Effectiveness of Negative Pressure Wound Therapy With Instillation and Dwell in Removing Nonviable Tissue, Promoting Granulation Tissue, and Reducing Surgical Debridements: A Systematic Literature Review.

Abstract

Surgical debridement is a common treatment for complex wounds but can present risks for patients. Negative pressure wound therapy with instillation and dwell (NPWTi-d) using reticulated open cell foam dressings with 1 cm holes (ROCF-CC) provides hydromechanical wound cleaning and preparation and can be applied outside the operating room at the bedside. This systematic literature review examined the effectiveness of NPWTi-d with ROCF-CC in removing nonviable tissue and infectious material, promoting granulation tissue, and reducing surgical debridements. A systematic search was conducted utilising PubMed, Embase, and ClinicalTrials.gov to identify studies conducted from 1 January 2015-31 August 2022. Study outcomes related to nonviable tissue, granulation tissue, and debridement were summarised and analysed using descriptive statistics. Twenty-one studies including 178 patients who received NPWTi-d with ROCF-CC were included. Evidence of reduction in necrotic and infected tissue following treatment was observed in 97.9% of wounds across 17 studies. Formation of granulation tissue after NPWTi-d with ROCF-CC was reported in 99.2% of wounds across 14 studies. Over 63% of patients avoided surgical debridements in 8 studies, and a statistically significant decrease in surgical debridements was noted in 2 comparative studies. This systematic review provides real-world evidence demonstrating the effectiveness of NPWTi-d with ROCF-CC in the hydromechanical removal of infectious materials, non-viable tissue, and wound debris; reduction of surgical debridements; and promotion of granulation tissue. Thus, NPWTi-d with ROCF-CC may potentially reduce or eliminate the need for surgical debridement by removing non-viable tissue through hydromechanical action.