Negative pressure wound therapy with instillation in lower extremity wounds may contribute to cost-savings: 4 case reports

Abstract

Background: Use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) can assist with wound bed preparation for successful closure. The authors present their experience using NPWTi-d to manage lower extremity wounds in 4 patients and discuss the feasibility of improving cost efficiency. Methods: NPWTi-d involved instillation of normal saline with an 8-to 10 minute dwell time, followed by 3 to 3.5 hours of -125 mm Hg. Therapy continued for 6 to 7 days with dressing changes every 2 to 3 days. Results: Patients were all male, between the ages of 24 and 83 years old. Wound etiologies included chemical burn, deep tissue laceration, compartment syndrome with hematoma, and diabetic foot osteomyelitis. All wounds required cleansing. Prior to NPWTi-d, surgical debridement and antibiotics were administered as necessary. After NPWTi-d, the wounds exhibited healthy granulation and reduced in size, allowing for discharge to outpatient care. Upon follow-up 2 to 6 months later, no patients experienced wound complications or required readmission to the operating room, potentially saving on time and cost. Conclusion: In these patients, use of NPWTi-d assisted in cleansing the wound surface and producing a positive healing outcome. Despite higher initial costs of NPWTi-d over standard dressings, a wound management protocol including NPWTi-d may help mitigate expenses incurred by delayed healing.