Negative pressure wound therapy with instillation: past, present, and future

Negative pressure wound therapy with instillation (NPWTi) is a novel treatment option that provides the combination of negative pressure with intermittent instillation of a solution. Standard Negative Pressure Wound Therapy (NPWT) is an established adjunctive treatment option that offers the ability to promote granulation tissue in wounds. However, there is limited evidence for its utility in the environment of active or senescent infection. Wounds that are acutely infected or that contain deleterious biofilm are a challenging problem, which require an intensive multimodal approach including antibiosis, surgical intervention, and local wound care. Adjunctive application of NPWTi can potentially expedite clearance of infection and wound closure. Although this technology has been commercially available for over a decade, its adoption has been limited. Recently, there has been a resurgence of interest in this therapy with emerging evidence from animal models as well as human clinical studies. There are remaining questions regarding NPWTi including the selection of the optimal instillation solution and device settings. This article discusses the past development, current knowledge, and future direction of NPWTi.