Concurrent Use of a GV/MB PVA Wide-cell Antibacterial Foam with Negative Pressure Wound Therapy

Introduction: Problem: 51-year-old female with history of Type 1 bipolar disorder, status-post elective abdominoplasty. Following multiple emergency department presentations, the patient reportedly took at a minimum 4 zolpidem then removed their surgical drains and abdominal binder at home. Subsequently they developed a large seroma leading to total abdominal incision dehiscence, and a large gaping dehisced abdom- inal wound with significant undermining (68.4sqcm; undermining 5cm), necrotic tissue present. Significance: Prior treatment included hydrogel and gauze. Upon wound center arrival, the patient was converted to neg- ative pressure wound therapy (NPWT) at 125mmHg intermittent setting in addition to standard wound hygiene protocol and non-contact low frequency ultrasound. Case complicated by patient pain, stress, and psy- chological burden including turning the machine off intermittently and refusing to remove dressing and place gauze between clinic appointments leading to pain, erythema, induration, and lack of wound progression. Methods: The patient was then transitioned to concurrent use of a methylene blue and gentian violet, polyvinyl alcohol, wide-cell, antibac- terial foam (GV/MB wide cell PVA) in contact with the wound bed, and NPWT changed three times weekly. Results: At four weeks the wound had decreased in size by 66% (23.49 sqcm). Clinical improvement noted: pain reduction, elimination of signs of inflammation, improved granulation tissue quality. At six weeks, wound dimensions had reduced by 75% (17.5 Sqcm) from presentation with wound edges attached and migrating and 100% bright red granula- tion tissue. At this point, NPWT was discontinued by patient request and they transitioned to a GV/MB bordered, poly urethane foam. Discussion: Concurrent use of GV/MB wide cell PVA with NPWT resulted in safe and effective complex wound management. The wide-cell antimicrobial foam displayed the desirable function of a wound dressing when NPWT was not functioning. This innovative case exemplifies the potential for both augmenting and expanding clinical treatment with NPWT for patients.