NPWTi-d for Infected Abdominal Dehiscence After Surgery
Managing Infected, Dehisced Abdominal Wounds After Body-Contouring Surgery: Early Outcomes Using NPWT With Instillation (NPWTi-d)
Medical education note: This article is for clinicians. Always follow device IFUs, local protocols, and individual patient factors.
Why this matters
Full-thickness abdominal wound dehiscence after abdominoplasty or liposuction is a serious complication that can lead to prolonged hospital stays, increased risk of incisional hernia, and repeat operations—especially when infection and slough stall progress. (1,2)
Negative pressure wound therapy with instillation and dwell (NPWTi-d) of a topical wound solution has been shown to automatically cleanse wound surfaces, solubilize devitalized tissue, remove infectious exudate, and reduce bacterial load—key goals when managing large, contaminated abdominal wounds. (1,3)
A recent three-case experience describes the use of NPWTi-d with hypochlorous acid (HOCl) via reticulated open-cell foam with through-holes (ROCF-CC) as an adjunctive pathway to rapidly convert infected, dehisced abdominal wounds to clean, granulating beds and then transition patients to outpatient care. (1)
Key takeaways (at a glance)
Population: Three patients with massive, infected, full-thickness abdominal dehiscence after elective body-contouring surgery. Infection was confirmed by non-contact, real-time fluorescence imaging. (1,4)
Therapy used: NPWTi-d via ROCF-CC foam; HOCl solution; −150 mmHg continuous pressure; instillation every 2.5–3.5 hours; 10–15-minute dwell; dressing changes three times per week. Near-infrared spectroscopy (NIRS) and fluorescence imaging guided care at each change. (1,3)
Starting point: Baseline slough covered 15–50% of the wound surface; post-debridement wound volumes ranged from 130.6 to 1,186.1 cm³, reflecting substantial tissue loss. (1)
Outcomes: Infection clearance and discharge in a mean of 8.7 days (range 7–11). All wounds progressed to closure after NPWTi-d was stopped and patients were transitioned to conventional NPWT; total healing time 7.9–12.8 weeks. (1,2)
(Photo on the right shows one of the patients with an infected abdominal dehiscence post-surgery)
What is NPWTi-d and why use it here?
NPWT with instillation and dwell intermittently bathes the wound with a topical solution and then resumes negative pressure. During instillation and dwell, the solution loosens slough, fibrin, and biofilm; during suction, the solution and solubilized debris are removed through the foam, supporting hydromechanical debridement while maintaining a moist wound environment. (3,5)
Consensus guidelines and real-world data suggest NPWTi-d with ROCF-type dressings can accelerate wound-bed preparation, reduce signs of local infection, and shorten time to readiness for closure compared with traditional NPWT alone in complex, contaminated wounds. (3,5)
For large, infected, dehisced abdominal wounds, this hydromechanical effect is particularly valuable: each cycle targets nonviable tissue and bioburden without requiring constant operative returns, while negative pressure helps manage edema and exudate. (1,3)
How the team ran NPWTi-d (clinic playbook)
1. Surgical debridement + antibiotics
All patients underwent sharp surgical debridement and received systemic antibiotics before or along with NPWTi-d. Infection was confirmed using non-contact fluorescence imaging at admission. (1,4)
2. Dressing choice and settings
A ROCF-CC foam dressing (with through-holes) was used with HOCl instillation at −150 mmHg continuous pressure. The team set cycles to instill every 2.5–3.5 hours with a 10–15-minute dwell, and dressing changes were scheduled three times per week—parameters that fall within published NPWTi-d protocols using HOCl solutions. (1,6)
3. Ongoing imaging at each change
At every dressing change, clinicians used fluorescence imaging to visualize areas of high bacterial load and NIRS to evaluate tissue oxygenation (StO₂) in and around the wound. Fluorescence imaging has been shown to improve detection of clinically significant bacterial burden, while NIRS provides non-invasive perfusion data that can guide escalation of vascular or local therapies. (4,7)
4. Transition plan
NPWTi-d was discontinued as soon as infection cleared (based on imaging and clinical exam). Patients were then discharged and continued healing under conventional NPWT in the outpatient setting, consistent with other NPWTi-d dehiscence protocols. (1,2)
Results that matter to the bedside
Across the three cases, infection cleared and patients were medically ready for discharge within 7–11 days (mean 8.7 days), supporting the idea that a focused NPWTi-d phase can substantially shorten the inpatient portion of the course for large, infected abdominal wounds. (1)
Once infection was controlled and NPWTi-d was stopped, all wounds went on to closure within 7.9–12.8 weeks under standard NPWT, mirroring healing trajectories reported in larger NPWTi-d dehiscence series. (1,2)
Clinically, serial images in the poster show dense slough and contamination at admission, rapid clearance of devitalized tissue under NPWTi-d, and the emergence of robust granulation tissue before transition to outpatient NPWT—a pattern consistent with other Veraflo Cleanse Choice case collections in complex abdominal wounds. (1,8)
Mechanism in action: hydromechanical debridement
Authors attribute progress in part to hydromechanical removal of nonviable tissue through the ROCF-CC dressing during instillation cycles: each HOCl dwell solubilizes debris, and the subsequent negative-pressure phase evacuates contaminated fluid and slough through the dressing’s through-holes. (1,3)
Systematic and consensus reviews of NPWTi-d highlight similar effects—enhanced wound cleansing, reduced bioburden, and faster development of a clean granulating base—especially when complete surgical debridement of a large, complex wound is difficult in one session. (3,5)
Practical pearls for dehisced abdomens
Confirm infection objectively.
Non-contact fluorescence imaging helps verify bioburden and track response between changes, reducing reliance on subjective clinical signs alone and supporting more targeted use of antibiotics and antimicrobials. (4,9)
Don’t skip debridement.
Sharp surgical debridement plus systemic antibiotics before or with NPWTi-d remains foundational; NPWTi-d is an adjunctive wound-bed preparation tool, not a replacement for source control. (1,3)
Be consistent with cycles.
Maintaining a tight instillation interval (2.5–3.5 hours) and dwell time (10–15 minutes) helps sustain hydromechanical cleansing between nurse visits, in line with parameters used in other complex-wound NPWTi-d protocols. (1,5)
Know when to switch.
Stop NPWTi-d as soon as infection clears and the wound shows a clean, granulating base; then transition to conventional NPWT or other closure strategies to complete healing in a lower-intensity outpatient setting. (1,2)
Who is a good candidate?
Patients with large, infected, surgically dehisced abdominal wounds after body-contouring procedures who can tolerate negative pressure and instillation cycles—and for whom debridement and appropriate antibiotic therapy are already underway—may benefit from a short NPWTi-d phase followed by outpatient NPWT. (1,3)
Selection should always account for device-specific contraindications and NPWTi-d guidelines (e.g., exposed organs or vessels, uncontrolled bleeding, untreated osteomyelitis), along with patient comorbidities and goals of care. (3,5)
Limitations to keep in mind
This is an initial, uncontrolled three-case series; outcomes may not generalize across all abdominal wounds, reconstructive techniques, or patient risk profiles. (1,2)
In addition, commercial involvement and device selection (e.g., specific NPWTi-d system and ROCF-CC dressing) should be considered when interpreting usability and performance claims, as most published NPWTi-d experience is tied to branded platforms. (3,8)
References
Desvigne M, Gonzales C. (CS-006) Management of Infected Dehisced Abdominal Wounds with Adjunctive Negative Pressure Wound Therapy and Instillation of a Topical Wound Solution. SAWC Spring 2025 Poster. Available at: https://sawcs2025posters.eventscribe.net/ajaxcalls/PosterInfo.asp?PosterID=730532
Porfidia R, et al. Treatment of wound dehiscence utilizing negative pressure wound therapy with instillation and dwell time (NPWTi-d). Wounds. 2020;32(2):E13–E18. Available at: https://pubmed.ncbi.nlm.nih.gov/33476292/
Silverman RP, et al. Negative Pressure Wound Therapy With Instillation and Dwell Time: Mechanisms and Evidence. Plast Reconstr Surg Glob Open. 2023;11(8):e5180. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10517669/
Armstrong DG, et al. Point-of-care fluorescence imaging reveals extent of bacterial load in diabetic foot ulcers. Int Wound J. 2023;20(2):554–566. Available at: https://pubmed.ncbi.nlm.nih.gov/36708275/
Acosta J, et al. Effectiveness of Negative Pressure Wound Therapy With Instillation and Dwell Time and ROCF-CC: Real-World Evidence. Wound Repair Regen. 2025 (systematic review). Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC12207569/
Kirkland KB, et al. Utilizing Instilling Negative Pressure Wound Therapy with Hypochlorous Acid–Based Wound Cleanser. Surg Sci. 2023;14(7):259–267. Available at: https://www.scirp.org/journal/paperinformation?paperid=123935
Račytė A, et al. Oxygen saturation increase in ischemic wound tissues during therapy monitored by NIRS. Biomedicines. 2024;12(8):1805. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10887106/
3M. V.A.C. Veraflo Therapy Cleanse Choice Dressing Case Study Collection. 3M Case Studies Book. 2020. Available at: https://woundsinternational.com/wp-content/uploads/2024/09/3M23_CS_Veraflo_WINT-web.pdf
Price N, et al. Routine fluorescence imaging to detect wound bacteria reduces antibiotic use and antimicrobial dressing expenditure while improving healing rates: retrospective analysis of 229 foot ulcers. Diagnostics. 2020;10(11):927. Available at: https://www.mdpi.com/2075-4418/10/11/927
McElroy EF, et al. Use of negative pressure wound therapy with instillation and dwell time using a reticulated open-cell foam dressing with through-holes. Int Wound J. 2019;16(5):1188–1194. Available at: https://onlinelibrary.wiley.com/doi/10.1111/iwj.13097
