Negative pressure therapy with instillation for the treatment of infected wounds: recommendations of utilization based on evidence

Objective: To establish recommendations related to negative pressure therapy with instillation according to effectiveness, safety, efficiency, consensus guidelines and stability data of instillation solutions. Method: A literature search was conducted to compare the available evidence regarding effectiveness, safety and efficiency of negative pressure therapy with instillation, as well as the existence of consensus guidelines for use. The articles were classified according to the “Scale of evidence classification for therapeutic studies” of the American Society of Plastic and Reconstructive Surgery. Results: A total of 13 studies were included, of which five were comparative cohort studies (level II and III of evidence), and the rest corresponded to case series (level IV of evidence). Two consensus guidelines were selected with recommendations regarding the type of wound, instillation solution, solution retention time, vacuum pressure and appropriate vacuum time. According to literature and available evidence, recommendations were proposed and established on negative pressure therapy with instillation in our hospital, including stability data of the proposed solutions. Conclusions: This paper provides preliminary guidelines on the application of negative pressure therapy with instillation until new evidence supports or modifies these recommendations.