New advances in instillation therapy in wounds at risk for compromised healing

Combined use of adjunctive negative pressure wound therapy (NPWT) and instillation of topical wound solutions and suspensions (NPWTi) has proven to be an effective next-generation NPWT technique for wounds at risk for compromised healing. Fluid instillation has been shown to enhance exudate and debris removal, provide regular cleansing of the wound bed, and add moisture to the wound. Positive results have been demonstrated with NPWTi in assisting healing of stalled wounds and treating painful wounds as well as wounds at high risk for amputation. NPWTi has been used instead of conventional NPWT in wounds with thick exudate and slough content, acute traumatic wounds, wounds acutely debrided due to infected soft tissue, large areas of post-debrided exposed bone, and cases of critical bacterial colonization. Instilled solutions have included topical solutions such as saline, topical wound cleansers, and antiseptics. While various systems that combine instillation or irrigation with NPWT have been commercialized during the past decade, until very recently these have been relatively cumbersome to use and limited in their ability to regulate solution volume delivery. Recent advances in NPWTi technology (V.A.C. VeraFlo™ Therapy, KCI, San Antonio, TX) include automated volumetrically controlled delivery of fluids and upgraded foam dressing technology to provide better control and delivery of solutions to the wound bed. This article describes the latest NPWTi technology and provides recommendations for successful application of NPWTi in an effort to inform clinicians about product decision-making and practice.