Analysis of Rinsing Fluid during Negative Pressure Wound Therapy with Instillation: A Potential Monitoring Tool in Acute and Chronic Wound Treatment. A Pilot Study.

Andreas Kehrer,Christian D Taeger,Teresa Martini,Daniel Schiltz,Stefan Wallner,Niklas Biermann,Lukas Prantl

doi:10.3390/cells10040732

Andreas Kehrer, Christian D Taeger + Show 5 more

Open Access

https://doi.org/10.3390/cells10040732

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Journal: Cells	Publication Date: Mar 26, 2021
Citations: 4	License type: CC BY 4.0

Affiliation: University Hospital Regensburg

Abstract

Background: During negative pressure wound therapy (NPWT), open wounds are draped with a nontransparent sponge, making daily wound evaluation impossible. Sometimes, late or undetected bacterial infections and postoperative bleeding result in repetitive surgery, thus prolonging inpatient time. With the introduction of additional fluid instillation (NPWTi), the wound surface is rinsed, and bacteria, proteins and biomarkers are flushed into a collecting canister, which is later discarded. Methods: The aim of this pilot study was to analyze rinsing fluid samples (0.9% sodium chloride) from the NPWTi device in patients with acute and chronic wounds. In 31 consecutive patients a standardized laboratory analysis was performed to evaluate cellular composition and potassium, phosphate, lactate dehydrooxygenase, pH and total protein levels. Results: While there was an increase in the total cellular amount and the number of polymorphonuclear cells, the number of red blood cells (RBC) decreased after surgery. Potassium and pH showed no significant changes in the first three postoperative days, whereas total protein showed an undulant and partially significant course. Conclusion: We were able to quantify cellular metabolites by analyzing the rinsing fluid of NPWTi. We propose the analysis of this material as a novel and potentially promising tool to monitor wound status without removal of the dressing. The establishment of reference values might help to improve the NPWTi therapy.

Highlights

Despite a steadily increasing application of negative pressure wound therapy with instillation (NPWTi) in acute and chronic wound care, a thorough understanding of the underlying physiology, as well as of monitoring tools during the dressing phase, is lacking [1,2,3,4,5,6,7,8]
Background: During negative pressure wound therapy (NPWT), open wounds are draped with a nontransparent sponge, making daily wound evaluation impossible
With the introduction of additional fluid instillation (NPWTi), the wound surface is rinsed, and bacteria, proteins and biomarkers are flushed into a collecting canister, which is later discarded

Summary

Introduction

Despite a steadily increasing application of negative pressure wound therapy with instillation (NPWTi) in acute and chronic wound care, a thorough understanding of the underlying physiology, as well as of monitoring tools during the dressing phase, is lacking [1,2,3,4,5,6,7,8]. In NPWTi, the additional fluid instillation is thought to facilitate the removal of microorganisms, dilute inflammatory and cytotoxic molecules, as well as more strongly influence angiogenesis due to intermittent suction intervals [9,10,11] This form of negative pressure wound therapy (NPWT) has been shown to be suitable for the treatment of infected wounds, and leads to improved granulation of the wound bed [11,12]. We analyzed the rinsing fluid during NPWTi in patients with acute and chronic wounds over several days The aim of this pilot study was to assess whether it was possible to detect metabolites or cytokines within the rinsing fluid, and whether these might be linked to the clinical course

Materials and Methods

Patients

Laboratory Analysis

Conclusions