Kim PJ, Attinger CE, Crist BD, Gabriel A, Galiano RD, Gupta S, Lantis Ii JC, Lavery L, Lipsky BA, Teot L, et al.
Wounds : a compendium of clinical research and practice. Date of publication 2015 Dec 1;volume 27(12):S2-S19.
1. Wounds. 2015 Dec;27(12):S2-S19.
Negative Pressure Wound Therapy With Instillation: Review of Evidence and
Recommendations.
Kim PJ(1), Attinger CE(2), Crist BD(3), Gabriel A(4), Galiano RD(5), Gupta S(6),
Lantis Ii JC(7), Lavery L(8), Lipsky BA(9), Teot L(10).
Author information:
(1)Department of Plastic Surgery and Center for Wound Healing, MedStar Georgetown
University Hospital, Washington, DC.
(2)Department of Plastic Surgery, Medstar Georgetown University Hospital,
Washington, DC.
(3)Department of Orthopedic Surgery, University of Missouri, Columbia, MO.
(4)PeaceHealth Medical Group Plastic Surgery, Vancouver, WA.
(5)Division of Plastic Surgery, Feinberg School of Medicine, Northwestern
University, Chicago, IL.
(6)Loma Linda University Medical Center, Department of Plastic Surgery, Loma
Linda, CA.
(7)St. Luke's-Roosevelt Hospital Center, New York, NY.
(8)Department of Plastic Surgery, University of Texas Southwestern Medical
Center, Dallas, TX.
(9)Division of Medical Sciences, University of Oxford, Oxford, UK.
(10)Wound Healing Unit and Burns Surgery, Montpellier University Hospital,
Montpellier, France.
Negative pressure wound therapy with instillation (NPWTi) and dwell time is an
adjunctive treatment modality for selected complex wounds. Because of the greater
amount of research now available, a multidisciplinary expert panel comprising the
fields of podiatry, plastic and general surgery, burn treatment, infectious
diseases, and orthopedics was convened on July 11, 2015, to produce a summary of
the data and recommendations on the use of NPWTi. The panel members each reviewed
available published literature on NPWTi in the PubMed, Cochrane, and Google
Scholar databases from 1 January 2012 up until 20 July 2015 using the string
search term negative pressure wound therapy instillation provided by the panel
moderator; there were no restrictions on the language or type of publication.
Panel members discussed their experiences and worked to reach consensus on
several predefined topics. NPWTi was found to be most appropriate for properly
selected complex hosts or wounds such as patients with multiple comorbidities,
patients with an American Society of Anesthesiology Classification ≥ 2, severe
traumatic wounds, diabetic foot infections, and wounds complicated by invasive
infection or extensive biofilm. NPWTi should not be used routinely to treat
simple wounds or hosts without comorbidities.There is evidence that when NPWTi is
added to standard of care in properly selected cases it provides better overall
clinical outcomes than standard of care alone, even when including NPWT. Based on
published evidence and panel member experience, the Panel recommends a dwell time
- fluid briefly instilled into the wound and allowed to diffuse for a
user-specified time - of 10-20 minutes followed by 2-4 hours of negative pressure
at -125 mmHg, although larger wounds may need times of up to 6 hours. Normal
saline (0.9%) is the preferred solution for NPWTi, except in special situations.
NPWTi with dwell time is an adjunct to other standard principles of appropriate
wound assessment and treatment (e.g., debridement, pressure offloading, systemic
antibiotic therapy, vascular assessment and revascularization when needed, or
glycemic control).
PMID: 26966814 [Indexed for MEDLINE]
