Wound bed preparation is the management of a wound in order to accelerate endogenous healing or to facilitate the effectiveness of other therapeutic measures.1 To facilitate wound healing, it is important to remove any necrotic tissue and debris from the wound bed, decrease excessive wound exudate, decrease the tissue bacterial level, and remove deleterious chemical mediators. These actions optimize the wound bed, allowing wound(s) the ability to rapidly accelerate endogenous healing or wound closure.2
Specialized dressings may need to be used because sharp debridement is not tolerated by some patients and excessive debridement may need to be minimized.3 Hypochlorous acid (HOCl; Vashe Wound Solution; SteadMed Medical LLC, Fort Worth, TX) can be used as a soak; it gently debrides when the soaked tissue is wiped away from the wound.4 Negative pressure wound therapy (NPWT) can be combined with fluid instillation to irrigate and remove fluid from the wound surface (VERAFLO Therapy, KCI, an Acelity Company, San Antonio, TX). This system is designed to facilitate controlled instillation along with a soaking/dwell time so thick wound exudate, fibrin, and other infectious materials may be removed.5 NPWT with instillation recently has been combined with a specialized 3-layer dressing that incorporates a contact layer with 1-cm holes that provide mechanical movement at the wound surface (VERAFLO CLEANSE CHOICE DRESSING, KCI, an Acelity Company, San Antonio, TX).6 This dressing, combined with cyclic delivery and instillation fluid dwell time, rapidly removes debris and thick exudate that is trapped in the outer 2 layers of the dressing, thus preventing the vacuum tube from clogging.
Combining NPWT with HOCl instillation has proven extremely useful in our practice in shortening the time for wound bed preparation. Three (3) illustrative cases demonstrate the effectiveness of this approach.