Irrigation Solutions for Vacuum-Assisted Wound Therapy: A Comparative Analysis of Efficacy and Safety (Literature Review)

Objective. To analyze the efficacy and safety of various irrigation solutions used in Negative Pressure Wound Therapy with Instillation (NPWTi) based on data from domestic and international literature sources.

Materials and Methods. The review includes PubMed/MEDLINE and eLibrary publications with additional viewing of links and relevant publications on the Web of Science, Google Scholar, and Cyberleninka by keywords over the past 10 years, which conducted a comparative assessment of standard vacuum therapy and its modifications with instillation.Solutions of isotonic sodium chloride, antiseptics, antibiotics, and bacteriophages used as instillates are considered, as well as their mechanisms of action, indications, efficacy, and safety profile.

Research Results. The analysis showed that the use of vacuum therapy with instillation provides rapid cleaning of the wound surface, reducing the degree of bacterial contamination, optimizing the timing of granulation tissue formation and preparation for plastic closure of the wound compared with the standard technique. Among instillation solutions, saline solution (0.9% NaCl) is characterized by safety and versatility, traditional antiseptics (Daken solution, silver nitrate) have a pronounced antimicrobial effect, modern polyhexanide-based on antiseptics (Prontosan®) have low cytotoxicity, and bacteriophages have a selective bacteriolytic effect, including activity against antibiotic resistant strains. The use of antibiotic solutions for instillation requires strict microbiological control and rational selection of drugs to minimize the risk of antibiotic resistance.

Conclusion. Vacuum therapy with instillation is a modern, pathogenetically proven method of treating infected and chronic wounds. Rational choice of the solution, taking into account the nature of the infection, the phase of the wound healing process and the microbial landscape, makes it possible to increase the effectiveness of therapy, bring the course of the process as close as possible to the physiological one and reduce the risk of complications. The use of bacteriophages as a safe and effective alternative to antibiotics and antiseptics in conditions of increasing antibiotic resistance is of particular interest.

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