Use of negative pressure wound therapy with instillation and a reticulated open cell foam dressing with through holes in the acute care setting.

Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an automated system used to deliver, dwell, and remove topical solutions from the wound bed. Recently, a reticulated open cell foam dressing with through holes (ROCF-CC) was developed, which assists with wound cleansing by removing thick exudate and infectious materials. We present our experience using NPWTi-d with ROCF-CC on complex wounds when complete surgical debridement was inappropriate because of medical instability, recurrent non-viable tissue, or palliative treatment plan. For all wounds, NPWTi-d with ROCF-CC was initiated by instilling normal saline, acetic acid, or hypochlorous acid with 2 to 10 minutes of dwell time, followed by 0.5 to 4 hours of negative pressure. Dressings were changed every 2 to 3 days. Fourteen patients with multiple comorbidities were treated for wound types including diabetic foot ulcers, necrotising fasciitis, dehisced wounds, and pressure injuries. Duration of NPWTi-d with ROCF-CC ranged from 1 to 15 days, and at dressing changes, wounds showed improved granulation tissue formation, less malodour, less surrounding erythema, and demarcation of healthy skin from devitalised tissue. Based on these patients, adjunctive use of NPWTi-d with ROCF-CC provided a practical option for improving tissue quality in wounds for patients in whom surgical debridement was not possible or desired.