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Effective wound management involves a comprehensive assessment of the patient and the wound to determine an optimal wound treatment plan. It is critical to identify and address factors that may impair wound healing, prior to selecting the most appropriate therapy for each patient. Negative pressure wound therapy ( NPWT ) is a well‐established advanced therapy that has been successful in adjunctive management of acute and chronic wounds. In recent years, the introduction of topical wound solution delivery in combination with  NPWT  has provided further benefits to wound healing. A commercially available system now offers automated, volumetric control of instilled topical wound solutions with a dwell time in combination with  NPWT  ( NPWTi ‐d; V.A.C.  VeraFlo ™ Therapy,  KCI , an Acelity company, San Antonio,  TX ). This  NPWTi ‐d system differs from other instillation systems in that a timed, predetermined volume of topical wound solution is intermittently delivered (versus continuously fed) and allowed to dwell in the wound bed (without  NPWT ), for a user‐selected period of time before  NPWT  is resumed. This added accuracy and process simplification of solution delivery in tandem with  NPWT  have prompted use of  NPWTi ‐d as first‐line therapy in a wider subset of complex wounds. However, considerably more research is required to validate efficacy of  NPWTi ‐d in various wound types. The purpose of this review is to provide a relevant overview of wound healing, describe current literature supporting the adjunctive use of  NPWTi ‐d, propose a clinical approach for appropriate application of  NPWTi ‐d and conclude with case studies demonstrating successful use of  NPWTi ‐d. Based on this review, we conclude that either a large case series examining effects of  NPWTi ‐d on different wound types or possibly a large prospective registry evaluating  NPWTi ‐d with real‐world topical wound solutions versus immediate debridement and closure would be valuable to the medical community in evaluating the efficacy of this promising therapy.

Clinical recommendations and practical guide for negative pressure wound therapy with instillation