Accelerated Preoperative Wound Bed Preparation Using Negative Pressure Wound Therapy With Instillation and Dwell Time: A Comparison With Conventional Negative Pressure Wound Therapy in Necrotic Wounds

ABSTRACT

Negative pressure wound therapy with instillation and dwell time (NPWTi‐d) and conventional NPWT are established treatments for complex wounds, yet direct comparative evidence remains limited. This retrospective observational study evaluated the clinical effectiveness of NPWTi‐d for hard‐to‐heal necrotic wounds using standardized parameters from our previous research. We included 116 patients (50 NPWTi‐d; 66 conventional NPWT). The primary endpoint was the time from therapy initiation to achieving a ‘reference wound’ suitable for definitive closure, defined in accordance with clinical trial guidance from the Japanese Pharmaceuticals and Medical Devices Agency (PMDA). The NPWTi‐d group achieved reference wound status in a median of 14 days versus 22 days for the conventional NPWT group—a statistically significant 8‐day reduction. Furthermore, whereas conventional NPWT typically requires a prolonged debridement phase prior to application, NPWTi‐d can be initiated earlier, even in the presence of residual necrotic tissue. Ultimately, NPWTi‐d provides a synergistic clinical advantage by both shortening active treatment duration and bypassing pre‐initiation delays, enabling clinicians to achieve surgical readiness significantly faster than with standard modalities.