Use of Reticulated Open Cell Foam Dressings With Through Holes During Negative Pressure Wound Therapy With Instillation and Dwell Time

A Large Case Study

Luis G. Fernández, MD, FACS, FASAS, FCCP, FCCM, FICS; Marc R. Matthews, MD, MS, MC, FACS; Cynthia Ellman, RN, BSN, CWOCN; Patricia Jackson, BSN, RN, CWOCN; David H. Villarreal, MD, FACS; Scott Norwood, MD, FACS, FCCM


Wounds. 2020;32(10):279-282. 

In This Article

Abstract and Introduction


Introduction: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been utilized in wounds with positive clinical benefits. A reticulated open cell foam dressing with through holes (ROCF-CC) was developed to assist with wound cleansing by removing thick wound exudate and infectious materials, and it may be used when debridement is not possible or appropriate. Use of NPWTi-d with ROCF-CC dressings has been reported with positive outcomes in complex wounds.

Objective: The present study reports the authors' experience using NPWTi-d with ROCF-CC dressings in 19 patients with complex wounds.

Materials and Methods: Of the 19 patients, 8 underwent sharp debridement. Oral and/or intravenous antibiotic treatment was initiated as needed prior to NPWTi-d. All patients received NPWTi-d with ROCF-CC dressings with instillation of quarter-strength Dakin's solution, hypochlorous acid solution, or saline with a dwell time of 5 to 10 minutes, followed by 2 to 3.5 hours of continuous negative pressure at -125 mm Hg. Dressing changes occurred every 2 to 3 days. Measurements and assessments of wound progression were done as per institutional protocols.

Results: The 19 treated patients consisted of 10 males and 9 females, with an average age of 58.2 ± 15.1 years. Common patient comorbidities included hypertension, diabetes, obesity, and paraplegia. Wound types included pressure injuries, traumatic wounds, and surgical wounds. The average length of NPWTi-d use was 9.5 ± 4.1 days. In all of the patients, the wound beds showed development of healthy granulation tissue following NPWTi-d with ROCF-CC. All patients were discharged to one of the following: another hospital facility, skilled nursing facility, long-term acute care facility, or home.

Conclusions: In the authors' clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of thick exudate and infectious materials and promoted development of granulation tissue.


Debris, exudate, infectious materials, and devitalized tissue in the wound bed hinder wound healing. Removal of these materials can occur through debridement, wound cleansing, or a combination of both.[1–3] However, surgical debridement under anesthesia may not be appropriate to use in all patients due to increased operative risk associated with the patient's clinical status and comorbidities.

Traditionally, negative pressure wound therapy (NPWT) has been utilized to help remove exudate and infectious materials.[4,5] This advanced wound therapy has evolved to include wound cleansing through NPWT with instillation and dwell time (NPWTi-d) of topical wound cleansing solutions within the wound bed.[6–8] For wounds with thick exudate, a reticulated open cell foam dressing with through holes (ROCF-CC) has been developed to assist with wound cleansing.[9–12] The present study reports the authors' experience using NPWTi-d with ROCF-CC dressings in 19 patients with complex wounds.