Authors (including presenting author) :
Lau SM (1), Shit KYF (2), Lau WY (1)
Affiliation :
(1) Department of Surgery, North District Hospital
(2) NTEC Wound Services Team, Department of Surgery, Prince of Wales Hospital
Introduction :
Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWT-id) is an advanced wound care modality that combines negative pressure therapy with the intermittent introduction of instillation solutions into the wound bed for cleansing. In this case, a 64-year-old male with a history of Fournier gangrene, chronic kidney disease and Diabetes Mellitus was undergone excisional debridement of wound in operation theater on 14 November, 2022. The wound was sized 248cm2 with undermining up to 3cm and exposed organs (testis). The wound was initially managed by daily wound dressing with packing of gauze roll. However, the wound size remained unchanged and more sloughy tissue was developed. With collaboration of surgeon, NPWT-id was considered to mange this complex perineal wound.
Objectives :
This case report aims to highlight the potential benefits of NPWT-id as a valuable adjunctive therapy in managing complex perineal wounds.
Methodology :
Team approach to the case management involved collaboration among surgeons and NTEC Wound Services Team nurse consultant to decide the regime of NPWT-id.
In the 1st phase of treatment, the instillation setting was 24ml NS with soaking time 5 minutes every 4 hours. The pressure was set at 125mmHg. 2 days after the commencement of NPWT-id, the volume of instilled solution was increased to 40ml.
In the 2nd phase of treatment, the instillation solution was changed into Granudacyn wound cleanser as wound culture after 1st phase of NPWT-id showed heavy growth of Pseudomonas aeruginosa, scanty growth of Enterococcus faecalis and Bacteroides species. Regular wound assessments were performed to monitor progress. After two phases of NPWT-id, the wound demonstrated significant improvements.
Result & Outcome :
The use of NPWT-id in the management of the complex perineal wound led to successful wound healing. The wound size reduced to 204cm2 with no undermining. The patient was reviewed by plastic surgeons and skin graft was performed on 19 December 2022. Follow-up evaluations demonstrated excellent wound healing outcomes with no signs of infection or complications.
The successful management of complex perineal wounds can be challenging, requiring innovative and comprehensive approaches. This case report highlights the successful use of NPWT-id as an adjunctive therapy in the management of a complex perineal wound.
