Experience of using negative pressure wound therapy with instillation in complex treatment of purulent-necrotic diseases of soft tissue of the trunk and extremities

Introduction. Negative pressure wound therapy (NPWT) has been widely used for over 20 years in the treatment of purulent–necrotic soft tissue infections. However, negative pressure wound therapy with instillation (NPWT-i) is a newer method employed in complex wound management.
Objective. To improve surgical treatment outcomes in patients with purulent-necrotic soft tissue infections.
Materials and methods. The study included 25 patients with purulent-necrotic soft tissue infections of the trunk and extremities, divided into two groups. Group I (15 patients) received conventional NPWT as part of comprehensive treatment, while Group II (10 patients) underwent NPWT-i with normal saline instillation. The groups were comparable in age, sex, wound size, and primary pathogen.
Results. The mean number of secondary surgical debridements was 5,50 ± 1,25 in Group I and 3,00 ± 0,82 in Group II (p < 0,05). The mean plasma C-reactive protein (CRP) level on day 7 after initial debridement was 99,65 ± 15,50 mg/L in Group I and 47,25 ± 32,26 mg/L in Group II (p < 0,05). The average hospitalization duration was 43,00 ± 8,08 days in Group I and 34,75 ± 4,65 days in Group II (p < 0,05). Computerized planimetric wound surface analysis on day 7 post-debridement showed that the mean granulation tissue area was 48,60 ± 4,34 % in Group I versus 71,25 ± 5,06 % in Group II (p < 0,05). Fibrin coverage was 27,00 ± 5,83 % and 15,75 ± 1,26 %, respectively (p < 0,05), while necrotic tissue area was 24,40 ± 2,70 % in Group I compared to 11,50 ± 2,08 % in Group II (p < 0.05).
Conclusion. Negative pressure wound therapy with instillation (NPWT–i) is an effective approach in the comprehensive treatment of purulent–necrotic soft tissue infections of the trunk and extremities.

1. Beschastnov V. V., Pevnev A. A., Malakhova N. I., Moskovskaya A. E. The results of microbiological monitoring of purulent wound treatment in a general surgical hospital. Technol. med. 2009, № 2, рр. 53–56. (In Russ.)

2. Psoinos C. M., Flahive J. M., Shaw J. J., Li Y., Ng S. C., Tseng J. F., Santry H. P. Contemporary trends in necrotizing soft-tissue infections in the United States. Surgery, 2013, № 6, рр.819–827.

3. Nawijn F., Smeeing D.P.J., Houwert R.M., Leenen L.P.H., Hietbrink F. Time is of the essence when treating necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg., 2020, № 15, рp 4.

4. Ovdenko A. G., Nefedov O. N. Vacuum treatment: from the roman empire to the present day. Health is the basis of human potential: problems and solutions, 2018, № 3, pp. 1159–1178. (In Russ.)

5. Silverman R. P. Negative Pressure Wound Therapy With Instillation and Dwell Time: Mechanisms of Action Literature Review. Eplasty, 2023, № 23, pр. 54.

6. Wolvos T. Wound instillation--the next step in negative pressure wound therapy. Lessons learned from initial experiences. Ostomy/wound management, 2004, № 11, рр. 56–66.

7. Wolvos T. The use of negative pressure wound therapy with an automated, volumetric fluid administration: an advancement in wound care. Wounds: a compendium of clinical research and practice, 2013, № 3, pp. 75–83.

8. De Pellegrin L., Feltri P., Filardo G., Candrian C., Harder Y., Galetti K., De Monti M. Effects of negative pressure wound therapy with instillation and dwell time (NPWTi-d) versus NPWT or standard of care in orthoplastic surgery: A systematic review and meta-analysis. International wound journal, 2023, № 6, рр. 2402–2413.

9. Anagnostakos K. and Mosser, P. Bacteria identification on NPWT foams: clinical relevance or contamination? Journal of wound care, 2012, № 7, рр. 333–339.

10. Raad W., Lantis J. C.2nd., Tyrie L., Gendics C., Todd G. Vacuum-assisted closure instill as a method of sterilizing massive venous stasis wounds prior to split thickness skin graft placement. International wound journal, 2010, № 2, рр. 81–85.

11. Kim P. J., Applewhite A., Dardano A. N., Fernandez L., Hall K., McElroy E., Mendez-Eastman S., Obst M. A., Thomas C., Waddell L., Wirth G., Téot L. Use of a Novel Foam Dressing With Negative Pressure Wound Therapy and Instillation: Recommendations and Clinical Experience. Wounds: a compendium of clinical research and practice, 2018, № 3, рр. 1–17.

12. Ivanov G. G., Yarosh V. N., Balashov I. A. Determination of the size and structural elements of the RAS based on computer planimetry. Photoprotocol in assessing the course of the wound process // Wounds and wound infections. The journal named after Professor B. M. Kostyuchenko, 2023, № 1, pp 38–44. (In Russ.)

13. Barkhatova N. A. Dynamics of the level of C-reactive blood protein as a way to assess the effectiveness of antibacterial therapy in purulentnecrotic soft tissue diseases. Scientific Notes of Pavlov St. Petersburg State Medical University, 2009, № 4, pp 63–66. (In Russ.)