Managing Wound Dehiscence With Mechanical NPWT

Abstract and Introduction

Abstract

Mechanical negative pressure wound therapy (mNPWT) is commonly used in the management of a variety of wounds, including diabetic foot ulcerations, surgical wounds, venous ulcerations, and wound dehiscence. This mechanically powered, disposable modality can be used to manage wounds in the outpatient setting and has been shown to be an effective wound care option when transitioning patients from the inpatient to outpatient setting and continuing NPWT for wound care. Mechanical NPWT helps promote wound healing by decreasing edema and via removal of tissue debris and exudate. Traditional NPWT is bulky, is often noisy, and requires a power source. A mechanically powered, disposable, easily applied, off-the-shelf mNPWT device is available for patients with small- to medium-sized wounds with mild to moderate exudate. The disposable mNPWT device provides −125 mm Hg pressure, is silent and small, can be worn under clothes, and allows the patient to be fully ambulatory, thus, more mobile. The mNPWT device tubing can be cut to fit to enable safer ambulation than the powered system and to enable the patient to work and enjoy social activities without a medical device showing. This single case study of a patient with chronic diabetic foot ulcerations of the medial first metatarsal head and dorsal proximal interphalangeal joints of the second and third toes of the left foot, which had not been successfully treated with conservative care and had been present for more than 1 year.

Introduction

With the aging population and the rising incidence of diabetes, the prevalence of wounds being managed in the inpatient and outpatient settings is increasing. In 2014, almost 15% of Medicare beneficiaries experienced a wound or infection (not pneumonia).^[1] According to data published in that study analyzing Medicare spending in the calendar year 2014 for all wound types (eg, diabetic foot ulcerations, chronic ulcerations, surgical wounds, wound dehiscence, venous ulcerations, traumatic wounds), the estimated cost of treatment for these wounds ranged from $28.1 billion to $96.8 billion.^[1] With the higher costs compared with the low-range estimate, mid-range estimate, and upper-bound estimate to manage these wounds, clinicians' support of the use of advanced wound care modalities and wound care therapies is subject to increased scrutiny and review within value-based reimbursement models.^[2] The use of disposable mechanical negative pressure wound therapy (mNPWT) can be used to manage wounds in the outpatient setting and has been shown to be an effective wound care option when transitioning patients from an inpatient to outpatient setting and continuing NPWT for wound care, and adds value to the patient and the health care system.^[3] Mechanical NPWT helps promote wound healing by decreasing edema and via removal of tissue debris and exudate.^[4,5] Traditional NPWT is bulky, is often noisy, and requires a power source. A mechanically powered, disposable, easily applied, off-the-shelf mNPWT device is available for patients with small- to medium-sized wounds with mild to moderate exudate.^[5]

Disposable mNPWT can be used in the outpatient setting for small- to medium-sized wounds with mild to moderate exudate.^[5,6] These single-use devices provide NPWT and help with the removal of tissue debris and exudate.^[5,6]

In this case report, the author uses a disposable mNPWT system (SNAP Therapy System; 3M) that is easy to use and comes prepackaged with a cartridge and dressing with integrated tubing. A key is used to activate and reset this system. When properly applied, this mNPWT system delivers pressure of −125 mm Hg. The dressing consists of a hydrocolloid layer that protects the periwound; blue reticulated open-cell foam is cut to the size of the wound and placed within the wound bed. The author places a ring-shaped hydrocolloid dressing around the periwound at a distance of 1 cm from the periwound to help maintain the seal. The cartridge and tubing are attached to a strap that can be worn on the affected extremity and concealed underneath the patient's clothing. The mNPWT device is portable and does not require a power source; in addition, the patient can check the visual indicator on the device to determine whether the system is providing negative pressure. Dressing changes are typically performed twice weekly by the wound care center nursing staff, home health agency, and/or the provider, although this varies based on the setting where dressing changes have been scheduled and arranged. Patients are instructed that they may shower with the mNPWT device but are cautioned not to immerse the dressing in water; rather, they are to take a quick shower and protect the dressing with an over-the-counter cast guard that can be purchased at a pharmacy or ordered online. Patients are typically seen every 1 to 2 weeks for follow-up to assess the wound and wound healing. The author discontinues mNPWT when healthy granulation tissue is noted and is observed to be close to the periwound skin level. Typically, the author then transitions the patient to an advanced wound care dressing (oxidized regenerated cellulose [ORC]/collagen/silver-ORC; [Promogran Prisma Matrix; 3M]) that remains in place until wound closure is achieved.