Early-Stage Management of Complex Lower Extremity Wounds Using Negative Pressure Wound Therapy With Instillation and a Reticulated Open Cell Foam With Through Holes

Windy Cole, DPM, FACFAS

Disclosures

Wounds. 2020;32(6):159-163. 

In This Article

Abstract and Introduction

Abstract

Introduction: Treatment modalities that overcome stalled wound healing in lower extremity wounds are crucial for reducing lower limb amputations, which have a 5-year mortality rate of an astounding 70%. Recent non-comparative studies have shown negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a dressing comprised of reticulated open cell foam with through holes (ROCF-CC) provides favorable clinical outcomes for various wound types, including complex lower extremity wounds.

Objective: The objective of this study is to compare NPWTi-d using ROCF-CC dressings (treatment group) with advanced wound dressings (control group) in patients with chronic lower extremity wounds and known systemic risk factors for delayed healing.

Materials and Methods: A retrospective assessment was performed for 10 patients with complex lower extremity wounds that underwent an initial debridement and then were treated with either advanced wound dressings (control group; n = 5) or NPWTi-d using ROCF-CC dressings (treatment group; n = 5). Advanced wound dressings were applied to wounds and changed 1 to 3 times per week. Negative pressure wound therapy with instillation and dwell time was applied by instilling normal saline onto wounds, with a dwell time of 20 minutes, followed by continuous negative pressure (-125 mm Hg) for 2 hours. The ROCF-CC dressings were changed every 2 to 3 days.

Results: Patients in the treatment group had significantly fewer wound complications (P = .024) and underwent significantly fewer surgical debridements (P = .004) when compared with patients in the control group. All wounds in the treatment group healed without complication, whereas only 2 of the 5 wounds in the control group healed. Demographics and comorbidities were similar between groups.

Conclusions: These data further support the use of NPWTi-d with ROCF-CC to help manage complex wounds of the lower limb.

Introduction

Impaired healing of chronic wounds has an estimated economic impact of more than $25 billion annually in the United States,[1,2] and chronic wounds of the lower extremities have been estimated to represent 30% to 40% of all wounds.[2] Failure to adequately heal complex wounds of the lower extremity can result in lower limb amputation, and 5-year mortality rates of up to 70% have been reported for patients undergoing lower limb amputations.[3,4] In fact, the 5-year mortality rate for persons with lower limb amputations is reported to be higher than all but 4 cancer types (ie, pancreatic, hepatobiliary, esophageal, and lung).[5] Therefore, treatment modalities that overcome stalled wound healing in lower extremity wounds, along with management of any underlying disease states (eg, peripheral vascular disease, uncontrolled diabetes mellitus), can profoundly impact patient quality of life and the economy.

Wound healing can be impaired by both systemic factors (eg, advanced age, diseases such as diabetes, obesity, and malnutrition) and local factors, including the presence of microorganisms, slough, and nonviable tissue in the wound bed.[6,7] In fact, slough, or nonviable tissue, is a prominent feature of chronic wounds, including many lower limb wounds, and needs to be removed for proper wound healing to occur.[7] The removal of slough generally occurs through debridement (eg, surgical or mechanical); however, debridements or repeated debridements are not possible in all patients due to patient discomfort.[7]

More recently, negative pressure wound therapy with instillation and dwell time (NPWTi-d) using a reticulated open cell foam with through holes (ROCF-CC) has been developed to assist with wound cleansing by removing thick exudate such as slough and infectious material in patients when debridement is not possible or appropriate.[8] Negative pressure wound therapy with instillation and dwell time using a ROCF-CC dressing has been reported to provide favorable clinical outcomes for large, complex wounds and chronic lower extremity wounds.[8–10] This study compared NPWTi-d using ROCF-CC dressings (treatment group) with advanced wound dressings (control group) in patients with chronic lower extremity wounds and known systemic risk factors for delayed healing.

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