Negative Pressure Wound Therapy with Instillation and Dwell Time in Patients on Hemodialysis

A Retrospective Study of 65 Cases

抄録

Background: Wound healing is challenging in patients on dialysis. Impaired immunocompetence makes these patients susceptible to infection, which prolongs hospital stays and shortens survival. Negative pressure wound therapy, especially with instillation and dwell time, is becoming established in wound care. This study compared the indications for and therapeutic effects of the different types of negative pressure wound therapy devices in patients on hemodialysis.
Methods: Patients on hemodialysis at our institution between September 2016 and December 2018 who developed skin wounds were retrospectively divided according to whether they received conventional negative pressure wound therapy (Group I) or negative pressure wound therapy with instillation and dwell time (Group II). Patient and wound characteristics, treatment regimens, and outcomes were compared between the groups.
Results: Sixty-five wounds occurred in 56 patients during the study period. There was no significant difference in comorbidities; however, the initial C-reactive protein value was significantly higher in Group II (2.3 vs. 0.9 mg/dl; P = 0.02), as was the increased positive wound culture rate. Group II included a range of wounds, including infected wounds in addition to diabetic foot ulcers. The wound closure rate was significantly higher in Group II (50.0% vs. 15.8%; P = 0.01), and the infection-related treatment cessation rate was lower. The mean duration of negative pressure wound therapy was longer in Group II.
Conclusions: Negative pressure wound therapy with instillation and dwell time can be used safely on wounds in patients on hemodialysis with a significantly higher wound healing rate than that achieved by conventional negative pressure wound therapy.