NPWTi-d provides negative pressure wound therapy with instillation and dwell time to manage trauma and orthopaedic wounds. It uses topical solutions to clean wounds, remove debris, and locally deliver drugs. Studies show NPWTi-d increases wound closure and granulation rates, reduces hospital stays and costs. However, it does not replace surgery or treat certain wound types. Overall, NPWTi-d facilitates wound healing by creating an optimal environment through negative pressure, irrigation, and local drug delivery.

1. Evolving role of negative pressure
wound therapy with instillation
abd dwell time (NPWTi-d-) in
management of trauma and
orthopaedics wounds
Saini et al, IJO,2023
Presenter - Dr. Shubhanshu
Guide – Dr. John Mukhopadhaya

2. Introduction
• Environment for wound healing
• Topical solution into wound bed
• Wound cleaning, removal of debris, delivery of
drug locally

3. • Fleischmann 1998 proposed this
• Three stages – irrigation, dwell, drainage
• NPWT – Normandin et al 2021
– Local blood flow
– Tissue edema
– Bacterial contamination
– granulation
• NPWTi-d additional benefit –
– Wound cleaning, exudate necrosis removal

4. Mechanism
1. Negative pressure setting – 125-150 psi
2. Installation mode
1. Intermittent – two phase
• Instillation and dwell phase – 2-3 hr negative pressure
& dwell time 10 min Faust E et al 2021
– Suitable solution – amount of solution for proper wound
absorbtion
3. NPWTi duration time - 3-14 days acute non
infectious wound 1 week to 9 weeks for
weeks

5. Installation Solution
• NS
• Antimicrobial solution – Silver ion/ Na
Hypoclorite sol/PHMB-
0.1%(polyhexamethyleneBiguanide)/ acetic
acid 0.25-0.1%/ betaine 0.1%
• Antibiotics – vancomycin/ polymyxomycin B,
gentamycin

6. Advantages
• Wound closure rate increases De Pellegrin et al,2023
• Granulation formation rate increases
• Hospital stay reduced kim et al, 2015
• Duration of surgical operation reduced
• Healing of wound increses
• Cost effectivegupta et al,2016

7. Disadvantages
• Does not complement surgery and
debridement
• Time frame not defined
• Not for STSG, dermal replacement, vein artery
exposed region, untreated abscess , critical
ischemic wound
• Tension pneumocephalous reported after post
surgical spine infection

8. Application
• Acute wounds – open #, Necrotizing fascitis
and soft tissue injury
• Chronic wound – OM, Wound with bone
tendon or fixation exposure , infected wound
• Salvage Orthopaedic fixation hardware – post
fixation SSI
Gabriel et al, 2012
Reider et al, 2018
Anghel et al, 2016
Novak et al, 2014

9. Advances
• Reticulated open cell foam dressing with
through holes (RCOF-CC)- better oxygenation
drainage Shimbo et al, 2022
• Smart NPWTi-d- material changes response to
environment Khuswaha et al, 2022
• 3-D printed NPWTi-d- Uchida et al, 2023

10. Efficacy and safety
• Wound closure achieved 65% cases Elhessey at al 2021
• NPWTi-d- with Saline solution better
outcomes Pellegrin et al 2023
• Wound granulation tissue recovers quickly
Enodien et al, 2021
• Goss et al, 2016 showed decreases CFU of
tissue culture treated with NPWTi-d-

11. Take home message
• Choosing right patient
• Create environment
• Provides wound hydration, irrigation and
facilitating local antibiotics.
• Cost-benefit assessment