On the significance of negative‐pressure wound therapy with instillation in dermatology

Abstract

SummaryMethods used in the treatment of acute and chronic wounds undergo constant evolution, reevaluation, and innovation. While negative-pressure wound therapy (NPWT) is an established treatment modality, the combination of NPWT and instillation of normal saline as well as solutions with active antiseptic components for topical treatment of the wound bed represents a novel approach. The well-known effects of NPWT may thus be combined with those of local antisepsis. They include a decrease in wound area, induction of granulation tissue, and reduction in bacterial colonization. To date, studies have focused on NPWT with instillation for orthopedic/surgical indications, whereas clinical data in dermatosurgery is limited to case reports or small case series. There are as yet no randomized prospective studies investigating NPWT with instillation in the treatment of skin disorders. The goal of this review is to present the method of NPWT with instillation, to highlight its mode of action as well as possible complications and contraindications, and to review the recent literature. In summary, there is increasing evidence that both simple and complicated wounds may be effectively treated with NPWT with instillation, resulting in markedly accelerated tissue granulation and thus earlier defect closure. Cornelia Sigrid Lissi Limitations of this articleThe fact that there is currently only one supplier (in Germany) of a fully automated device for negative-pressure wound therapy with instillation renders it difficult to present this method in a discriminative manner. Moreover, studies of this treatment modality in defined indications have been rather inadequate. These points limit the objective assessment of this method. Even though the evidence regarding negative-pressure therapy with and without instillation is steadily improving, assessment of this method currently largely depends on the users' personal experience. The objective of this review article on negative-pressure therapy with instillation as a supplementary or alternative method in the treatment of acute and chronic wounds was to present this method along with published data (evidence) and the authors' personal experience. The target audience includes dermatologists with a special interest in dermatosurgery and wound therapy and other physicians who are routinely involved in the management of acute and chronic wounds.

Does negative pressure wound therapy with saline instillation improve wound healing compared to conventional negative pressure wound therapy? - A randomized controlled trial in patients with extremity ulcers

“…Apart from conventional moist saline gauze dressings, various modalities of local wound therapy described to improve wound healing are ultrasound therapy [ 1 ], infrared therapy [ 2 ], platelet rich plasma. Negative pressure wound therapy (NPWT) remains an established means to manage acute and chronic extremity wounds, especially challenging wounds, as an adjunct to debridement, systemic antibiotic therapy, topical antiseptics/antimicrobials [ [3] , [4] , [5] ].…”

“…Topical irrigation solutions like normal saline (NS) have been used in wounds for cleansing of wound beds, removing exudate/debris and controlling microbial growth. Combining NPWT with instillation (NPWTi) of topical solution influences wound healing owing to cyclic cleansing, dilution of wound debris, disruption of biofilm, accelerated granulation tissue and thus earlier reduction in wound size [ 5 , 7 , 8 ].…”

“…Owing to above mentioned benefits of NPWTi, reduced wound size, earlier wound closure and reduced hospital stay are other observed advantages emphasizing its cost-effectivness as well [ 5 , 7 , 12 ].…”

Retrospective 8‐year analysis of negative pressure wound therapy in dermatosurgery: a single‐centre experience

“…In this article, we consistently use the terms ‘negative‐pressure wound therapy’ (NPWT), ‘negative‐pressure wound therapy with instillation’ (NPWTi) and incisional NPWT. Current indications for NPWT include acute traumatic, subacute and dehiscent wounds, chronic wounds, ulcers, first‐ and second‐degree burns, tissue flaps and grafts . In the beginning, most studies focused on NPWT and its variants (NPWTi and incisional NPWT) in trauma and orthopedic surgery.…”

“…In the beginning, most studies focused on NPWT and its variants (NPWTi and incisional NPWT) in trauma and orthopedic surgery. Emerging evidence currently concerns distinct clinical settings, as wounds in the context of diabetic foot syndrome, osteomyelitis, necrotizing fasciitis, infected joint prostheses and venous ulcers …”