What are the management options for wounds that become desiccated during Negative Pressure Wound Therapy (NPWT)?

Management of Desiccated Wounds During NPWT

When wounds become desiccated during NPWT, immediately reduce the negative pressure to 50-80 mmHg and ensure a non-adherent interface layer is properly positioned between the foam and wound bed to maintain moisture balance. 1

Immediate Pressure Adjustment

• Lower the continuous negative pressure to 50-80 mmHg to reduce excessive fluid evacuation that causes desiccation 1
• Pressures up to 120 mmHg increase fluid drainage, which may be excessive for wounds without significant exudate 1
• Use the lower end of this range (50 mmHg) for vulnerable wound beds that are already showing signs of desiccation 1

Critical Interface Layer Management

• Always use a non-adherent interface layer between the foam dressing and the wound bed to prevent direct contact that promotes desiccation 1
• This protective layer maintains the wound in a moist environment, which is essential for healing 1
• The adhesive film covering creates a sealed environment that prevents uncontrolled evaporative fluid loss 1

Consider NPWT with Instillation

• For persistently dry wounds, consider switching to NPWT with instillation and dwell time (NPWTi-d) using normal saline 2, 3, 4
• This system delivers predetermined volumes of saline that dwell in the wound bed before negative pressure resumes, actively rehydrating the tissue 4
• NPWTi-d has demonstrated superior outcomes compared to standard NPWT in complex wounds, including shorter time to closure 3

Verify Proper Foam Selection

• Ensure you are using specialized foam-based dressing kits designed for NPWT, not improvised materials like surgical towels 1
• Commercial polyurethane foam maintains appropriate moisture balance better than vac-pack alternatives 1
• Foam should be placed within the wound cavity, not on top of surrounding skin, to preserve skin integrity 1

Maintain Continuous Pressure

• Never use intermittent or variable pressure settings, as these severely compromise wound splinting and moisture regulation 1
• Continuous pressure maintains consistent fluid management and prevents alternating cycles of over-drying 1

Common Pitfalls to Avoid

• Do not increase pressure thinking it will improve outcomes—higher pressures worsen desiccation by removing more fluid than necessary 1
• Do not remove the interface layer—direct foam contact with wound bed accelerates desiccation 1
• Do not extend dressing change intervals beyond 2-3 days when desiccation is occurring, as this prevents timely assessment and adjustment 4

When to Discontinue NPWT

• If desiccation persists despite pressure reduction to 50 mmHg and proper interface layer use, consider temporarily discontinuing NPWT 1
• Transition to conventional moist wound dressings until adequate wound bed moisture is restored 5
• NPWT works best when wounds have adequate exudate—minimal drainage wounds may not be appropriate candidates 1