Elsevier

Burns Open

Volume 2, Issue 4, October 2018, Pages 208-212
Burns Open

Utility of negative pressure wound therapy with instillation in a burn center

https://doi.org/10.1016/j.burnso.2018.05.004Get rights and content
Under a Creative Commons license
open access

Highlights

  • Burn, contaminated wound, and necrotizing fasciitis requires multi-modal treatment.

  • NPWTi-d may offer clinical benefit during management of these complex wounds.

  • NPWTi-d use in 21 patients is described.

  • NPWTi-d use led to wound cleansing, expedited coverage, and decreased patient pain.

  • All wounds were closed without added complications after NPWTi-d treatment.

Abstract

Introduction

Current standard of care for complicated and deep burn wounds includes removal of devitalized tissue, infection treatment/prevention, temporary coverage, and pain management before and during wound closure. Negative pressure wound therapy with instillation and dwell time (NPWTi-d) utilizes both negative pressure and instillation of topical wound solutions for wound cleansing and removal of infectious materials. We describe our experience using NPWTi-d for complicated wound management in a burn center.

Methods

Twenty-one patients were included in a retrospective analysis of burn wounds (n = 15) or wounds resulting from necrotizing fasciitis (n = 6). Patients received systemic antibiotics and underwent wound debridement as indicated. NPWTi-d was initiated by instilling Dakin’s solution (quarter strength), mafenide solution, or normal saline with a dwell time of 5–10 min followed by 4–6 h of NPWT at −75, −100, or −125 mmHg.

Results

Mean percent total body surface area (TBSA) was 11.6% for the burn wounds and 10.0% for the necrotizing fasciitis wounds. Mean duration of NPWTi-d therapy was 10.0 days prior to wound closure by split-thickness skin graft (n = 13), graft and flap (n = 3), primary intention and graft (n = 1), secondary intention (n = 1), or amputation (n = 3). All wounds were successfully closed and no complications occurred during NPWTi-d treatment.

Conclusions

In these patients, NPWTi-d provided safe and effective adjunctive therapy for complicated wounds resulting from burns or necrotizing fasciitis.

Keywords

Burns
Negative pressure wound therapy with instillation
Necrotizing fasciitis
Burn center

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