ePlasty: Vol. 16
Use of Multiple Adjunctive Negative Pressure Wound Therapy Modalities to Manage Diabetic Lower-Extremity Wounds
Windy E. Cole, DPM

Cleveland Clinic Akron General Wound Center, Akron, Ohio

Correspondence: drwec@yahoo.com
Key words: negative pressure, instillation, hyperbaric oxygen, diabetic foot ulcer, lower extremity

Objective: Various treatment options exist for wound healing; however, clinical assessment of the patient and the wound environment must be considered before determining an optimal wound treatment plan. Negative pressure wound therapy alone and/or with an instilled topical solution can be effective in adjunctive management of acute and chronic wounds. Hyperbaric oxygen therapy has also been shown to contribute to the wound-healing process. A pilot evaluation using a multistep approach of adjunctive negative pressure wound therapy with instillation and a dwell time, standard negative pressure wound therapy, and hyperbaric oxygen therapy was explored to manage postsurgical, diabetic lower-extremity wounds with a significant bioburden. Methods: Three diabetic patients with lower-extremity ulcers were treated after surgical intervention. Multistep wound therapy consisted of (1) negative pressure wound therapy with instillation of normal saline with a 20-minute dwell time, followed by 2 hours of negative pressure at −150 mm Hg for 3 to 4 days; (2) 1 to 3 weeks of continuous negative pressure at −150 mm Hg; and (3) mult .......