Source Control and Graft Preservation Using Negative Pressure Wound Therapy with Antibiotic Instillation: A Case Report

Abstract

Negative pressure wound therapy (NPWT) is widely used to treat many types of complex wounds, and the advent of the instillation and dwell time (NPWTi-d) technique has enhanced this system with the addition of automated treatment with topical solutions. In the field of vascular surgery, NPWT is utilized to help close wounds over underlying grafts; however keeping these wounds free of infection and avoiding large reoperation when infection occurs remains a challenge. In this case report we present a patient who required acute intervention for limb ischemia, with a large wound created in the groin for anastomosis of a prosthetic graft bypass. Postoperatively, the wound became infected, and the challenge became balancing infection control and graft preservation with the patient’s multiple comorbidities including postoperative non-ST segment elevation myocardial infarction (NSTEMI). To avoid a large reoperation, we chose NPWTi-d with automated instillation of an antibiotic solution. There was no reinfection or return to the operating room (OR), the patient was discharged after four weeks and the wound closed on its own shortly thereafter. This case demonstrates that for high-risk surgical patients with known wound infections in the proximity of a bypass graft, NPWTi-d with antibiotic instillation may be an effective augmentation to current treatment strategies and may be considered as a stand-alone technique for wound closure in select cases.

Treatment Outcomes of Postoperative Mediastinitis After Cardiac Surgery: A Comparison of Negative Pressure Wound Therapy Performed with Instillation Method and Non-Instillation Method

“…It removes inhibitory factors such as metalloproteases and destroys glycocalyx responsible for resistance to antisepsis. 26,27 In conclusion, efficiency of NPWT on the treatment of mediastinitis after sternotomy was known previously. NPWT with instillation is a recently introduced treatment modality and performed NPWT with irrigation solution.…”

Antibacterial hydrogels for managing wound infections

“…NPWT are superior to standard therapy for these wounds as they typically produce a lot of exudates which conventional dressings cannot drain promptly. NPWT expedites wound drainage and newer devices even have the ability to instil antibiotics and saline to sterilize the wound [77]. HBOT involves delivering oxygen in a high-pressure…”