【Objective】
Chronic wound has become a more and more attention-calling medical issue, as increased incidence of Diabetes and the growing of aging population. However, our current health insurance system allow us only to treat patient under frame of limited budget, which restrict our treatment course, especially the length of stay. Institution is becoming only for acute stage care. It is now a dilemmatic decision whether to keep hospitalization for difficult chronic wound treatment or just discharge for better cost benefit. We, nevertheless, thought if a method that could be the best of both worlds. As a result, we tried to care chronic wound by using advanced wound care modality (i.e. NPWT) at home to lower the burden of hospitalization and to maximize the profit of patients at once.

【Materials and Methods】
From Jan. 2018 to July. 2018, there were totally 11 patients who had received home-based NPWT care for stage3-4 chronic wounds with a total of 44 treatment courses conveyed. These patients had received care for chronic wounds during their Hospitalization, and our team was consulted for evaluation of further wound management. Accompanied with NPWT, the patient discharged and regular outpatient clinic follow arranged for re-evaluation to maintain NPWT or to terminate.

【Results】
Six of eleven patients (55%) had obvious improvement of wound condition, and went into next stage of wound closure. Two were interrupted by persistent fecal contamination of wound bed from frequent diarrhea. Two were interrupted due to financial issues, while the wound was improved. Two were shifted to other management option due to progressed deterioration of wound condition. One was expired, but not related to wound. One had medical dispute.

【Conclusions】
Home care with advanced wound care modality such as NPWT seems to be a better and even unavoidable choice in treating difficult-to-heal chronic wound. The major fields feasible for such application in Taiwan are 1. Pressure injury 2. Complex acute wound 3. Difficult chronic wound. The practice to extend the application of NPWT for home is still rare and not a common sense. Proper case selection and accurate execution of this approach to avoid unfavorable case while to increase favorable result is utmost critical for success. With the coming era of budgeted medical care, we believe the home care with NPWT will be the future trend.

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