Case Study
Introduction. Negative-pressure wound therapy (NPWT) with instillation is a major advancement in the treatment of infected complex wounds. It adds the benefits of topical solution instillation to the known beneficial properties of negative-pressure therapy.
Methods. A 47 year-old female underwent abdominoplasty for skin laxity correction. The patient had no comorbidities, but she was a moderate smoker. She evolved with abdominal flap necrosis and wound dehiscence (Figure 1). She underwent dressing care with topical antibiotics (silver sulfadiazine) and performed hyperbaric oxygen therapy (10 sessions) with limited success. She was transferred to our facility in the 13th postoperative day. In the 14th postoperative day it was indicated a surgical debridement and negative-pressure wound therapy with instillation (Figure 2). The pressure device was set to 125 mmHg for 4 hours with instillation of normal saline in the intervals (20 ml for 20 minutes). A new debridement with Veraflo changing was performed in the 17th postoperative day. The would was in better conditions but with some debris. In the 20th postoperative day the patient was submitted to a surgical closure with bilateral local flap advancement (Figure 3).
Results. The closure was successful and the patient was discharged at the 27th postoperative day. The cultures at the day of the closure were negatives. After 2 weeks of the closure the patient was performing daily activities with restrictions (Figure 4). And after 4 weeks she was able to return to the previous activity level she had before the initial surgery.
Discussion. The properties of traditional NPWT are several such as stimulation of wound granulation, reduction of edema, reduction of excess fluid and wound debris and reduction of bacterial colonization in the wound. The association of NPWT with solution instillation has the potential to increase wound cleaning by debris removal, help in infectious combat by dilution of microorganisms and destruction of the biofilm. It appears that the NPWT with instillation’s greatest appeal, due to its properties, is in the case of complex, contaminated or infected wounds. In these cases, NPWTi has the potential to allow a smaller number of surgical interventions and to reach an earlier definitive wound closure.
Conclusion. The use of negative-pressure wound therapy with instillation was vital for the successful resolution of this aesthetic surgical complication in a short period of time.