Experience with negative-pressure wound therapy with instillation in complex infected orthopaedic wounds

Abstract

Chronic exudative wounds are frequently seen in hospitalised patients, consuming hospital resources and leading to increased morbidity. Negative-pressure therapy (NPWT) with topical instillation "NPWTi" may be used to improve the wound healing process, with the unique features (removal of wound exudate, edema reduction, promotion of tissue perfusion and granulation tissue formation, as well as drawing the edges of the wound to facilitate, in addition to the cyclic cleansing mechanism). This report is a descriptive study of our experience with NPWTi on complex infected orthopaedic wounds as a potential method to decrease the need for multiple surgical debridements required for the closure of such wounds. A prospective observational study was conducted. Twenty patients with complex infected orthopaedic wounds were enrolled in our study. These patients were consulted by the Bone and Joint Infection Service and enrolled to receive NPWTi intraoperatively and to be used during their inpatient stay. Twenty patients with 20 complex infected lower limb wounds were included in our study. Of all the 20 wounds, the etiology was post-surgical in 80% (n = 16) and post-traumatic in 20% (n = 4). None of the patients received previous treatment with conventional NPWT before participation in the study. There were 11 males (55%) and 9 females (45%) with an average age of 57 years (22-83). All wounds were located in the lower limbs, with 25% leg (n = 5), 20% thigh (n = 4), 20% knee (n = 4), 20% foot (n = 4), 10% heel (n = 2), and 5% ankle (n = 1). The average length of treatment with NPWTi was 5.2 days (2-10). Successful wound closure within 6 weeks was achieved in 65% of the cases (n = 13). Of the closed wounds (n = 13), 54% (n = 7) were closed primarily and 46% (n = 6) were closed by secondary procedures (skin graft or skin flap). NPWTi is still considered a novel technique that can be used in the management of complex wounds, and the goal of this prospective study is to report our experience with NPWTi in the management of complex infected orthopaedic lower limb wounds. Randomised control studies with optimally matched wounds comparing NPWTi to the conventional methods of treatment are warranted.

Keywords: NPWTi; infected orthopaedic wounds; negative-pressure wound therapy with instillation.