Kimberley Leow1, Jackie Tey1, Aprine Tan2, Kimberly Tan3, Keng Lin Wong4. 1. Department of Podiatry, Sengkang General Hospital, Singapore. 2. Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore. 3. Department of Podiatry, Sengkang General Hospital, Sengkang, Singapore. 4. Department of Orthopaedic Surgery, Sengkang General Hospital, Singapore; Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Musculoskeletal Sciences Academic Clinical Programme, Duke-NUS Medical School, Singapore.
Abstract
BACKGROUND: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an integrated system that combines conventional NPWT with an irrigation feature. Wound size and location of diabetic foot wounds may make NPWTi-d utilization difficult, commonly resulting in leakages and blockages. OBJECTIVE: This study evaluates the effectiveness of a novel waterfall technique, a modification of the usual bridging used during NPWTi-d application, to facilitate the channeling of instillation fluid into diabetic foot wounds with small entry points. MATERIALS AND METHODS: A literature review of NPWTi-d use in the treatment of infected diabetic foot wounds and a case series of 9 patients with infected diabetic foot wounds who were admitted to a tertiary health care institution from September 2019 to May 2020 were carried out. RESULTS: Six patients were male and 3 were female, with a median age of 56 years (range, 45-67 years). All patients underwent a surgical procedure of the infected foot wounds (7 minor ray amputations, 2 wound debridements). All resultant wounds were ray amputation wounds over the metatarsals, except for one wound over the plantar midfoot. Wound sizes ranged from 2 cm x 4 cm x 4 cm to 11 cm x 4 cm x 8 cm. Median duration from surgery to initialization of NPWTi-d was 2 days (range, 1-22 days). Only 1 case reported a leak in NPWTi-d, which was resolved with minor adjustments and without changing the dressing in its entirety; no incidents of blockage were encountered. None of the patients required repeat surgical debridement during index hospitalization, and full epithelialization was achieved in 88.9% of patients. CONCLUSIONS: The waterfall technique ensures placement of the NPWTi-d tubing pad in a dependent position to improve flow of instillation fluid with minimal risk of leakage or blockage.
BACKGROUND: Negative pressure wound therapy with instillation and dwell time (NPWTi-d) is an integrated system that combines conventional NPWT with an irrigation feature. Wound size and location of diabetic foot wounds may make NPWTi-d utilization difficult, commonly resulting in leakages and blockages. OBJECTIVE: This study evaluates the effectiveness of a novel waterfall technique, a modification of the usual bridging used during NPWTi-d application, to facilitate the channeling of instillation fluid into diabetic foot wounds with small entry points. MATERIALS AND METHODS: A literature review of NPWTi-d use in the treatment of infected diabetic foot wounds and a case series of 9 patients with infected diabetic foot wounds who were admitted to a tertiary health care institution from September 2019 to May 2020 were carried out. RESULTS: Six patients were male and 3 were female, with a median age of 56 years (range, 45-67 years). All patients underwent a surgical procedure of the infected foot wounds (7 minor ray amputations, 2 wound debridements). All resultant wounds were ray amputation wounds over the metatarsals, except for one wound over the plantar midfoot. Wound sizes ranged from 2 cm x 4 cm x 4 cm to 11 cm x 4 cm x 8 cm. Median duration from surgery to initialization of NPWTi-d was 2 days (range, 1-22 days). Only 1 case reported a leak in NPWTi-d, which was resolved with minor adjustments and without changing the dressing in its entirety; no incidents of blockage were encountered. None of the patients required repeat surgical debridement during index hospitalization, and full epithelialization was achieved in 88.9% of patients. CONCLUSIONS: The waterfall technique ensures placement of the NPWTi-d tubing pad in a dependent position to improve flow of instillation fluid with minimal risk of leakage or blockage.