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Case report
peer-reviewed
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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.

NPWTi-d, when compared to NPWT, has been reported to lead to a decrease in time to operative closure, hospital length of stay, as well as operative procedures required. The cost-benefit analysis in one retrospective review noted a $1,400 savings when these factors were taken into account.

This mode of wound care therapy has significant benefits that warrant the development of a prospective randomized controlled trial to further define the improvement in quality-of-life provided to the patient and the reduction of potential overall healthcare costs.



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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


Author Information

Robert Felte Corresponding Author

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

Kathy E. Gallagher

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

Glen H. Tinkoff

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

Mark Cipolle

Director, Surgical Service Line Outcomes, Department of Surgery, Christiana Care Health System


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: The authors have declared that no conflicts of interest exist.


Case report
peer-reviewed

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


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Negative Pressure Wound Therapy with Instillation

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

  • Author Information
    Robert Felte Corresponding Author

    Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

    Kathy E. Gallagher

    Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

    Glen H. Tinkoff

    Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

    Mark Cipolle

    Director, Surgical Service Line Outcomes, Department of Surgery, Christiana Care Health System


    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: The authors have declared that no conflicts of interest exist.

    Acknowledgements


    Article Information

    Published: November 07, 2016

    DOI

    10.7759/cureus.865

    Cite this article as:

    Felte R, Gallagher K E, Tinkoff G H, et al. (November 07, 2016) A Case Review Series of Christiana Care Health System’s Experience with Negative Pressure Wound Therapy Instillation. Cureus 8(11): e865. doi:10.7759/cureus.865

    Publication history

    Received by Cureus: September 29, 2016
    Peer review began: October 04, 2016
    Peer review concluded: November 01, 2016
    Published: November 07, 2016

    Copyright

    © Copyright 2016
    Felte et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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.

NPWTi-d, when compared to NPWT, has been reported to lead to a decrease in time to operative closure, hospital length of stay, as well as operative procedures required. The cost-benefit analysis in one retrospective review noted a $1,400 savings when these factors were taken into account.

This mode of wound care therapy has significant benefits that warrant the development of a prospective randomized controlled trial to further define the improvement in quality-of-life provided to the patient and the reduction of potential overall healthcare costs.



Want to read more?

Create a free account to continue reading this article.

Already a member? Login.



Robert Felte

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

For correspondence:
robert.felte@gmail.com

Kathy E. Gallagher

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

Glen H. Tinkoff

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

Mark Cipolle

Director, Surgical Service Line Outcomes, Department of Surgery, Christiana Care Health System

Robert Felte

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

For correspondence:
robert.felte@gmail.com

Kathy E. Gallagher

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

Glen H. Tinkoff

Department of Surgery, Surgical Critical Care Wound Service, Christiana Care Health System

Mark Cipolle

Director, Surgical Service Line Outcomes, Department of Surgery, Christiana Care Health System