clinical evidence with v.a.c. veraflo therapy & dermatac

Clinical Evidence With V.A.C. VERAFLO™ Therapy & DERMATAC™ Drape Use With V.A.C.® Therapy

Posters Presented at SAWC Spring 2020

Frequency of Surgical Debridement During Use of Negative Pressure Wound Therapy with Instillation* Versus Control: Systematic Review and Meta-Analysis1

Allen Gabriel, MD, FACS1, Paul Kim, DPM2, Mark Camardo, MS3

1Private Practice, Vancouver, WA; 2UT Southwestern Medical Center, Dallas, TX; 33M, San Antonio, TX

Presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society: A Virtual Experience, July 24-26, 2020

NOTE: Specific indications, contraindications, warnings and precautions, and safety information exist for these products and therapies. Please consult product labeling prior to use.

*V.A.C. VERAFLO™ Therapy, KCI, now part of 3M Company.The authors thank 3M for poster preparation and production.

Introduction• Large randomized, controlled trials that evaluate the effects of negative

pressure wound therapy with instillation of a topical solution and dwell time (NPWTi-d) are lacking.

• There is a need to synthesize existing data across multiple studies to provide a more precise estimate of the clinical effects of NPWTi-d.

Methods

Purpose• A systematic literature review and meta-analysis of comparative studies

were performed to determine the effects of NPWTi-d* versus control therapy in the adjunctive management of complex wounds.

• We performed a systematic literature review and meta-analysis according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

• Weighted standardized mean difference or odds ratios and 95% confidence intervals were calculated to pool study and control group results in each publication for analysis.

• Thirteen studies comprising 720 patients1-13 were included in the analysis.

NPWTi-d, when used in conjunction with good clinical practice (e.g., debridement, appropriate antibiotics), was more beneficial than the comparator with respect to number of surgical debridements during therapy, time to readiness for final wound closure, duration of therapy, number of wounds closed, and number of patients with reduced bacterial bioburden.

Conclusions

Outcome or Subgroup Studies Subjects/Wounds

Standardized means across

studies

Effect EstimateStd Mean

Difference (95% CI)

Odds Ratio(95% CI)

p-value I2

NPWTi Control

Number of surgical debridements 7 495 2.23 3.07 -0.84 (-1.51, -0.17) N/A 0.01 91%

Time to final surgical procedure (days) 8 525 3.02 4.16 -1.14 (-2.17, -0.12) N/A 0.03 96%

Length of therapy (days) 4 183 1.52 3.49 -1.97 (-3.75, -0.19) N/A 0.03 95%

Number of wounds closed 6 413 -- -- N/A 2.39 (1.22, 4.68) 0.01 10%

Subjects with bacterial count reduction 2 86 -- -- N/A 4.40 (1.65, 11.7) 0.0003 0%

Length of hospital stay (days) 3 254 1.17 3.28 -2.11 (-4.35, 0.13) N/A 0.06 97%

• Endpoint results of the meta-analysis are shown in Table 1.

• Significantly fewer surgical debridements were performed in NPWTi-d patients versus control patients (p=0.01) (Figure 1).

• Wounds in the NPWTi-d group were ready for closure faster than control wounds (p=0.03) (Figure 2).

• The odds of reducing bacterial count from baseline in the NPWTi-d group was 4.4 times greater than control group wounds (p=0.003) (Figure 3).

• Percent reduction of bacterial count in NPWTi-d wounds was evident in all studies that captured that endpoint (Figure 4).

• Wounds in NPWTi-d group were 2.39 times more likely to close than control group wounds (p=0.01).

• There was a significantly shorter length of therapy in NPWTi-d patients versus control patients (1.5 days vs 3.5 days, p=0.03).

Results

Results (Cont’d) Results (Cont’d)

References1. Chowdhry SA, Wilhelmi BJ. PRS Global Open. 2019 Jan 4;7(1):e2087.2. Daeschlein G, Napp M, Lutze S, et al. Wound Medicine. 2016 Jun;13:5-11.3. DeFazio MV, Economides JM, Anghel EL, et al. Wounds. 2017 Oct;29(10):289-

296.4. Gabriel A., Shores J, Heinrich C, et al. Int Wound J. 2008; 5(3):399-413.5. Gabriel A, Kahn K, Karmy-Jones R. Eplasty. 2014 Nov 3;14:e41.6. Garcia-Ruano A, Deleyto E, Garcia-Fernandez S. Journal of Surgical Research.

2016 Dec;206(2):292-7.7. Goss SG, Schwartz JA, Facchin F, et al. J Am College Clinical Wound Specialists.

2014;4:74-80.

8. Jurkovic A, Bartos J, Bencurik V, et al. Rozhledy v Chirurgii. 2019 Spring;98(4):152-158.

9. Kim PJ, Attinger CE, Steinberg JS, Evans KK, Powers KA, et al. Plastic and Reconstructive Surgery. 2014 Mar;133(3):709-16.

10. Kim PJ, Lavery LA, Galiano RD, et al. Int Wound J. In press. 202011. Omar M, Gathen M, Liodakis E, et al. J Wound Care. 2016 Aug;25(8):475-8.12. Timmers MS, Graafland N, Bernards AT, et al. Wound Repair Regen.

2009;17:278-286.13. Yang C, Goss SG, Alcantara S, et al. Wounds. 2017;29:240-246.

Figure 1. Number of surgical debridements (Forest plot: NPWTi-d vs Control).

Figure 2. Time to wound readiness for closure (Forest plot: NPWTi-d vs Control).

Figure 4. Bioburden level percent change from baseline (CFU/gram).

Table 1. Meta-analysis endpoint results.

Figure 3. Number of subjects with bacterial count reduction (Forest plot: NPWTi-d vs Control).

-21

-37

16

-37

14

-43

Daeschlein 2016

Goss 2014

Kim 2014

Yang 2017

Percent Change in Bacterial Culture

-28

-60 -40-80 -20 0 20

Tissue culture change

TreatmentInstillation

Control

-87

Early-Stage Management of Wounds With Nonviable Tissue Using Negative Pressure Wound Therapy With Instillation2 Saeed A. Chowdhry, MD, FACS

Rosalind Franklin University of Medicine and Science, Chicago Medical School, Chicago, IL

Introduction• Early-stage cleansing and debridement have long been known as crucial steps in treatment

wounds,1 since nonviable tissue and slough can delay healing.

• Negative pressure wound therapy with instillation and dwell time (NPWTi-d*) − the cyclic delivery, dwell, and removal of topical wound solutions − using a reticulated open-cell foam dressing with through holes (ROCF-CC†) was reported to aid in loosening and removing thick exudate such as slough and nonviable tissue from wounds.2

Purpose• In this study, we describe the adjunctive use of NPWTi-d between surgical debridements in

7 patients (3 females and 4 males).

Methods• After initial surgical debridement, NPWTi-d using ROCF-CC dressings was used on 4 patients,

and NPWTi-d using ROCF dressing without through holes (ROCF-V‡) was used for 3 patients.

• NPWTi-d consisted of the following:

– Instillation of Dakin’s solution (1/8-strength)

– A 20-minute dwell time, followed by

– Negative pressure at -125 mmHg for 2 hours

• The total duration of NPWTi-d ranged from 6-10 days with ROCF dressings changed every 2-3 days.

– Surgical debridement was performed at dressing changes.

• Antibiotics were prescribed for 3 patients with positive bacterial cultures.

Conclusions• In these cases, the adjunctive use of NPWTi-d was a viable option in the early-stage management

of wounds, potentially helping to reduce the surface area of the wound that required surgical debridement.

• In addition, the use of NPWTi-d in these cases allowed us to be selective and targeted in our approach to surgical debridement.

Presented at Symposium on Advanced Wound Care/Wound Healing Society: A Virtual Experience, July 24-26, 2020

The authors thank 3M for poster preparation and production.

*V.A.C. VERAFLO™ Therapy; †V.A.C. VERAFLO CLEANSE CHOICE™ Dressing; ‡ V.A.C. VERAFLO™ Dressing (KCI, San Antonio, TX)NOTE: Specific indications, contraindications, warnings and precautions, and safety information may exist for these products and therapies. Please consult product labeling prior to use.

Results• The mean patient age was 40 ± 11.4 years (Table 1).

• Comorbidities included hypertension and diabetes mellitus (Table 1).

• Wound types included post-surgical and trauma wounds.

• The initial wound surface area that required debridement before NPWTi-d was 243.4 ± 117.4 cm2, while the final area, after NPWTi-d, requiring debridement was 74.3 ± 20.9 cm2 (Figure 1).

• After NPWTi-d was discontinued, 4 wounds were closed with flap reconstruction, and 3 wounds were covered with split-thickness skin grafts (STSGs).

• Complete wound closure was achieved in each case (Figures 2-4).

Degloving Injury of Lower Left Leg. A 42-year-old male presented following a construction accident involving a bulldozer. The patient suffered a degloving injury to the left posterior calf and foot. The patient was initially evaluated by the orthopedic surgery department before transfer to plastic surgery care. ROCF-CC dressings were applied for 4 days. Wound closure was achieved with skin graft reconstruction.

Representative Cases

Necrotizing Soft Tissue Infection. A 53-year-old female, with a history of morbid obesity, diabetes mellitus, hypertension, and hyperlipidemia, presented for care with a necrotizing soft tissue infection of the left groin. Initial debridement was performed by the General Surgery service but a subsequent STSG failed. Antibiotics were administered throughout NPWTi-d use. After 3 days of NPWTi-d, the patient underwent a skin graft reconstruction.

Sternotomy Revision. A 44-year-old male, with a medical history of coronary artery disease, previous myocardial infarction, morbid obesity, diabetes mellitus, hyperlipidemia, and prior coronary artery bypass graft, presented with sternal dehiscence and subsequent infection. Antibiotics were administered throughout NPWTi-d use. ROCF-V dressings were used for 3 days then ROCF-CC dressings were applied. After 3 days of NPWTi-d with ROCF-CC Dressings, targeted excision of nonviable tissue was performed followed by wound closure with a muscle flap reconstruction.

References1. Attinger CE, Bulan EJ. Foot Ankle Clinics. 2001;6(4):627-660.

2. Téot L, Boissiere F, Fluieraru S. Int Wound J. 2017;14(5):842-848.

Initial debridement

Final debridement

0

100

200

300

400

Surf

ace

area

deb

rided

(cm

2 )

Size of Debridement

Figure 1. Size of surface area debrided.

Parameter n=7

Age (Years)

Mean ± SD40.00 ±

11.43Sex, n

Female 3

Male 4

Comorbidities/Medical History, n

Diabetes Mellitus 2

Hypertension 2

Asthma 1 Chronic Obstructive Pulmonary Disease

1

Coronary Artery Disease 1

Hyperlipidemia 1

Wound Type, n

Post-surgical 3

Trauma 4

Dressing Changes/Debridements, n

Mean ± SD 2.71 ± 0.76

Results (Cont’d)Table 1. Patient and wound characteristics

SD = Standard deviation

Figure 2A. Wound at presentation (Day 1)

Figure 2B. Wound on Day 7, before debridement

Figure 2C. Wound on Day 7, after debridement

Figure 2D. Wound after 4 days of NPWTi-d with ROCF-CC dressings

Figure 2E. Lower left leg 6 weeks after skin graft reconstruction

Figure 3A. Wound at presentation to Plastic Surgery (Day 1)

Figure 3B. Application of NPWTi-d using ROCF-CC dressings (Day 1)

Figure 3C. Wound after 3 days of NPWTi-d

Figure 3D. Left groin region 16 weeks after skin graft reconstruction

Figure 4A. Wound at presentation to Plastic Surgery (Day 1)

Figure 4B. Application of NPWTi-d using ROCF-V dressings

Figure 4C. Wound after 3 days of NPWTi-d with ROCF-V dressings

Figure 4D. Application of NPWTi-d using ROCF-CC dressings (Day 3)

Figure 4E. Wound after 3 days of NPWTi-d with ROCF-CC dressings (Day 6)

Wound Bed Preparation of Lower Extremity Wounds Using Negative Pressure Wound Therapy With Instillation: Taking Cost Into Consideration3

Ralph J. Napolitano, Jr., DPM, CWSP, FACFAS; OrthoNeuro, Columbus, OH

Presented at the Symposium on Advanced Wound Care/Wound Healing Society, July 22-26, 2020NOTE: Specific indications, contraindications, warnings and precautions, and safety information exist for these products and therapies. Please consult product labeling prior to use.

*V.A.C. VERAFLO™ Therapy, †V.A.C.® Therapy (KCI, San Antonio, TX)

The author wishes to thank 3M for the preparation and production of this poster.

Background• Use of negative pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d*)

to deliver, dwell, and remove topical solutions from the wound bed can assist health care practitioners in preparing a clean surface for successful closure.

• By promoting wound healing, NPWT technologies have the potential to help reduce the total treatment-associated costs over conventional therapies, despite having a higher unit price.1-3

Purpose• We present our experience using NPWTi-d* to manage lower extremity wounds in 3 patients

and discuss the feasibility of improving cost efficiency.

Methods• All patients underwent surgical debridement and partial closure with sutures.

• NPWTi-d was applied for 6-7 days in a traditional hospital inpatient setting.

• Normal saline was instilled into the wounds, with a dwell time of 5-10 minutes, followed by a 3.5-hour NPWT cycle at -125 mmHg.

• Dressings were changed every 2-3 days.

References1. Deleyto, E., Garcia-Ruano, A., Gonzalez-Lopez, J.R. Hernia. 2017.2. Gabriel, A., Kahn, K., Karmy-Jones, R. Eplasty. 2014; 14: e41.3. Driver, V.R., Eckert, K.A., Carter, M.J., French, M.A. Wound Repair Regen. 2016; 24: 6, 1041-1058.4. Ban KA, Minei JP, Laronga C, et al. 2017;224(1):59-74.5. Health Forum, 1999 - 2018 AHA Annual Survey. In: AHA Hospital Statistics™. 2019. < https://www.kff.org/health-

costs/state-indicator/expenses-per-inpatient-day-by-ownership>

Conclusion• In these patients, use of NPWTi-d assisted in cleansing the wound surface and produced a

positive healing outcome.

• Patients 1 and 2 had a single operation whereas patient 3 required a second surgery for complete delayed closure. None required readmission, potentially saving on time and cost.

• On average, complications such as surgical site infection extend hospital stay by 9.7 days.4 In a private, non-profit hospital in Ohio, the hospital adjusted expenses per inpatient day is $2,842, meaning a 9 to 10-day extension of hospital stay would cost an additional $25,578 to $28,842.5 Providing adequate wound management that supports complication-free recovery can help reduce costs sustained by both hospital and patient.

Figure 3. Flap dehiscence after right below knee amputation. A) Wound at presentation. B) Application of NPWTi-d after flap revision and surgical debridement. C) Flap closure after 6 days of NPWTi-d. D) Follow-up at 1 month.

Results• In each case, extensive wound bed preparation was required.

• Patient 1 was a 83-year-old male with mild comorbidities that presented with a crush injury resulting in a gelatinous hematoma and soft tissue necrosis of the right medial calf (Figure 1).

• Patient 2 was a 51-year-old male with multiple sclerosis and profound lower extremity lymphedema, who presented with a deep tissue injury and tissue loss of the right medial calf (Figure 2).

• Patient 3 was a 65-year-old female with recurrent right foot diabetic ulcers and infection ultimately requiring below knee amputation. She developed a dehiscence at the amputation site 2 weeks after the amputation surgery (Figure 3).

• Upon discharge from the hospital, Patients 1 and 2 were transitioned to conventional NPWT† for 3 weeks; Patient 3 underwent primary closure.

• Upon follow-up 2-6 months later, all wounds were closed with no signs of complication.

Results (Cont'd) Results (Cont'd)Table 1. Patient characteristics and treatment outcomes.

Case Sex Age Comorbidities Wound Type Outcome Follow-Up

1 M 83Hypertension, coronary artery disease, venous

insufficiency

Right leg contusion with

gelatinous hematoma

Transitioned to NPWT, closed

5 months (no complications)

2 M 51

Multiple sclerosis, limb girdle weakness,

profound lymphedema, wheelchair bound

Deep tissue injury

Transitioned to NPWT, discharged

to SNF

4 months (no complications)

3 F 65Recurrent diabetic foot

ulcers, progressive vasculopathy

Dehisced right below knee amputation

Flap closure2 months

(no complications)

NPWT = negative pressure wound therapy, SNF = skilled nursing facility

Figure 1. Traumatic injury with gelatinous hematoma. A) Wound at presentation. B) Application of NPWTi-d after surgical debridement. C) Wound after 10 days of NPWTi-d. D) Complete wound healing and return to normal function at 6 months. Initial amputation surgery and performed by Nicholas A. Cheney, D.O., OrthoNeuro, Columbus, Ohio.

Figure 2. Deep tissue injury of the right leg. A) Wound at presentation. B) Wound after surgical debridement and partial closure. C) Wound after 6 days of NPWTi-d. D) Completed healing after 1 week of NPWTi-d, followed by 3 weeks of conventional NPWT.

A B C D

A B C D

A CB D

Acknowledgements• Nicholas A. Cheney, DO (OrthoNeuro, Columbus, OH) provided initial surgical care for case 3.

Management of Nonviable Tissue Buildup in Abdominal Wounds4 Mary Anne R. Obst, RN, BSN, CWON; Michael D. Kalos, BSN, RN, CWOCN; Kaitlin Nelson BSN, RN, PHN, CWOCN

Regions Hospital, St. Paul, MN

*V.A.C.® Therapy; †V.A.C. VERAFLO™ Therapy; ‡V.A.C. VERAFLO CLEANSE CHOICE™ Dressing (KCI, San Antonio, TX)

The authors thank 3M for assistance with the preparation and production of this poster.

Introduction• In cases where full closure is not achieved after open abdominal surgery, patients are left

with open cutaneous wounds with knotted, heavy sutures at the wound base, providing fascial closure.

• The goal for these wounds is secondary wound closure; however, nonviable tissue and slough readily develops around the suture knots and delays healing.

• Repetitive sharp debridement is needed to remove the nonviable tissue, so minimizing nonviable tissue buildup would benefit patients tremendously.

Methods• The patients were divided into two groups: NPWT and NPWTi-d with ROCF-CC.

• In the NPWT group, 11 patients received continuous NPWT at -125 mmHg.

• In the NWPTi-d group, 9 patients received NPWTi-d using ROCF-CC dressings. Normal saline (30-60 mL) was instilled onto the wounds with a dwell time of 10 minutes followed by 3.5 hours of NPWT at -125 mmHg. No saline was able to enter the abdominal cavity.

• In both groups, dressings were changed 2-3 times per week.

• Group characteristics are shown in Table 1.

Purpose• At our hospital, negative pressure wound therapy (NPWT*) is the standard care for

managing closure of abdominal wounds. However, NPWT with instillation and dwell time (NPWTi-d†) using a reticulated open-cell foam dressing with through holes (ROCF-CC‡) has shown advantages over conventional NPWT in multiple wound types.

• In this study, we retrospectively compared the impact of these two forms of negative pressure therapies on the outcomes of patients undergoing abdominal surgical repair.

Representative Cases (NPWTi-d Group) Results• The fascial closure remained intact in both groups.

• A summary of patient outcomes for each group is shown in Table 2.

• In the NPWT group, 100% of patients developed nonviable tissue, requiring up to 23 weekly postoperative sharp debridements. In the NPWTi-d group, no patients experienced nonviable tissue buildup (P<.001).

• After negative pressure therapy, all patients in the NPWT group required at least one debridement to remove nonviable tissue. No sharp debridements were required (P=.001).

• The number of days to wound healing was significantly fewer in the NPWTi-d group compared to the NPWT group (P=0.028)

• Representative cases are shown in Figures 1-3.

Table 1. Patient demographics & wound types.

CharacteristicsNPWTn=11

NPWTi-d with ROCF-CCn=9

P-value

Age (years), mean ± SD 57.0 ± 14.6 55.0 ± 17.0 .780

Sex, nMaleFemale

65

90

Wound size (cm3), median (range)

270 (90-1680) 172.6 (45-744) .445

NPWT = negative pressure wound therapy; NPWTi-d = NPWT with instillation and dwell time; ROCF-CC = reticulated open cell foam dressing with through-holes; SD = standard deviation

Table 2. Procedures & patient outcomes.

Procedure/OutcomeNPWTn=11

NPWTi-d with ROCF-CCn=9

P-value

Nonviable tissue formation, n 11 0 <.001

Number of debridements,mean ± SD

3.13 ± 1.73 0.0 ± 0.0 .001

Days to healing, mean ± SD 163.9 ± 109.0 63.3 ± 44.4 .028

Figure 1. Abdominal wound after fascial closure. Panels A-C show three separate patients with visible buildup of nonviable tissue at the wound base needing repetitive sharp debridement and delayed wound healing.

Presented at the Symposium on Advanced Wound Care/Wound Healing Society: A Virtual Experience, July 24-26, 2020


NPWT = negative pressure wound therapy; NPWTi-d = NPWT with instillation and dwell time; ROCF-CC = reticulated open cell foam dressing with through holes; SD = standard deviation

A B C

A B C

A B C

Figure 2. (A) Abdominal closure after fistula repair and abdominal wall reconstruction - note knotted suture at base. (B) Placement of ROCF-CC dressing immediately after repair. (C) Full healing without any sharp debridement, 51 days to complete healing.

Figure 3. (A) Abdominal wound after traumatic injury, with closed fascia. (B) Placement of ROCF-CC dressings. (C) Healed wound at 3-month follow-up.

Conclusions• In this patient population, use of NPWTi-d with ROCF-CC over abdominal wounds was

associated with a significant reduction in nonviable tissue, fewer debridements, and a shorter time to healing.

• NPWTi-d using ROCF-CC dressings is a valid option for helping manage abdominal wounds with heavy sutures applied, which prevents instillation solution from entering the abdominal cavity (instillation into the open abdomen is contraindicated by the manufacturer).

• The author now uses NPWTi-d with ROCF-CC dressings to cleanse complex wounds that are at risk for development of nonviable tissue.

Representative Cases (NPWT Group)

Cleansing Trauma Wounds Using Negative Pressure Wound Therapy With Instillation and Dwell Time5 Elizabeth Faust, MSN, CRNP, CWS, CWOCN-AP, DAPWCA

Reading Hospital, West Reading, PA

Presented at the Symposium on Advanced Wound Care/Wound Healing Society: A Virtual Experience, July 24-26, 2020


*V.A.C.® Therapy, †V.A.C. VERAFLO™ Therapy (KCI, San Antonio, TX)


Introduction• Negative pressure wound therapy (NPWT) combined with the instillation and

dwelling (NPWTi-d) of topical wound solutions onto the wound bed enables wound cleansing via the solubilization and removal of infectious materials from the wound surface.

Purpose• We present a case series demonstrating the use of NPWTi-d in the management of

3 trauma wounds.

Methods• In all cases, patients received antibiotics.

• Debridements or incision & drainage were performed as necessary.

• Patients 1 and 3 were initially treated with conventional NPWT*.

• All patients were treated with NPWTi-d†, instilling normal saline with a dwell time of 5-10 minutes, followed by 2-3.5 hours of -125 mmHg negative pressure.

• Dressing changes were performed every 72 hours.

Case 1. A 41-year-old male with diabetes and history of tobacco use presented with necrotizing soft tissue infection.

A. Wound after debridement of the right arm and chest.

Case 2. A 66-year-old female with hypertension, past abdominal surgery, and recent tobacco use presenting with worsening flank edema after a fall 2 weeks prior.

A. Patient at presentation with flank edema.

B. Wound appearance after incision and drainage of 700 cc of purulence.

Conclusion• The use of NPWTi-d in the management of these trauma wounds supported wound

healing in these patients.

Results• Patient 1 (Case 1) was a 41-year-old male with a history of opioid abuse and type

II diabetes, who presented to the emergency department after a motor vehicle collision. In addition to bilateral rib fractures and hemoperitoneum without solid organ injuries, he was found to have a 3-day old wound with purulent drainage on the ventral aspect of the right forearm, which, upon examination, revealed a necrotizing soft tissue infection.

• Patient 2 (Case 2) was a 66-year-old female with a history of hypertension, smoking, and past abdominal surgery, who presented with 2-week-old fall injury with worsening flank edema and swelling.

C. Wound after periodic wash-outs, NPWTi-d for 2 weeks, followed by NPWT for 5 days.

B. Wound after conventional NPWT (4 days), NPWTi-d (3 days), and return to NPWT until primary partial closure.

Case 3. A 85-year-old obese male with multiple serious comorbidities and previous surgeries presenting with a large right knee hematoma.

A. Hematoma with eschar requiring debridement and incision and drainage.

B. Wound after 3 days of conventional NPWT, 1 week of NPWTi-d, and placement of a split thickness skin graft.

• Patient 3 (Case 3) was an 84-year-old male with a history of cervical disc disease, degenerative joint disease, coronary artery disease, hepatitis, hyperlipidemia, hypertension, myocardial infarction, obesity, venous insufficiency, and multiple cardiac and orthopedic surgeries. He presented with a large right knee hematoma with superficial eschar.

• After 3-8 days of NPWTi-d, the patients transitioned to conventional NPWT to allow discharge from hospital and support eventual wound closure.

Results (Cont'd)Results (Cont'd)

Use of Negative Pressure Wound Therapy with Instillation and Closed Incision Negative Pressure Therapy for Complex, At-Risk Colorectal Patients: A Case Series6

Rosemary Hill, BSN, CWOCN, WOCC (C)Lions Gate Hospital, Vancouver Coastal Health, North Vancouver, BC, Canada

Presented at the Symposium on Advanced Wound Care/Wound Healing Society: A Virtual Experience, July 22-24, 2020NOTE: Specific indications, contraindications, warnings and precautions, and safety information exist for these products and therapies. Please consult product labeling prior to use.

*V.A.C. VERAFLO™ Therapy, †V.A.C. VERAFLO CLEANSE CHOICE™ Dressing, ‡PREVENA® Therapy (KCI, San Antonio, TX)


Introduction• Complex open infected wounds of varying etiology have benefited from negative

pressure wound therapy (NPWT) with instillation and dwell time (NPWTi-d*) using a reticulated open-cell foam dressing with through holes (ROCF-CC†), in conjunction with debridement and antibiotic therapy.1

• There are growing numbers of cases for using NPWTi-d with ROCF-CC dressing for complex wounds when debridement is not appropriate or readily available.2

• Colorectal surgical procedures are impacted by high rates of surgical site infections, as high as 45%.3

• decuder nwohs evah noitalupop siht nihtiw slairt dellortnoc dezimodnar tneceRcomplications compared to the standard of care when closed incision negative pressure therapy (ciNPT‡) is applied to closed incisions.

Methods• Three patients aged 58, 78, and 89 years, presented with wound infections (2 were

positive for methicillin-resistant Staphylococcus aureus) and need for debridement, received NPWTi-d using ROCF-CC.

– Instillation of saline with 5-minute dwell time, followed by 2-3 hours of NPWT over a 10 to 14-day period with dressing changes 3 times per week.

– These patients received antibiotics but were unable to undergo further surgical debridement.

• Three additional high-risk patients with rectal cancer (ages: 63, 84, and 94 years) received continuous ciNPT (-125 mmHg) over their closed surgical incision lines of the perineal region.

• Antibiotics were administered as needed in these patients.

Case 1. An 89-year-old male presenting with a right leg hematoma.

A. Knee at presentation.

Case 2. A patient presenting with a pressure ulcer and superficial and deep heavy growth methicillin resistant Staphylococcus aureus.

Conclusions• Consideration should be given to incorporate advanced technologies such as

NPWTi-d using ROCF-CC that help cleanse the wound bed and prepare the wound bed for eventual closure.

• Additionally, the use of ciNPT over closed incisions for patients at risk for dehiscence should be incorporated into patient care in the surgical setting.

Results (Cont'd)

References1. Gabriel A, Shores J, Heinrich C, et al. Negative pressure wound therapy with instillation: a pilot study

describing a new method for treating infected wounds. Int Wound J. 2008;5(3):399-413.

2. Kim PJ, Applewhite A, Dardano AN, et al. Use of a Novel Foam Dressing With Negative Pressure Wound Therapy and Instillation: Recommendations and Clinical Experience. Wounds. 2018;30(3 suppl):S1-S17.

3. Sahebally SM et al. Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery. I 2018 Nov; 153(11):e183467

B. Wound after surgical debridement.

C. Wound after 5 days of NPWTi-d with ROCF-CC dressing.

D. Wound after 1 week of NPWTi-d.

E. Wound after transitioning to 8 days of conventional NPWT.

F. Wound 3 weeks after closure with a split thickness skin graft.

A. Pressure injury at presentation.

B. Wound after initial surgical debridement.

C. Initiation of NPWTi-d with off-loading and antibiotic therapy.

D. Wound after 2 weeks of NPWTi-d.

Case 3. A 63-year-old patient with abdominal perineal resection for rectal tumor.

A. Incision with application of ciNPT.

B. Incision appearance after 7 days of ciNPT.

C. Healed incision at 6-week follow-up.

Results• Representative cases are shown in Cases 1-3.

• Wound bed preparation and removal of infectious material, such as slough, occurred in three cases with 90% granulation tissue noted before switching to portable NPWT.

• All closed incisions in perineal region remained approximated and closed permanently following 7 days of ciNPT.

• Health practitioners are challenged with patients who have multiple comorbidities and large wounds that require surgical debridement.

Purpose• We present a case series of 6 high-risk patients benefiting from the use of negative

pressure devices: 3 of whom received NPWTi-d with ROCF-CC and 3 who received ciNPT.

Results (Cont'd)

Use of a Novel Silicone-Acrylic Drape With Negative Pressure Wound Therapy in Anatomically Challenging Wounds7 Luis G. Fernández, MD, FACS, FASAS, FCPP, FCCM, FICS1; Marc R. Matthews, MD, MS, FACS2; Carol Benton, BSN, RN, CWON1; Rebecca Buresch, BSN, RN, CWCN1; Angela Sutherland, BSN, RN, CWCN1;

Natalie Tillison, RN1; Jenny Brooks, CNA, Wound Care Tech1

1University of Texas Health Science Center, Tyler, TX; University of Texas, Arlington, TX; University of North Texas, Fort Worth, TX; 2Burn Emergency Services, Respiratory Care Services, Arizona Burn Center, Maricopa Medical Center, University of Arizona College of Medicine, Phoenix, AZ

Background• Negative pressure wound therapy (NPWT*) utilizes a polyurethane drape with an

acrylic adhesive† over foam dressings to create a seal.

• In anatomically challenging areas, it can be difficult to create a seal without the use of ancillary products.

• Additionally, healthcare providers are often unable to remove and reposition the drape once it has been placed.

• A novel hybrid drape (HA-drape‡) consisting of a polyurethane film with acrylic adhesive and a silicone perforated layer has been developed for use with NPWT to allow for repositioning after initial placement and easy removal.

Purpose• This 6-patient case study reports on the use of the HA-drape with NPWT over

anatomically challenging wounds.

Methods• Three males and three females were treated with NPWT using the HA-drape.

• Dressing changes occurred every 2-3 days.

• Ease of application, repositioning, and ability to maintain a seal under negative pressure were evaluated by the healthcare providers following each dressing change.

• Intravenous and/or oral antibiotics were administered, if necessary.

Results (Cont’d)• During NPWT application, the HA-drape was repositioned 1-2 times without any

periwound skin irritation in a majority of wounds.

• Prior to the initial drape application, ancillary products such as skin prep ointment were applied to help create a seal.

– However, by the second or third HA-drape application, healthcare providers were no longer using ancillary products in 4/6 wounds.

• Amount of HA-drape overlap used in 11/17 dressing applications across the 6 wounds was less than 3 cm.

• None of the dressing applications (with or without ancillary products) resulted in NPWT seal leaks.

Conclusions• In these patients, healthcare providers were able to:

– Reposition the HA-drape upon initial placement without periwound skin irritation.

– Successfully create a negative pressure seal without the need of ancillary products in anatomically challenging wound locations.

Presented at Symposium on Advanced Wound Care/Wound Healing Society: A Virtual Experience, July 24-26, 2020

The authors thank 3M for poster preparation and production.

*V.A.C.® Therapy System with V.A.C.® GRANUFOAM™ Dressing, †V.A.C.® Drape, ‡DERMATAC™ Drape (KCI, San Antonio, TX)NOTE: Specific indications, contraindications, warnings and precautions, and safety information may exist for these products and therapies. Please consult product labeling prior to use.

Results• Wound types treated included trauma, abdominal wall abscess, infected femoral

popliteal bypass graft and site, transmetatarsal amputation, and below-the-knee amputation.

• Previous medical history included diabetes (type 1 and 2), hypertension, peripheral arterial disease, obesity, and chronic kidney disease (stage 4).

• Representative cases are shown in Figures 1-3.

Traumatic Wound. The patient presented for care with a traumatic wound (8.5 cm x 4 cm x 1 cm with a 2.5 cm tunnel) to the plantar surface of the right foot. Previous medical history included diabetes, hypertension, Klinefelter syndrome, neuropathy, peripheral artery disease, and polysubstance abuse. Sharp debridement was performed followed by application of NPWT with HA-drape.

Case Studies

Adominal Wall Abscess. The patient presented for care with left lower quadrant pain. Patient examination identified an anterior abdominal wall abscess with vesicocutaneous fistula. Previous medical history included stage 4 renal disease, urostomy, chronic metabolic acidosis, recurrent pancreatitis, and a previous abdominal surgery. The abscess was drained and NPWT with traditional drape was applied for 10 days, followed by transition to NPWT with HA-drape. The fistula was located outside of the drape field.

Figure 2a. Wound after removal of abdominal abscess

Figure 2b. Application of NPWT with HA-drape

Infected Femoral Popliteal Bypass Graft and Site. The patient presented for care with an infected femoral popliteal bypass graft and site. The groin wound measured 6.5 cm x 3.8 cm x 4 cm and the left lower extremity wound measured 10 cm x 3 cm x 4.2 cm. Previous medical history included diabetes, hyperlipidemia, coronary artery disease, and peripheral artery disease. Oral antibiotics were administered followed by sharp debridement and application of NPWT with HA-drape.

Case Studies (Cont’d)

Figure 3a. Wounds after sharp debridement (groin wound on left, left lower extremity wound on right)

Figure 3b. Application of NPWT with HA-drape

Figure 3c. Close up image of NPWT with HA-drape application on groin wound

Figure 1a. Wound at presentation

Figure 1b. Application of NPWT with HA-drape (lateral view)

Figure 1c. Application of NPWT with HA-drape (plantar surface view)

Use of a Novel Silicone-Acrylic Drape With Negative Pressure Wound Therapy in Four Patients With Periwound Skin Breakdown8

Emily Greenstein, APRN, CNP, CWON, FACCWS; Nancy Moore, MSN, RN, CWON Sanford Health, Fargo, ND

Presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society: A Virtual Experience, July 24-26, 2020

The author thanks 3M for poster preparation and production.

*V.A.C.® Therapy, †V.A.C.® Drape; ‡V.A.C. DERMATAC™ Drape, §V.A.C.® GRANUFOAM™ Dressing ; KCI, San Antonio, TX

NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for these products and therapies. Please consult product labeling prior to use.

Introduction• Negative pressure wound therapy (NPWT*) is applied using a foam dressing and an adhesive

acrylic drape† to create a seal.

• Removal of this drape can be painful and may play a role in periwound skin breakdown during dressing changes.

• A novel silicone-acrylic hybrid drape (HA-drape‡) has been developed for use with NPWT to allow for reposition following initial placement and easier removal.

Purpose• This 4-patient case series reports on the use of the HA-drape in patients who developed periwound

skin breakdown.

• The goal was to protect the periwound skin during NPWT while maintaining a seal on the dressing.

Methods• Four patients with mild to moderate periwound skin breakdown were selected to receive NPWT

with HA-drape.

• NPWT was applied utilizing a reticulated open cell foam dressing§ followed by placement of the HA-drape to create a seal.

• NPWT was initiated at -125 mmHg with dressing changes occurring every 2 days.

• Wound healing, periwound healing, and patient reported pain were assessed at dressing changes.

Figure 1a. Periwound skin prior to NPWT with HA-drape use.

Results

Conclusion• Patient demographics and previous medical history are shown in Table 1.

• All 4 patients showed significant periwound skin improvement after the first dressing change.

• All patients reported a decrease in the pain with dressing removal.

• Cases 1-3 are shown in Figures 1-3.• In these 4 patients, use of NPWT with the HA-drape resulted in an intact periwound with improved

periwound skin protection and reduced patient reported pain associated with dressing changes.

Case Number Age Sex Previous Medical History Wound Type

1 77 Male Above-the-Knee Amputation Stage 4 Pressure Injury

2 68 Male Paraplegia Stage 4 Pressure Injury

3 62 Female Hernia Repair Surgical

4 65 MaleExploratory Laparotomy for

Necrotizing PancreatitisSurgical

Table 1. Patient demographics

• A 77-year-old male with history of an above-the-knee amputation developed a Stage 4 pressure injury to the left thigh and buttock due to prolonged sitting.

• The wound underwent surgical debridement followed by application of NPWT.

• Initial NPWT use resulted in the development of periwound skin erythema and irritation.

• Reduction in periwound skin erythema and irritation was noted 2 days after HA-drape use was initiated.

• The periwound skin continued to show improvements throughout the NPWT with HA-drape use period.

Case 1

Figure 1b. Application of NPWT with HA-drape.

Figure 1c. Reduced periwound skin erythema and irritation 2 days after NPWT with HA-drape use.

Figure 1d. Continued periwound skin improvement after 4 days of NPWT with HA-drape use.

• A 68-year-old male with history of paraplegia developed a Stage 4 pressure injury to the coccyx, post failed rotational flap.

• Initial NPWT use resulted in the development of periwound skin erythema and irritation.

• Periwound skin erythema and irritation was reduced 2 days after HA-drape use was initiated.

• The periwound skin improvements continued throughout the NPWT with HA-drape use period.

Case 2

Results (Cont’d)

• A 62-year-old female with history of hernia repair complicated by infection developed a wound with an enterocutaneous fistula.

• Initial NPWT use with fistula isolation resulted in the development of periwound skin erythema and irritation.

• NPWT with HA-drape use over the wound with fistula isolation was initiated.

• Two days after NPWT with HA-drape use, periwound skin erythema and irritation was reduced.

• Continued improvements in the periwound skin were observed throughout the NPWT with HA-drape use period.

Case 3

Figure 2a. Wound prior to application of NPWT with HA-drape.


Figure 2c. Periwound skin after 2 days of NPWT with HA-drape use.

Figure 2d. Periwound skin after 4 days of NPWT with HA-drape use.

Figure 3f. Periwound skin after 21 days of NPWT with HA-drape use.

Figure 3e. Periwound skin after 4 days of NPWT with HA-drape use.

Figure 3d. Periwound skin after 2 days of NPWT with HA-drape use.

Figure 3c. Application of ostomy appliance over isolated fistula.


Figure 3a. Wound prior to NPWT with HA-drape use.

NOTE: Specific indications, contraindications, warnings, precautions and safety information exist for these products and therapies. Please consult a clinician and product instructions for use prior to application. Rx only.© 2020 3M. All Rights Reserved. 3M and the other marks shown are marks and/or registered marks. Unauthorized use prohibited. LIT#29-A-444 • PRA-PM-US-01580 (08/20)

To learn more about V.A.C. VERAFLO™ Therapy, please visit VERAFLO.com

This guide may be used in deciding which V.A.C. VERAFLO™ Dressing to use in conjunction with V.A.C. VERAFLO™ Therapy

V.A.C. VERAFLO™ Dressings V.A.C. VERAFLO™ Large Dressing V.A.C. VERAFLO CLEANSE™ Dressing V.A.C. VERAFLO CLEANSE CHOICE™ Dressing

Wound Characteristics

Open wounds, including wounds with shallow undermining or tunnel areas where the distal aspect is visible

Large open wounds, including wounds with shallow undermining or tunnel areas where the distal aspect is visible

Wounds with complex geometries, including explored tunnels or undermining where the distal aspect is not visible

Wounds with thick wound exudate, such as fibrin, slough, infectious material

Key Goal(s) of Therapy

• When used in conjunction with V.A.C. VERAFLO™ Therapy, to facilitate the removal of wound exudate and infectious material

• Generation of granulation tissue


• Generation of granulation tissue in large wounds


• Easy application into tunneling and undermining

• When used in conjunction with V.A.C. VERAFLO™ Therapy to help facilitate the removal of thick wound exudate, such as fibrin, slough, and other infectious material, to provide a wound cleansing option for clinicians when surgical debridement is delayed or is not possible or appropriate

Shape Spiral-cut foam Block foam pre-slit into two layers Tubular shape Block foam pre-slit into three layers

Application Characteristics

Easy application:• Size without scissors• Precut area for pad application when used for bridging• Single pad application

Easy application:• Ideal for large surfaces areas with shallow depths• Provided with V.A.C. VERAT.R.A.C. DUO™ Tube set for extended surface

area coverage

Application flexibility:• Ideal for addressing wounds with complex geometries (eg, tunnels,

undermining)• Single pad application

Easy application with flexibility:• Thin layers for improved conformability• Multiple layers provide application options for wounds with varying

depths• Ideal for wounds that require wound cleansing treatment prior to OR

debridement or for which OR debridement may not be immediately available

• Single pad application

V.A.C.ULTA™ Therapy System ordering information for VERAFLO™ Therapy

Part Number DescriptionULTDEV01/US V.A.C.ULTA™ Therapy Unit, United StatesULTVFL05SM V.A.C. VERAFLO™ Dressing, 5-pack, SmallULTVFL05MD V.A.C. VERAFLO™ Dressing, 5-pack, MediumULTVCL05MD V.A.C. VERAFLO CLEANSE™ Dressing, 5-pack, MediumULTVFL05LG V.A.C. VERAFLO™ Dressing, 5-pack, LargeULTLNK0500 V.A.C. VERALINK™ Cassette with 38mm Spikeable Cap Adapter, 5-packULTDUO0500 V.A.C. VERAT.R.A.C. DUO™ Tube Set, 5-pack400230 PRONTOSAN® Wound Irrigation with Adapter, case of 10M8275063/5 500ml INFOV.A.C.™ Canister with GelM8275093/5 1000ml INFOV.A.C.™ Large Canister with GelULTVCC05MD V.A.C. VERAFLO CLEANSE CHOICE™ Dressing Medium, 5-PackULTVCC05LG V.A.C. VERAFLO CLEANSE CHOICE™ Dressing Large, 5-Pack

V.A.C. VERAFLO™ Therapy Dressing selection guide

Indications for Use:The V.A.C.ULTA™ Therapy System is an integrated wound management system that provides Negative Pressure Wound Therapy with an instillation option. Negative Pressure Wound Therapy in the absence of instillation is intended to create an environment that promotes wound healing by secondary or tertiary (delayed primary) intention by preparing the wound bed for closure, reducing edema, promoting granulation tissue formation and perfusion, and by removing exudate and infectious material. The instillation option is indicated for patients who would benefit from vacuum assisted drainage and controlled delivery of topical wound treatment solutions and suspensions over the wound bed. The V.A.C.ULTA™ Therapy System with and without instillation is indicated for patients with chronic, acute, traumatic, sub-acute and dehisced wounds, partial thickness burns, ulcers (such as diabetic, pressure and venous insufficiency), flaps and grafts.

As with any case study, the results and outcomes should not be interpreted as a guarantee or warranty of similar results. Individual results may vary depending on the patient’s circumstances and condition.References: 1. Gabriel A, Kim P, Camardo M. Frequency of Surgical Debridement During Use of Negative Pressure Wound Therapy with Instillation Versus Control: Systematic Review and Meta-Analysis. Poster presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society:

A Virtual Experience, July 24-26, 2020.2. Chowdhry S. Early-Stage Management of Wounds With Nonviable Tissue Using Negative Pressure Wound Therapy With Instillation. Poster presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society:

A Virtual Experience, July 24-26, 2020.3. Napolitano R. Wound Bed Preparation of Lower Extremity Wounds Using Negative Pressure Wound Therapy With Instillation: Taking Cost Into Consideration. Poster presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society:

A Virtual Experience, July 24-26, 2020.4. Obst M, Kalos M, Nelson K. Management of Nonviable Tissue Buildup in Abdominal Wounds. Poster presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society: A Virtual Experience, July 24-26, 2020.5. Faust E. Cleansing Trauma Wounds Using Negative Pressure Wound Therapy With Instillation and Dwell Time. Poster presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society: A Virtual Experience, July 24-26, 2020.6. Fernandez L, Mathhews M, Benton C, et al. Use of a Novel Silicone-Acrylic Drape With Negative Pressure Wound Therapy in Anatomically Challenging Wounds. Poster presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society: A Virtual Experience, July

24-26, 2020.7. Greenstein E, Moore N. Use of a Novel Silicone-Acrylic Drape With Negative Pressure Wound Therapy in Four Patients With Periwound Skin Breakdown. Poster presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society: A Virtual Experience, July 24-26, 2020.8. Hill R. Use of Negative Pressure Wound Therapy with Instillation and Closed Incision Negative Pressure Therapy for Complex, At-Risk Colorectal Patients: A Case Series. Poster presented at the Symposium on Advanced Wound Care Spring/Wound Healing Society: A Virtual

Experience, July 24-26, 2020.

clinical evidence with v.a.c. veraflo therapy & dermatac

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