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Case report
peer-reviewed

## A Case Review Series of Christiana Care Health System’s Experience with Negative Pressure Wound Therapy Instillation

### Abstract

Acute and chronic wounds afflict a multitude of patients to varying degrees. Wound care treatment modalities span the spectrum of technological advancement and with that differ greatly in cost. Negative pressure wound therapy (NPWT) can now be combined with instillation and dwell time (NPWTi-d). This case review series of 11 patients in a community hospital setting provides support for the utilization of NPWTi-d. Additionally, current literature on the use of NPWTi-d in comparison to NPWT will be reviewed.

We highlight three specific cases. The first case is a 16-year-old male who was shot in the left leg. He suffered a pseudoaneurysm and resultant compartment syndrome. This required a fasciotomy and delayed primary closure. To facilitate this, NPWTi-d was employed and resulted in a total of four operative procedures before closure 13 days after admission. Next, a 61-year-old uncontrolled diabetic female presented with necrotizing fasciitis of the lower abdomen and pelvis. She underwent extensive debridement and placement of NPWTi-d with Dakin’s solution. A total of four operative procedures were performed including delayed primary closure six days after admission. Finally, a 48-year-old female suffered a crush injury with internal degloving. NPWTi-d with saline was utilized until discharge home on postoperative day 12.

### Conclusions

The goal of any innovation is to better provide our patients with quality care. How to achieve that quality without added expense for the patient and the overall healthcare system is the hurdle we must overcome. By providing the appropriate environment, NPWTi-d has been shown in the literature to support an increased rate of wound healing. When one considers how many patients are affected by both acute and chronic wounds, the possible impact of this therapy should not be overlooked. NPWTi-d has the opportunity to have a great impact on patient care and healthcare in general. As such, a prospective randomized controlled trial comparing multiple modalities of wound care including NPWTi-d with and without antibacterial adjuncts should be pursued.

### References

1. Gabriel A, Kahn K, Karmy-Jones R: Use of negative pressure wound therapy with automated, volumetric instillation for the treatment of extremity and trunk wounds: clinical outcomes and potential cost-effectiveness. Eplasty. 2014, 14:328-338. Accessed: September 2016: http://www.eplasty.com/images/PDF/eplasty14e41.pdf.
2. Brinkert D, Ali M, Naud M, Maire N, Trial C, Téot L: Negative pressure wound therapy with saline instillation: 131 patient case series. Int Wound J. 2013, 10 Suppl 1:56-60. 10.1111/iwj.12176
3. Goss SG, Schwartz JA, Facchin F, Avdagic E, Gendics C, Lantis JC 2nd: Negative pressure wound therapy with instillation (NPWTi) better reduces post-debridement bioburden in chronically infected lower extremity wounds than NPWT alone. J Am Coll Clin Wound Spec. 2014, 4:74-80. 10.1016/j.jccw.2014.02.001
4. Kim PJ, Attinger CE, Steinberg JS, et al.: The impact of negative-pressure wound therapy with instillation compared with standard negative-pressure wound therapy: a retrospective, historical, cohort, controlled study. Plast Reconstr Surg. 2014, 133:709-716. 10.1097/01.prs.0000438060.46290.7a
Case report
peer-reviewed

### Author Information

###### Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. IRB approved. We are awaiting the approval number. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Case report
peer-reviewed

8.0