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. 2018 Dec;15(6):978-984.
doi: 10.1111/iwj.12958. Epub 2018 Jul 4.

Negative pressure wound treatment with computer-controlled irrigation/instillation decreases bacterial load in contaminated wounds and facilitates wound closure

Ingo Ludolph  1 , Frederik W Fried  1 , Katharina Kneppe  1 , Andreas Arkudas  1 , Marweh Schmitz  1 , Raymund E Horch  1
Affiliations

Negative pressure wound treatment with computer-controlled irrigation/instillation decreases bacterial load in contaminated wounds and facilitates wound closure

Ingo Ludolph et al. Int Wound J. 2018 Dec.

Abstract

Microbial wound contamination is known to be a hindrance to wound healing. Negative pressure wound therapy (NPWT) with or without irrigation is known to optimise conditions in problem wounds. The aim of this study was to investigate the influence of computer-controlled wound irrigation with NPWT on the bacterial load in contaminated wounds. A total of 267 patients were treated with NPWT with automated instillation because of problematic wounds using an antiseptic instillation solution. In 111 patients, a minimum of 4 operative procedures were necessary, and swabs were taken at least at the first and at the fourth operation in a standardised procedure. The number of different bacteria and the amount of bacteria were analysed during the course. In a subgroup of 51 patients, swabs were taken at all 4 operative procedures and analysed separately. In an overall analysis, the number of different bacteria and the amount of bacteria significantly decreased independent of wound localisation and diagnosis. NPWT with automated instillation demonstrates a positive influence in the reduction of bacterial load in problem wounds. Thus, it may help to optimise wound conditions before definite wound closure.

Keywords: bacterial load; contaminated wounds; instillation; negative pressure wound therapy.

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Figures

Figure 1
Figure 1
Distribution of patients according to dependence of wound entity (y‐axis number of patients) [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Reduction of the number of different bacteria (NDB) in different wounds under negative pressure wound therapy with automated instillation (NPWTi) during the course from the first to the fourth operation (y‐axis number of different bacteria) [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 3
Figure 3
Reduction of the amount of bacteria (AB) in different wounds under negative pressure wound therapy with automated instillation (NPWTi) during the course from the first to the fourth operation (y‐axis AB) [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 4
Figure 4
A, Combination of a basal cell carcinoma and a squamous cell carcinoma at the lower right leg. B, Lower right leg with negative pressure wound therapy with automated instillation (NPWTi). C, Wound at the lower right leg after tumour resection. D, Lower right leg after wound reconstruction with a free microvascular latissimus dorsi flap [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 5
Figure 5
A, Chronic wound right foot after abscess incision 4 month ago at the time of admission to our department. B, Wound on the right foot after initial debridement. C, Defect reconstruction with a free rectus abdominis flap with perforator based skin island for postoperative flap monitoring. D, Right foot 6 months after defect reconstruction [Colour figure can be viewed at wileyonlinelibrary.com]
Figure 6
Figure 6
Development of the number of different bacteria (NDB) and the amount of bacteria (AB) under negative pressure wound therapy with automated instillation (NPWTi) during the course of 4 operations (analysis of swabs at each operation) [Colour figure can be viewed at wileyonlinelibrary.com]
See this image and copyright information in PMC

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