WoundReference improves clinical decisions
 Choose the role that best describes you
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
MD, PhD, MBA
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
* Information provided without clinical evaluation and is not intended as a replacement for in-person consultation with a medical professional. The information provided through Curbside Consult is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.