Using Negative Pressure Wound Therapy With Instillation and Dwell Time to Create a Path to Closure for Older Patients With Chronic Wounds: A Retrospective Case Series

Abstract

BACKGROUND: 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. PURPOSE: This retrospective case series describes the use of NPWTi-d to prepare 4 chronic wounds for closure in older patients with multiple comorbidities. METHODS: 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. RESULTS: All 4 wounds responded positively to therapy, exhibiting reduced slough, growing granulation tissue, and size reduction. Closure was achieved in all cases. CONCLUSION: 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.