Negative Pressure Wound Therapy with Instillation and Dwell for the Management of a Complex Burn: A Case Report and Review of the Literature

Research over the last 50 years has led to significant improvements in outcomes for burn victims. Advances in infection control, attenuation of the hypermetabolic response, and new improved surgical approaches have led to decreased morbidity and mortality. Early wound excision eliminates the devitalized tissue, which is the main reservoir for pathogen propagation. Immediate autografting reestablishes the natural barrier of the skin, which blocks pathogen access to the host. Advances in burn care have increased treatment options for patients with devastating injuries presenting with multiple comorbidities. Over the last 20 years, negative pressure assisted wound therapy (NPWT) has shown to improve wound management and healing as well as decrease the length of recovery in burn patients. As NPWT applications evolve, the development of negative pressure wound therapy with instillation and dwell time (NPWTi-d) for the management of complex and infected wounds has proven vital for patient care. We present the case of a 68-year-old male patient presenting with a three-day-old third-degree burn wound spanning 46% of the total body surface area (TBSA). After the infected wound was treated unsuccessfully with the standard of care (excision, debridement, and grafting), the team utilized NPWTi-d in order to mitigate the infection and promote the formation of granulation tissue, leading to the successful grafting of the burn wound. NPWTi-d was a useful adjunct in treating and stimulating wound healing in a complex patient. This is the first case report of its kind, utilizing a whole-body vacuum assisted closure (VAC) with NPWTi-d, with successful results showing a decreased bacterial burden, decreased morbidity and mortality, and patient wound closure.