Diverse applications of negative pressure wound therapy: a multiple case report

The purpose of this retrospective case report was to describe the results of negative pressure wound therapy (NP WT) in the treatment of wounds of various size, location and etiology in four patients. The effects of NP WT were assessed in the following patients. 1) A 68-year-old male diagnosed with cellulitis presenting with two open wounds on the left foot; 2) a 60-year-old male diagnosed with Type II diabetes mellitus presenting with a full thickness wound on the plantar surface of the right foot; 3) a 64-year-old male diagnosed with necrotizing fasciitis, diabetes mellitus, and Crohn's disease presenting with a left gluteal wound; and 4) a 47-year-old obese female diagnosed with necrotizing fasciitis presenting with a wound of the right groin and buttock. All wounds were debrided of devitalized tissue and contained nearly 100% granulation tissue prior to NPWT treatment. NPWT was applied three times per week, each application lasting 48 hrs, followed by dressing change, cleaning of the wound bed and continued debridement as required. Treatment duration, varying from 4-9 weeks, corresponded to the patient's length of stay at the sub-acute rehabilitation facility, and pressure settings ranged from 100 to 200 mmHg. Measurements of wound length, width, depth and appearance were recorded once a week. Follow-up was conducted 6-18 months post treatment to assess self-reported wound status. NPWT resulted in reductions of wound length, width, and depth, with the greatest reduction in each case being wound depth. Reduction in wound depth ranged from 75-100% (100% being complete wound closure), with four of the five wounds exceeding 90%. Reduction in wound length ranged from 32-100%, with three wounds exceeding 80%, and reduction in wound width ranged from 35-100%, with three wounds exceeding 80%. Three wounds closed completely either during therapy or soon (2-4 weeks) thereafter, and two wounds were reduced in size sufficiently for treatment via skin grafts. NPWT, applied to wounds of diverse size, location, and etiology, resulted in reductions in wound length, width, and depth in four patient cases, with the greatest influence of reducing wound depth.