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. 2020 Dec 24:61:73-80.
doi: 10.1016/j.amsu.2020.12.015. eCollection 2021 Jan.

Does negative pressure wound therapy with saline instillation improve wound healing compared to conventional negative pressure wound therapy? - A randomized controlled trial in patients with extremity ulcers

Prakriti Giri  1 , Balamourougan Krishnaraj  1 , Sarath Chandra Sistla  1 , Sujatha Sistla  2 , Debdatta Basu  3 , Gomathi Shankar  1 , Sujiv Akkilagunta  4 , Jigish Ruparelia  1
Affiliations

Does negative pressure wound therapy with saline instillation improve wound healing compared to conventional negative pressure wound therapy? - A randomized controlled trial in patients with extremity ulcers

Prakriti Giri et al. Ann Med Surg (Lond). .

Abstract

Background: Wounds are important health problems that cause significant financial burden and loss of time to work, more so in low and lower middle income countries. Negative pressure wound therapy (NPWT) is widely established in managing acute and chronic extremity wounds. We studied the effects of addition of normal saline instillation to NPWT in terms of changes in granulation tissue, bacterial-burden and overall wound healing using readily available means and materials including wall suction for negative pressure, sponge and adhesive transparent sheet for dressing and normal saline for irrigation.

Methods: All patients with extremity ulcers initially underwent surgical debridement. They were then allotted into two groups, group 1 (NPWT with normal saline instillation- NPWTi) including 25 patients and group 2 (NPWT) including 23 patients. Tissue-bit samples taken on day1 and day 10 were used for bacteriology and for assessing histology. The wound surface-area was measured using the software ImageJ on day 1 and day 10.

Results: Median log difference in colony-count between day1 and day10 was 0.6 (0.2-1.4) in group1 and 0.13 (0.04-0.6) in group 2 (p < 0.05). Mean percentage reduction in wound size was 28.82 and 19.80 in group 1 and group 2 respectively (p < 0.05). Histological parameters of wound healing assessed as surface epithelium, granulation, inflammatory cells, proliferative blood-vessels and fibroblasts were significantly better in group1. A drawback observed with NPWTi was skin maceration around the ulcer which was successfully managed.

Conclusion: Our findings suggest that wound healing is significantly better when saline instillation is combined with NPWT. It can aid in complex extremity ulcers management by reducing the size of the wound with healthier looking granulation tissue.

Keywords: Bacterial load; Granulation; Negative pressure wound therapy; Saline solution; Ulcer.

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Conflict of interest statement

The authors have no conflict of interest.

Figures

Fig. 1
Fig. 1
Images showing procedure of negative pressure wound therapy with normal saline instillation (NPWTi). A. NPWTi showing foam covering the wound in two layers with a drain tube placed between the two layers of foam and connected to suction device and system sealed with adhesive transparent sheet. B. Instillation of normal saline till the foam is visibly saturated. C. Following 10 min of dwell time, drain tube re-connected to the negative suction.
Fig. 2
Fig. 2
Images of the wound. A. Day 1 picture showing the wound over left leg (medial aspect) at the initiation of NPWTi. B. Day 10 picture of the same wound at the end of intervention period following NPWTi.
Fig. 3
Fig. 3
Consort diagram.
Fig. 3
Fig. 3
Consort diagram.
See this image and copyright information in PMC

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References

    1. Kavros S.J., Liedl D.A., Boon A.J., Miller J.L., Hobbs J.A., Andrews K.L. Expedited wound healing with noncontact, low-frequency ultrasound therapy in chronic wounds: a retrospective analysis. Adv. Skin Wound Care. 2008 Sep;21(9):416–423. - PubMed
    1. Lin C.-C., Chang C.-F., Lai M.-Y., Chen T.-W., Lee P.-C., Yang W.-C. Far-infrared therapy: a novel treatment to improve access blood flow and unassisted patency of arteriovenous fistula in hemodialysis patients. J Am Soc Nephrol JASN. 2007 Mar;18(3):985–992. - PubMed
    1. A N., Khan W.S., J P. The evidence-based principles of negative pressure wound therapy in trauma & orthopedics. Open Orthop. J. 2014;8:168–177. - PMC - PubMed
    1. Kim P.J., Attinger C.E., Crist B.D., Gabriel A., Galiano R.D., Gupta S. Negative pressure wound therapy with instillation: review of evidence and recommendations. Wounds Compend Clin Res Pract. 2015;27(12):S2–S19. - PubMed
    1. Müller C.S.L., Burgard B., Zimmerman M., Vogt T., Pföhler C. On the significance of negative-pressure wound therapy with instillation in dermatology. J Dtsch Dermatol Ges J Ger Soc Dermatol JDDG. 2016 Aug;14(8):786–795. - PubMed