Using negative pressure wound therapy with instillation and dwell time to create a path to closure for older patients...

Chronic podiatric wounds are common causes of morbidity and mortality in older patients. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) has been recommended in wounds with high levels of exudate, contaminated wounds, and wounds in which healing progression has stalled.

This retrospective case series describes the use of NPWTi-d to prepare 4 chronic wounds for closure in older patients with multiple comorbidities.

Patients (N = 4) ranged in age from 65 to 95 years and had wounds present for at least 90 days. Previous treatments included conventional NPWT and debridement. NPWTi-d consisted of instillation of 10 to 20 mL normal saline, dwell time for 1 minute, followed by 3-hour cycles of -125 mm Hg. Antibiotics were administered as needed. Wounds included a 210-day Wagner grade 3 diabetic foot ulcer (3.2 × 1.8 × 0.3 cm³), a 90-day dehisced wound (9.5 × 2.6 × 0.4 cm³), a 300-day neuropathic ulcer (0.7 × 0.5 × 2.1 cm³), and a 150-day Wagner grade 2 diabetic foot ulcer (4.5 × 3.3 × 0.9 cm³). NPWTi-d was applied for 3 to 33 days, when care was transitioned to advanced wound dressings.

All 4 wounds responded positively to therapy, exhibiting reduced slough, growing granulation tissue, and size reduction. Closure was achieved in all cases.

In these 4 patients, NPWTi-d, used as part of a treatment regimen including debridement, antibiotics, and advanced wound dressings, was effective in creating an environment that promoted wound healing and prepared the wounds for eventual closure.