Assuming you have ruled out any osteomyelitis or is present, has already had treatment begun, black foam or gauze negative pressure wound therapy can suffice if there are sinus tracts You may wish to fill them with either a gauze ribbon as long as you know that it can be removed or white foam. I can assume that this patient already has adequate pressure redistribution for this wound and a good nutritional status.

Expanding on Catherine's answer. I believe KP HH uses Renasys NPWT?
- if foam: RENASYS-F Foam Dressing Kits can be used. Generally a pressure level of 120mmHg is used when starting with foam. If a patient experiences discomfort, it may help to reduce the pressure level. A lower pressure range between 40mm-80mmHg provides less painful NPWT while handling most exudate levels, types, and
consistencies. RENASYS-F Foam Dressing Kits should be changed 48 hours after initiating therapy to assess the patient's response to the therapy. If the patient is comfortable and the wound is responding positively to the therapy, the subsequent dressing change frequency is 2-3 times per week or 48 to 72 hours. Wound contact layer should be used if tendon, bone, and/or other fragile structures are exposed.
https://www.smith-nephew.com/global/assets/pdf/products/wound/us/npwt-renasys-and-pico-clinical-guidelines.pdf
If there are any other types of wound vacs available to you and you'd like some opinions on how to choose among them please let us know.

Thanks! Yes has osteo and on ABX. Did both photos upload OK?

Amy,
Yes, photos uploaded well...just as a reminder for your staff...it is important to document how many pieces of foam (and if it is white or black) or any other material (such as gauze, non-adherent dressings over bone/tendon, etc) in the wound as it alerts the clinician who changes the NPWT device to what is in the wound and to make sure it is removed/replaced.

Black foam, cover bone or tendon with mepitel. I don't like gauze but agree with black granufoam (KCI) or similar, white foam (comes in rope) for tunnels. I think 125-150 mm Hg neg pressure, constant is my usual and would work in this area.

Coming in to comment a little late, but I would also note that pressures should definitely be titrated primarily to patient comfort level, and secondarily to therapy goals, as well as type of dressing medium utilized with NPWT. If patient is tolerating therapy and adequate negative pressure can be utilized (I believe most studies recommend 90+ for granulation tissue formation--I will try to find citation), it should be understood that gauze as well as more dense foams and contact layers over the wound bed will cause slowed deposition of granulation tissue. While deploying these methods is important in patients who are having persistent discomfort with NPWT, it also prolongs treatment, necessitating a delicate balance between comfort and need for expedited healing. This also becomes an important factor with reimbursement for therapy, with many payors and NPWT companies having a specific threshold of decrease in wound size with each therapy interval (generally 4 weeks I believe.