title: Negative Pressure Wound Therapy With Instillation: Review of Evidence and Recommendations.
abstract: Negative pressure wound therapy with instillation (NPWTi) and dwell time is an adjunctive treatment modality for selected complex wounds. Because of the greater amount of research now available, a multidisciplinary expert panel comprising the fields of podiatry, plastic and general surgery, burn treatment, infectious diseases, and orthopedics was convened on July 11, 2015, to produce a summary of the data and recommendations on the use of NPWTi. The panel members each reviewed available published literature on NPWTi in the PubMed, Cochrane, and Google Scholar databases from 1 January 2012 up until 20 July 2015 using the string search term negative pressure wound therapy instillation provided by the panel moderator; there were no restrictions on the language or type of publication. Panel members discussed their experiences and worked to reach consensus on several predefined topics. NPWTi was found to be most appropriate for properly selected complex hosts or wounds such as patients with multiple comorbidities, patients with an American Society of Anesthesiology Classification ≥ 2, severe traumatic wounds, diabetic foot infections, and wounds complicated by invasive infection or extensive biofilm. NPWTi should not be used routinely to treat simple wounds or hosts without comorbidities.There is evidence that when NPWTi is added to standard of care in properly selected cases it provides better overall clinical outcomes than standard of care alone, even when including NPWT. Based on published evidence and panel member experience, the Panel recommends a dwell time - fluid briefly instilled into the wound and allowed to diffuse for a user-specified time - of 10-20 minutes followed by 2-4 hours of negative pressure at -125 mmHg, although larger wounds may need times of up to 6 hours. Normal saline (0.9%) is the preferred solution for NPWTi, except in special situations. NPWTi with dwell time is an adjunct to other standard principles of appropriate wound assessment and treatment (e.g., debridement, pressure offloading, systemic antibiotic therapy, vascular assessment and revascularization when needed, or glycemic control).
authors.affiliation: Department of Plastic Surgery and Center for Wound Healing, MedStar Georgetown University Hospital, Washington, DC.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Kim
authors.affiliation: Department of Plastic Surgery, Medstar Georgetown University Hospital, Washington, DC.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Attinger
authors.affiliation: Department of Orthopedic Surgery, University of Missouri, Columbia, MO.
authors.forename: Brett D
authors.initials: BD
authors.lastname: Crist
authors.affiliation: PeaceHealth Medical Group Plastic Surgery, Vancouver, WA.
authors.forename: Allen
authors.initials: A
authors.lastname: Gabriel
authors.affiliation: Division of Plastic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Galiano
authors.affiliation: Loma Linda University Medical Center, Department of Plastic Surgery, Loma Linda, CA.
authors.forename: Subhas
authors.initials: S
authors.lastname: Gupta
authors.affiliation: St. Luke's-Roosevelt Hospital Center, New York, NY.
authors.forename: John C
authors.initials: JC
authors.lastname: Lantis Ii
authors.affiliation: Department of Plastic Surgery, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Lawrence
authors.initials: L
authors.lastname: Lavery
authors.affiliation: Division of Medical Sciences, University of Oxford, Oxford, UK.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lipsky
authors.affiliation: Wound Healing Unit and Burns Surgery, Montpellier University Hospital, Montpellier, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Teot
mesh_terms: D003646:Debridement / Q000379:methods*; D006801:Humans; D054843:Negative-Pressure Wound Therapy / Q000379:methods / Q000592:standards; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D007507:Therapeutic Irrigation / Q000379:methods*; D014945:Wound Healing; D014946:Wound Infection / Q000473:pathology / Q000628:therapy*; D014947:Wounds and Injuries / Q000473:pathology / Q000628:therapy*