BACKGROUND
NPWT with instillation and dwell time (NPWTi-d) enhances functionality by incorporating intermittent channels for localized solution delivery, effectively cleansing wounds. Here we report a case with multiple comorbidities which limit the feasibility for repeated debridement and reconstruction.
CASE REPORT
A 60-year-old housewife with a history of diabetes mellitus, hypertension, end-stage renal disease, heart failure and peripheral arterial occlusive disease initially presented with a diabetic foot ulcer. The wound progressed to necrotizing fasciitis, a limb-threatening emergency, and subsequently the patient underwent fasciotomy and sequestrectomy due to accompanying osteomyelitis.
The wound exhibited a surface area of 240 cm2 with 95 cm2 of bone exposure, accounting for 3% and 1% of the patient's total body surface area (TBSA), respectively. In addition to proper antibiotic coverage, NPWTi-d and the combination of artificial dermis with NPWT were initiated to reduce the frequency of surgeries, minimize infections, and accelerate wound healing. Among nine-month treatment, the patient underwent 3 times of NPWTi-d, 5 times NPWT, and twice dermal template matrix integration. Approximately 75% of the wound had completely healed, with minimal bone exposure (4 cm2). The patient could walk by herself with assistance.
CONCLUSION
NPWTi-d and the integration of artificial dermis with NPWT may potentially reduce the risk of wound infections and decrease the frequency of required debridement sessions, ultimately offering improved prognostic outcomes. This approach had offered an alternative to surgical or reconstructive solutions for diabetes foot complicated with necrotizing fasciitis and bony exposure.
KEY WORDS
Diabetic foot ulcer, NPWTi-d, Artificial dermis, NPWT, Necrotizing fasciitis

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