Hello,
Thank you for sharing your question. Here are some initial thoughts, colleagues might have additional comments.
Given the fact that according to the PCP, there appears to be a decrease of wound size, NPWT might be resulting in beneficial effects. Regardless, it'd be important to assess the patient and the ulcer, to rule out contraindications to NPWT such as:
- Osteomyelitis without current antibiotic therapy,
- wound malignancy,
- exposed organs, bowel, or blood vessels,
- use in thoracic or abdominal cavities,
- necrotic tissue with eschar present,
- unstable structures (e.g. flaps or grafts),
- patients at increased risk of bleeding, and
- non-enteric or unexplored fistulas (to clarify, NPWT can be applied around or in the vicinity of a fistula, but not applied to directly evacuate fistula contents).
Regarding the presence of slough, non-viable tissue should be debrided as needed/possible. NPWT is often used even in wounds with some slough, as it can help manage exudate and promote wound bed preparation. However, if there is significant necrotic tissue or extensive slough, debridement may be necessary first. Not only it can help better visualize depth and wound bed, but also it can help promote wound healing more rapidly if the wound is free of /debris and devitalized tissue; mechanical debridement can be performed as needed during dressing changes to remove sessile tissue, but more invasive excisional debridement may need to be performed for more adherent slough or eschar.
Regarding unknown depth, further diagnostic evaluation (e.g., probing or imaging) can help identify conditions that may be a contraindication to NPWT. If further diagnostic evaluation is not feasible, it is essential to closely monitor the wound for any signs of deterioration.
The topics below have further information:
Hope this helps!
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