Abstract
Background: When negative-pressure wound therapy is initiated, many chronic wounds may already contain non-removable contaminated tissues, leading to hesitation in the application of negative-pressure wound therapy. Negative-pressure wound therapy devices incorporating automated instillation, such as the V.A.C. Ulta Therapy System, are recommended for such wounds. However, we identified a limitation in effectively instilling the depths of wounds with pockets or in cases of dehisced median sternotomy wounds using existing systems. To address this issue, we developed a simple modification of the V.A.C. Ulta dressing kit that facilitates deep wound irrigation.
Materials and methods: A V.A.C. Ulta dressing kit was used for this method. The irrigation tube was cut, and the tip was wrapped in foam before being placed into the wound depth. Dressing of the wound was then performed according to the standard procedure, with attention to preventing leakage around the tubing.
Discussion: In cases where V.A.C. Ulta was applied without modification, we observed that, while the surface granulation tissue appeared to heal, the deeper areas remained unhealed. This is because of the existing system design, which instills and retrieves fluid from the wound surface. Our method will improve such wounds and is indicated for wounds with a narrow opening and deep, wounds forming deep pockets, and cases where negative-pressure wound therapy is needed while irrigating deep areas with necrotic bone or other contaminants.
Conclusion: Our new method, which allows for irrigation starting from the depth of the wound with fluid retrieval at the surface, maximizes the effectiveness of negative-pressure wound therapy and ensures comprehensive wound healing.
(a) Instillation fluid is introduced from the top of the wound. (b) The “soaking” phase. (c) The fluid is retrieved from the same upper location. (d) NPWTci can be likened to “continuous rinsing wash”. It functions like a river flow, with the fluid introduced at the upstream site and drainage collected downstream.
