Rotation Flap Closure of Pressure Injuries Following Negative Pressure Wound Therapy With Instillation for Wound Cleansing

Abstract

Introduction. Wound cleansing is integral during early-stage wound management and affords the transition to modalities promoting granulation tissue formation and reepithelialization, or preparation for wound coverage/closure. NPWTi-d includes periodic instillation of topical wound cleansing solutions and negative pressure for infectious material removal. Materials and Methods. This was a retrospective study of 5 patients who were admitted to an acute care hospital and treated for PI. After initial wound debridement, NPWTi-d instilled normal saline or HOCl solution (40 mL–80 mL) onto the wound for a dwell time of 20 minutes followed by 2 hours of subatmospheric pressure (−125 mm Hg). NPWTi-d duration was 3 to 6 days with 48-hour dressing changes. Results. NPWTi-d helped cleanse 10 PIs in 5 patients (age, 39–89 years) with comorbidities to facilitate primary closure using rotation flaps. In 4 patients, rotation flap closures were performed without immediate postoperative complications, followed by hospital discharge within 72 hours. In one patient, closure was preempted due to an unrelated medical issue. A stoma was created to prevent further contamination. The patient returned for flap coverage post colostomy. Conclusion. The findings herein support the use of NPWTi-d in the cleansing of complex wounds and suggest that it may facilitate an expedited transition to rotation flap closure for this wound type.