Long-Term Outcome Assessment Between Anti-Septic and Normal Saline for Negative Pressure Wound Therapy with Instillation.

Objective To analyze long-term outcomes following inpatient treatment of infected wounds with antimicrobial or normal saline instillation during negative-pressure wound therapy. Approach This was a single-center retrospective study analyzing the course of patients receiving 0.9% normal saline or 0.1% polyhexanide plus 0.1% betaine as instillation for wounds requiring surgery. Measured outcomes included rates of dehiscence, new wounds, re-operations, amputations, and mortality over 5 years. The manuscript adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Results 42 patients received normal saline instillation and 41 the anti-septic solution. Rates of dehiscence, wound recurrence, and re-operations in the saline and anti-septic cohorts were 6.3% and 5.6%, 9.4% and 5.6%, and 14.3% and 9.8%, respectively (p > 0.05). In patients requiring further surgery, time to wound closure averaged 104 and 130 days in the saline and anti-septic cohorts, respectively (p=0.81). 5-year amputation and mortality rates were 14.3% and 22% (p=0.36), and 24% and 17% (p=0.45) in the saline and anti-septic cohorts, respectively. Innovation To compare clinical outcomes associated with two fundamentally different instillation solutions over the full wound-care episode and elucidate the potential impact of these results for future applications. Conclusion This is the first evaluation of non-surrogate outcomes of different instillations for negative pressure wound therapy in infected wounds. The results indicate that normal saline instillation outcomes are comparable to those of 0.1% polyhexanide 0.1% betaine. The clinical success, cost benefit and accessibility of normal saline can expand the utilization of this therapeutic approach for larger patient populations.