Wound chemotherapy by the use of negative pressure wound therapy and infusion

Abstract

Introduction: Although the use of negative pressure wound therapy (NPWT) is broadly efficacious, it may foster some potentially adverse complications. This is particularly true in patients with diabetes who have a wound colonized with aerobic organisms. Traditional antiseptics have been proven useful to combat such bacteria but require removal of some NPWT devices to be effective.

Methods: In this article, we describe a method of "wound chemotherapy" by combining NPWT and a continuous infusion of Dakins' 0.5% solution either as a standardized technique in one device (ITI Sved) or as a modification of standard technique in another (KCI VAC) NPWT device. The twin goals of both techniques are to effectively reduce bacterial burden and to promote progressive wound healing.

Results: We present several representative case examples of our provisional experience with continuous streaming therapy through 2 foam-based negative pressure devices.

Discussion: Wound chemotherapy was successfully applied to patients with diabetes, without adverse reactions, complications, or recolonization during the course of treatment. We believe this to be a promising method to derive the benefits of NPWT without the frequent adverse sequela of wound colonization.

Figure 1

Four images to exemplify the devices, dressings, and modifications used in this study. (a) ITI Sved foam dressing with an infusion and drainage port; (b) a modified KCI VAC dressing with an intravenous (IV) pump infusion catheter; (c) KCI VAC with Sved infusion catheter; and (d) a modified KCI VAC foam dressing with an IV pump infusion catheter.

Figure 2

Examples of cases 1 to 4 before wound chemotherapy treatment: (a) case 1; (b) case 2; (c) case 3; and (d) case 4.

Figure 3

Examples of cases 1 to 4 after wound chemotherapy treatment for the number of followed days: (a) case 1; (b) case 2; (c) case 3; and (d) case 4.

Figure 4

A 3-step method for the modification of a standard VAC foam dressing with a standard disposable suture removal kit. (a) Step 1: The initial slit in the dressing using scissors and countersinking of underlying foam using tweezers to accommodate the interface of the intravenous (IV) tubing. (b) Step 2: Insertion of the IV tubing interface into the foam through the covering dressing. (c) Step 3: The application of dressing seal around the IV tubing.