LEA 8. Use of Negative Pressure Wound Therapy With Instillation in Diabetic Foot Wounds: Initial Experience in an Asian Population

Abstract

The management of diabetic foot wounds is multimodal, comprising both local and systemic measures. Negative pressure wound therapy with instillation (NPWTi) is a useful adjunct in the management of diabetic foot wounds. The cyclic instillation of solutions to the wound bed is thought to augment the benefits of NPWT by decreasing wound bioburden and promoting granulation. We report our early experience using NPWTi in the management of diabetic foot wounds. Data were analyzed from 17 consecutive patients receiving NPWTi after lower extremity minor amputation or débridement between August 1, 2017, and April 30, 2018. The use of NPWTi over standard NPWT was at the discretion of the surgeon, typically for wounds deemed at high risk of residual infection. All patients had NPWTi applied using 10 mL of saline instillation with a 10-minute dwell time followed by continuous negative pressure at 125 mm Hg during 3 hours. The median age of the cohort was 67 years (range, 49-82 years). Six patients (35%) underwent ray amputation, seven patients (41%) underwent wound débridement, and the rest underwent forefoot amputation after revascularization. All patients were of American Society of Anesthesiologists class 3. Sixteen patients (94%) were diabetic and eight patients (47%) had end-stage renal failure. Seven patients (41%) had monomicrobial wound infections, whereas seven patients had polymicrobial wound infections. Antibiotics were administered to all patients for a median duration of 22 days (range, 8-54 days). The median length of stay was 23 days (range, 4-47 days). Premature termination of NPWTi occurred in six patients (35%), allowing blockage of the NPWTi system. One patient (6%) developed skin maceration from NPWTi. Eight patients (47%) underwent further minor amputation, whereas 12 patients (71%) eventually required major limb amputation. There were no deaths resulting from progression of critical limb ischemia in this series. The use of NPWTi is well tolerated with minimal complications. The poor limb salvage rates likely reflect its use in “high-risk” wounds. Larger studies are required to ascertain its impact in the management of complex diabetic foot wounds.