Negative Pressure Wound Therapy With Saline Instillation Improves Early Healing in Purulent Soft-Tissue Disease

Background Negative pressure wound therapy (NPWT) is widely used in the treatment of purulent-inflammatory soft tissue diseases, while negative pressure wound therapy with instillation (NPWT-i) has recently emerged as a promising approach to enhance wound healing. Methods We conducted a prospective, single-center randomized study, including 29 patients with purulent-inflammatory soft tissue infections of the trunk and extremities treated between December 2024 and June 2025. Patients were randomized to conventional NPWT (Group I, n=17) or NPWT-i with normal saline (Group II, n=12) after accounting for exclusions during follow-up. All patients underwent standardized surgical debridement protocols, and outcomes were assessed by planimetric wound analysis, serum C-reactive protein (CRP) measurement, number of repeated surgical debridements, and length of hospital stay. Results By day 7 after initial surgical debridement, patients in the NPWT-i group demonstrated significantly greater granulation tissue formation (70.5 ± 4.6% vs. 48.7 ± 4.1%), reduced fibrin coverage (17.2 ± 1.4% vs. 28.1 ± 5.2%), and smaller areas of necrosis (12.3 ± 3.1% vs. 23.6 ± 2.8%) compared to the NPWT group (all p < 0.05). CRP levels decreased more rapidly with NPWT-i (49.4 ± 29.1 mg/L vs. 96.3 ± 14.2 mg/L, p < 0.05). Patients in the NPWT-i group required fewer repeat debridements (3.1 ± 0.7 vs. 5.4 ± 1.2, p < 0.05) and had a shorter mean hospital stay (32.5 ± 4.2 vs. 41.7 ± 6.1 days, p < 0.05). Conclusion NPWT-i accelerates wound healing, reduces inflammation, decreases the number of repeated surgical interventions, and shortens hospitalization compared with standard NPWT. This justifies NPWT-i consideration as an advanced therapeutic option, particularly for the management of extensive purulent wounds where efficient and early wound-bed preparation is critical. Further large-scale, multicenter trials are warranted to confirm these preliminary findings, evaluate long-term outcomes, and establish standardized instillation protocols.