Sterile-water negative pressure instillation therapy for complex wounds and NPWT failures

Objective: To investigate use of negative pressure wound therapy (NPWT) combined with instillation for patients either presenting with a complex wound or after failure of classic NPWT. Method: A retrospective case series study conducted on patients treated using an NPWT instillation system (V.A.C. Instill; KCI Inc.) from January to December 2012. The instillation machine was used with pure saline so as not to interfere with local antibacterial solutions. Two clinical indications-patients presenting either large undermining, deep inaccessible wounds or infected wounds and those for whom conventional NPWT had proved ineffective, were analysed-with efficacy of the promotion of granulation tissue as the primary outcome. Length of instillation time, the rhythm and the amount of liquid to be injected compared with the estimated volume of the cavity were also evaluated. Results: Twenty-four patients were included in this series-12 post-NPWT failures and 12 complex wounds-with positive outcomes in 23 cases. Surgical closure was realised after promotion of granulation tissue, using either flaps or skin grafts alone, or combined with previous application of a dermal substitute. No complications linked to instillation were observed during the period of use. Conclusion: The results of this case series suggests that use of NPWT combined with pure saline instillation could have a positive impact on the healing trajectory of patients with complex wounds or after failure of classic NPWT.