Hi Kathryn,

Thanks for sharing this case. Other colleagues might have suggestions too; Scott Robinson MD and I talked about it today and here are some thoughts:

Hypergranulation after NPWT is a sign that NPWT should be discontinued.[1] To manage hypergranulation, one can perform a conservative sharp wound debridement (CSWD) or apply silver nitrate. A wound swab could be collected using the Levine technique after CSWD if it hasn't been already collected (periwound seems erythematous, is it warmer or/and painful?). For dressing, one option could be collagen + silver (e.g Promogran), covered with a nonadherent dressing. To help manage hypergranulation, assuming blood supply to the ulcer is adequate, one thought is to apply gentle pressure by wrapping the foot with gauze and a single layer of compression bandage (e.g. Coban). In addition to local wound care, proper offloading would be important as well. Ulcer could be evaluated within a week. NPWT could be reconsidered then or in the following week if need be. Hope this helps!

[1] https://www.cadth.ca/sites/default/files/pdf/INESSS_TPN_Recommandations_pour_la_pratique_final_e.pdf