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This wound began as a DFU plantar surface and erupted medially. Surgical debridement about 4 weeks ago. NPWT was applied in surgery, patient was referred to outpatient wound care 1 week post-op. No contact layer over exposed metatarsal head until seen in wound clinic. Wound has been granulating but is now hypergranulating even with decreasing exudate. Patient has seen a plastic surgeon and has surgery planned 6 weeks from now for a skin graft. Should we discontinue the NPWT? What would be appropriate management of the hypergranulation in the interim?
Sep 20, 2021 by Kathryn Erickson, RN, BSN, PHN MBA, CWCN
1 replies
Elaine Horibe Song
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
Sep 21, 2021
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