title: Long-term follow-up of negative pressure wound therapy with instillation: a limb salvage procedure?
abstract: Negative pressure wound therapy (NPWT) is a treatment to reduce oedema, stimulate granulation tissue formation, remove wound exudate and diminish wound area, thus preparing it for secondary healing, skin grafting or coverage with flaps. The association of instillation to NPWT (NPWTi) is a new method for treating severe wounds, in particular, limb lesions at high risk for amputation. This therapy helps to deliver instillation fluid automatically into the contaminated wound, before application of negative pressure. These steps, repeated cyclically, help to remove infectious material, leading to a better moist environment, a necessary condition for wound healing. We report our experience of treating three patients with complex wounds and associated noble structure exposition conservatively with NPWTi and flap coverage. In a long-term follow-up (5 years), we were able to achieve a stable surgery reconstruction on preserved limbs, without evidence of chronic infection and other sequelae or complications. Despite the fact that our experience is limited , as it is based on only a few cases, it suggests how NPWTi could be considered useful in a conservative approach to the treatment of acute complex wounds of the lower extremities. In these patients with high risk of amputation, a long-term follow-up becomes fundamental in order to evaluate wound bed status after NPTWi.
authors.affiliation: Department of General and Specialistic Surgery, Division of Plastic and Reconstructive Surgery, Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy. info@danielebollero.it.
authors.forename: Daniele
authors.initials: D
authors.lastname: Bollero
authors.affiliation: Department of General and Specialistic Surgery, Division of Plastic and Reconstructive Surgery, Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy.
authors.forename: Kiran
authors.initials: K
authors.lastname: Degano
authors.affiliation: Department of General and Specialistic Surgery, Division of Plastic and Reconstructive Surgery, Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy.
authors.forename: Ezio N
authors.initials: EN
authors.lastname: Gangemi
authors.affiliation: Department of Orthopaedics Surgery, Division of Muscular-Skeletal Traumatology, AOU Città della Salute, CTO Hospital, Turin, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Aloj
authors.affiliation: Department of General and Specialistic Surgery, Division of Plastic and Reconstructive Surgery, Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Malvasio
authors.affiliation: Department of General and Specialistic Surgery, Division of Plastic and Reconstructive Surgery, Burn Center, AOU Città della Salute, CTO Hospital, Turin, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Stella
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D023821:Limb Salvage / Q000379:methods*; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D007507:Therapeutic Irrigation; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology*; D014946:Wound Infection / Q000628:therapy*; D055815:Young Adult
keywords: Amputation; Instillation; Limb salvage; Negative pressure; Wound healing