Our system has several advantages compared with commercial NPWTi systems. After 3 months, the patient was able to bear weight, ambulatory, and required no dressing ( Fig. On postoperative days 3 and 5, 1 L of 0.9% normal saline plus 1% povidone-iodine was instilled to prevent infection and dilute the inflammatory exudate. A split-thickness skin graft was performed, and NPWTi was applied to the split thickness skin graft as adjunctive treatment for 7 days postoperatively. After 7 weeks of NPWTi, infection was resolved, local tissue edema decreased, and the defect size decreased from 12×20 to 4×16 cm, with granulation tissue covering the exposed bone and tendon. The wound was treated for 7 weeks with NPWTi. We particularly selected instillation solution of hypertonic saline plus povidone-iodine (Betadine) for this patient because of the tissue edema. After debridement operation, NPWTi was applied to granulate and cleanse the wound and to reduce exudate. His wound was not healed by conventional NPWT, and a biofilm repeatedly covered the wound surface. The wound was infected by Corynebacterium and multidrug-resistant Acinetobacter baumannii and had tissue edema. The patient was a 70-year-old man with necrotizing fasciitis and osteomyelitis on the right heel, with exposed bone and tendons. Three liters of instillation solution was instilled daily. An instillation solution was made using a 3 L, 0.9% normal saline bag, after removing 300 mL of normal saline from the bag and adding 300 mL of 10% povidone-iodine solution. A 0.9% normal saline plus 1% povidone-iodine solution infiltrated through the IV line continuously. An NPWT system (CuraVac CGbio, Seongnam, Korea) was placed over it with an intravenous (IV) line placed in the deepest surface of the wound to allow for instillation of the antiseptic solution ( Fig. Tulle-gras dressing (Bactigras Smith & Nephew, London, UK) was applied on the wound surface to block the adherence of reticulated open-pore polyurethane foam of the NPWT dressing. An absorbable collagen hemostat (Novacol Fibrillar Kyeron, Enschede, the Netherlands) was applied for hemostasis. Devitalized and infected tissues were removed, tunnels and abscess pockets were explored, and the capsules surrounding the tunnels and pockets were excised. All patients were excisionally debrided by a single surgeon (JHK) using sharp technique in the operating room. H-1907-021-081) and was performed in accordance with the principles of the Helsinki Declaration of 1975 (revised 2008). The study was approved by the Institutional Review Board of Pusan National University Medical Center (IRB No. The treatment modalities performed in this study were accepted by the patients, and they gave written informed consent. Patients whose general condition or situation was not eligible for reconstructive surgery or patients who refused reconstructive surgery were excluded from the study ( Fig. We defined “complex wounds” using a previously proposed definition in a review article, and included patients with wounds complicated by invasive infection or extensive biofilm, massive soft tissue infections (necrotizing fasciitis, Fournier’s gangrene, and gas gangrene), wounds in which healing progression had “stalled” following traditional NPWT therapy, dehisced/infected surgical wounds that have not healed using traditional NPWT therapy, severe traumatic wounds with exposed critical structures (bone, tendon, and muscle), inflammation with exposed surgical materials or implants, and/or diabetic foot wound infections. This single-institution, prospective clinical experimental study enrolled patients who were admitted to a tertiary referral hospital with complex wounds and required surgical debridement in the operating room between January 2017 and March 2019.
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