antimicrobial agents is limited. 46 Biofilm can form on the surface of a wound within 10 h and is difficult to eradicate due to its recalcitrant nature, including the relative lack of effectiveness of antibiotics due to penetration and the relatively quiescent bacterial colonies encased in a glycocalyx structure.…”

Effect of whole course seamless nursing mode on patients with chronic infectious wounds

“…Chronic infectious wounds refer to the wound infection induced by the invasion of pathogenic microorganisms after injury, leading to delayed wound healing or even unhealed wounds and seriously affecting patients' quality of life 1 - 3 . Considering the slow healing of chronic infectious wounds, it is necessary to perform reasonable nursing measures to better facilitate wound healing 4 .…”