Fernández L, Ellman C, Jackson P, et al.
Wounds : a compendium of clinical research and practice. Date of publication 2019 Jan 1;volume 31(1):E1-E4.
1. Wounds. 2019 Jan;31(1):E1-E4.
Use of Negative Pressure Wound Therapy With Instillation in the Management of
Complex Wounds in Critically Ill Patients.
Fernández L(1), Ellman C(1), Jackson P(1).
Author information:
(1)Christus Trinity Mother Frances Hospitals, Tyler, TX.
INTRODUCTION: Negative pressure wound therapy with instillation and dwell time
(NPWTi-d) cleanses wounds with cyclic delivery, dwell, and removal of topical
solutions to solubilize infectious materials and wound debris.
OBJECTIVE: In this 2-patient case study, the authors report their experiences
using NPWTi-d on 2 critically ill patients requiring management of large, complex
wounds.
MATERIALS AND METHODS: In both cases, normal saline was instilled with 10- to
20-minute dwell times, followed by 2 hours of negative pressure wound therapy
(NPWT) at -125 mm Hg.
RESULTS: Patient 1 was a 67-year-old woman, with a history of Roux-en-Y gastric
bypass surgery, who required emergency surgery about 36 hours after ischemic
efferent limb detorsion. After damage control surgery, NPWTi-d was applied for
about 2 weeks. Once the wound was granulating, treatment was switched to
conventional NPWT. Definitive surgery was planned for once she became
physiologically optimized. Patient 2 was a 45-year-old woman presenting with
septic shock and complex, necrotic wounds due to Fournier's gangrene. She
received appropriate debridement, antibiotics, and adjunctive nutritional and
critical care support. Then, NPWTi-d and NPWT were applied for 68 days, after
which split-thickness skin grafts were used to close the right thigh, inguinal
area, perineum, suprapubic area, right superior buttocks region, and back.
Conventional NPWT was applied over the grafts as a bolster, and the patient was
discharged to a rehabilitation center 27 days later with a 95% graft take.
CONCLUSIONS: In the authors' clinical experience, NPWTi-d promoted wound healing
in critically ill patients with large wounds.
PMID: 30694212 [Indexed for MEDLINE]
