Patent Publication Number: US-2020289739-A1

Title: Combination fluid instillation and negative pressure dressing

Description:
RELATED APPLICATIONS 
     This application is a divisional of U.S. patent application Ser. No. 15/328,415, filed Jan. 23, 2017, which is a U.S. National Stage Entry of PCT/US2015/042097, filed Jul. 24, 2015, which claims the benefit, under 35 USC § 119(e), of U.S. Provisional Patent Application No. 62/028,672, entitled “Combination Fluid Instillation and Negative Pressure Dressing,” filed Jul. 24, 2014, which are incorporated herein by reference for all purposes. 
    
    
     FIELD 
     This disclosure relates generally to medical treatment systems and, more particularly, but not by way of limitation, to systems, dressings, devices, and methods suitable for treating a tissue site. 
     BACKGROUND 
     Depending on the medical circumstances, reduced pressure may be used for, among other things, reduced-pressure therapy to encourage granulation at a tissue site, draining fluids at a tissue site, closing a wound, reducing edema, promoting perfusion, and fluid management. Further, therapeutic fluids may be instilled or distributed to a tissue site in combination with or in lieu of reduced-pressure therapy. The instillation of such fluids to a tissue site may assist with preventing infection, enhancing healing, and other therapeutic benefits. 
     Challenges can exist with distributing fluids to and extracting fluids from a tissue site being subjected to reduced-pressure therapy or fluid instillation. For example, tissue sites may vary in volume, size, geometry, orientation, and other factors. Further, access to these tissue sites may be restricted. These and other factors can make extraction of waste fluids from the tissue site and distribution of therapeutic fluids to the tissue site difficult to perform in a uniform or even manner. Further, directional changes in fluid flow between reduced-pressure therapy cycles and instillation fluid cycles can force waste fluids being extracted during a reduced-pressure therapy cycle back into a tissue site upon switching to a fluid instillation cycle. 
     Types of tissue sites that may present particular difficulties may include locations such as a peritoneal cavity, and more generally, an abdominal cavity. When a tissue site involves the abdominal cavity, a treatment system that may allow for improved and efficient care, and may address such complications as peritonitis, abdominal compartment syndrome, and infections that might inhibit final healing may be particularly beneficial. Thus, improvements to treatment systems that may adapt to various types of tissue sites and orientations, enhance the uniformity of waste fluid extraction and therapeutic fluid distribution, and increase efficiency and healing times may be desirable. 
     SUMMARY 
     Shortcomings with certain aspects of tissue treatment systems, dressings, devices, and methods are addressed as shown and described in a variety of illustrative, non-limiting embodiments herein. 
     In some embodiments, a treatment system for providing fluid instillation and reduced pressure treatment at a tissue site may include a plurality of fluid distribution lumens, a fluid hub, a plurality of leg members, a reduced-pressure hub, a fluid supply lumen, and a reduced-pressure lumen. The plurality of fluid distribution lumens may be defined between a first film layer and a second film layer. Each of the fluid distribution lumens may have a delivery aperture in fluid communication with the fluid distribution lumen. The fluid hub may be positioned in fluid communication with the plurality of fluid distribution lumens. Further, the fluid hub and the plurality of fluid distribution lumens may define a fluid instillation pathway. Each leg member of the plurality of leg members may include a leg manifold. The reduced-pressure hub may be in fluid communication with the plurality of leg members. Further, the reduced-pressure hub and the plurality of leg members may define a reduced-pressure pathway separate from the fluid instillation pathway. The fluid supply lumen may be adapted to be coupled in fluid communication with the fluid hub, and the reduced-pressure lumen may be adapted to be coupled in fluid communication with the reduced-pressure hub. 
     In some embodiments, an instillation assembly for treating a tissue site may include a fluid distribution lumen and a fluid hub. The fluid distribution lumen may have a length and opposing sides positioned normal to the length. The fluid distribution lumen may be defined by a first film layer and a second film layer. The first film layer may be sealingly coupled to the second film layer at the opposing sides and along the length of the fluid distribution lumen. A delivery aperture may be disposed into the fluid distribution lumen and in fluid communication with the fluid distribution lumen. The fluid hub may be positioned in fluid communication with the fluid distribution lumen. The fluid hub may be positioned between the first film layer and the second film layer. Further, the fluid hub and the fluid distribution lumen may define a fluid instillation pathway. 
     In some embodiments, a method of manufacturing a treatment system for treating a tissue site may include defining a plurality of fluid distribution lumens between a first film layer and a second film layer, and disposing a delivery aperture into each of the plurality of fluid distribution lumens. The delivery aperture in each of the fluid distribution lumens may be in fluid communication therewith. The method may further include positioning a fluid hub in fluid communication with the fluid distribution lumens, forming a plurality of leg members, and positioning the plurality of leg members in fluid communication with a reduced-pressure hub. 
     In some embodiments, a method for providing fluid instillation and reduced pressure treatment at a tissue site may include positioning a dressing adjacent to the tissue site. The dressing may include a fluid instillation pathway and a reduced-pressure pathway separate from the fluid instillation pathway. The method may further include coupling a fluid instillation reservoir in fluid communication with the fluid instillation pathway, and coupling a reduced-pressure source in fluid communication with the reduced-pressure pathway. The coupling of the reduced-pressure source with the reduced-pressure pathway may be separate from the coupling of the fluid instillation source with the fluid instillation pathway. The method may further include supplying instillation fluid from the fluid instillation reservoir to the tissue site through the fluid instillation pathway. Additionally, the method may include providing reduced pressure from the reduced-pressure source to the tissue site through the reduced-pressure pathway, and extracting fluid from the tissue site through the reduced-pressure pathway. 
     Other aspects, features, and advantages of the illustrative embodiments will become apparent with reference to the drawings and detailed description that follow. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         FIG. 1  is a cut-away view of an illustrative embodiment of a treatment system for providing fluid instillation and reduced pressure treatment at a tissue site, depicting an illustrative embodiment of a dressing for positioning at the tissue site; 
         FIG. 2  is an exploded, perspective view of a portion of the treatment system and the dressing of  FIG. 1 , depicting an illustrative embodiment of an instillation assembly and a reduced-pressure assembly; 
         FIG. 3  is a top, plan view of the dressing of  FIG. 1 ; 
         FIG. 4A  is detail view of a portion of the dressing of  FIG. 1  taken at reference  FIG. 4A  depicted in  FIG. 3 ; 
         FIG. 4B  is a cross section of the dressing of  FIG. 1  taken at lines  4 B- 4 B referenced in  FIG. 4A ; 
         FIG. 5  is an exploded, perspective view of the illustrative embodiments of the instillation assembly and the reduced-pressure assembly of the dressing of  FIG. 1 ; 
         FIG. 6  is an exploded, perspective view of a portion of another illustrative embodiment of a treatment system suitable for use with the dressing of  FIG. 1 ; 
         FIG. 7A  is a top, plan view of another illustrative embodiment of a dressing suitable for use with the treatment system of  FIG. 1 ; 
         FIG. 7B  is an exploded, perspective view of another illustrative embodiment of an instillation assembly and a reduced-pressure assembly depicted in  FIG. 7A ; 
         FIG. 8A  is a top, plan view of another illustrative embodiment of a dressing suitable for use with the treatment system of  FIG. 1 ; and 
         FIG. 8B  is an exploded, perspective view of another illustrative embodiment of an instillation assembly and a reduced-pressure assembly depicted in  FIG. 8A . 
     
    
    
     DETAILED DESCRIPTION OF ILLUSTRATIVE EMBODIMENTS 
     In the following detailed description of non-limiting, illustrative embodiments, reference is made to the accompanying drawings that form a part hereof. Other embodiments may be utilized, and logical, structural, mechanical, electrical, and chemical changes may be made without departing from the scope of the appended claims. To avoid detail not necessary to enable those skilled in the art to practice the embodiments described herein, the description may omit certain information known to those skilled in the art. The following detailed description is non-limiting, and the scope of the illustrative embodiments are defined by the appended claims. As used herein, unless otherwise indicated, “or” does not require mutual exclusivity. 
     Referring to  FIG. 1 , in some illustrative embodiments, a treatment system  102  may include a therapy device  104 , a dressing sealing member  106 , a distribution manifold  108 , a fluid supply lumen  110 , a reduced-pressure lumen  112 , and a dressing  114 . The treatment system  102  may be suitable for providing fluid instillation and reduced pressure treatment at a tissue site  116 . The tissue site  116  may be may be the bodily tissue of any human, animal, or other organism, including bone tissue, adipose tissue, muscle tissue, dermal tissue, connective tissue, cartilage, tendons, ligaments, or any other tissue. The tissue site  116  may extend through or otherwise involve an epidermis  118 , a dermis  120 , and a subcutaneous tissue  122 . The tissue site  116  may be a sub-surface tissue site as depicted in  FIG. 1  that extends below the surface of the epidermis  118 . Further, the tissue site  116  may be a surface tissue site (not shown) that predominantly resides on a surface of the epidermis  118 . 
     As shown in  FIG. 1 , the tissue site  116  may include tissue in a body cavity such as, without limitation, an abdominal cavity  124 . The abdominal cavity  124  may include abdominal contents  126  or other tissue proximate the abdominal cavity  124 . The dressing  114  may be disposed in the abdominal cavity  124  and supported on a surface of the abdominal contents  126 . The dressing  114  may also be positioned in or proximate to a left lateral or first paracolic gutter  128  and a right lateral or second paracolic gutter  130 . The first paracolic gutter  128  and the second paracolic gutter  130  may each be, for example, an open space on opposing sides of the abdominal cavity  124  among the abdominal contents  126 . The first paracolic gutter  128  may be laterally disposed from the second paracolic gutter  130  or otherwise positioned on an opposite side of the tissue site  116  from the second paracolic gutter  130 . Although  FIG. 1  depicts the treatment system  102  deployed at the abdominal cavity  124 , the treatment system  102  may be used without limitation at other types of tissue sites. Further, the treatment of the tissue site  116  may include, without limitation, the removal of fluids, such as ascites and exudates, reduced-pressure therapy, instillation or distribution of fluids to the tissue site  116 , and protection of the tissue site  116 . 
     Continuing with  FIG. 1 , the therapy device  104  may be for coupling in fluid communication with the fluid supply lumen  110  and the reduced-pressure lumen  112 . The fluid supply lumen  110  and the reduced-pressure lumen  112  may be coupled in fluid communication with the dressing  114  as described below. Further, the fluid supply lumen  110  and the reduced-pressure lumen  112  may be combined or formed as part of a multi-lumen conduit  115  as shown in  FIG. 1 . Referring to another illustrative embodiment in  FIG. 6 , the fluid supply lumen  110  and the reduced-pressure lumen  112  may be separate conduits, tubes, or pipes, for example. 
     The therapy device  104  may include a reduced-pressure source  136 , a canister  138 , a positive-pressure source  140 , and a fluid instillation reservoir  142 . The canister  138  and the fluid instillation reservoir  142  may each be any suitable containment device for holding a liquid and communicating fluids. Further, in some embodiments, the therapy device  104  may include a controller  146 , a positive-pressure valve  148 , and a reduced-pressure valve  150  for controlling components of the therapy device  104  as described below. The components of the therapy device  104  may be arranged or associated with one another as shown in  FIG. 1  to form the therapy device  104 . However, in other embodiments (not shown), the components of the therapy device  104  may be provided separately or independently from the therapy device  104 . 
     The reduced-pressure source  136  may be for coupling in fluid communication with the reduced-pressure lumen  112 . The canister  138  may be positioned in fluid communication with the reduced-pressure source  136 . The reduced-pressure source  136  may be adapted to be coupled in fluid communication with the reduced-pressure lumen  112  through the canister  138 . Thus, the canister  138  may have an inlet for receiving reduced pressure from the reduced-pressure source  136  and an outlet for delivering the reduced pressure to the reduced-pressure lumen  112 . The reduced-pressure source  136 , the reduced-pressure lumen  112 , and the canister  136  may be fluidly coupled to one another in any suitable manner, such as, without limitation, through tubing, piping, adhesives, bonding, welding, couplers, or interference fit. 
     The positive-pressure source  140  may be for coupling in fluid communication with the fluid supply lumen  110 . The fluid instillation reservoir  142  may be positioned in fluid communication with the positive-pressure source  140 . The positive-pressure source  140  may be adapted to be coupled in fluid communication with the fluid supply lumen  110  through the fluid instillation reservoir  142 . Thus, the fluid instillation reservoir  142  may have an inlet for receiving positive pressure from the positive-pressure source  140  and an outlet for delivering the positive pressure and instillation fluid to the fluid supply lumen  110 . Instillation fluid may be urged from the fluid instillation reservoir  142  by the positive pressure into the fluid supply lumen  110 . The positive-pressure source  140 , the fluid supply lumen  110 , and the fluid instillation reservoir  142  may be fluidly coupled to one another in any suitable manner, such as, without limitation, through tubing, piping, adhesives, bonding, welding, couplers, unions, or interference fit. 
     As shown in  FIG. 1 , a portable pump  156  may provide both the reduced-pressure source  136  and the positive-pressure source  140 . For example, the pump  156  may include a suction port or pump inlet  158  and an exhaust port or pump outlet  160 . The pump inlet  158  may provide the reduced-pressure source  136 , and the pump outlet  160  may provide the positive-pressure source  140 . The reduced-pressure valve  150  may be positioned in fluid communication between the reduced-pressure lumen  112  and the pump inlet  158 . Reduced pressure from the reduced-pressure source  136  may be communicated to the reduced-pressure lumen  112  through the pump inlet  158  and the reduced-pressure valve  150 . The positive-pressure valve  148  may be positioned in fluid communication between the fluid supply lumen  110  and the pump outlet  160 . Positive pressure from the positive-pressure source  140  may be communicated to the fluid supply lumen  110  through the pump outlet  160  and the positive-pressure valve  148 . Positive pressure applied to the dressing  114  may assist with communicating and distributing instillation fluid from the fluid instillation reservoir  142  to the dressing  114  and the tissue site  116 . Fluid head, gravitational forces, and other factors may assist with communicating and distributing instillation fluid to the dressing  114  and the tissue site  116  with or without the application of positive pressure. Thus, some embodiments may not require the positive-pressure source  140 . 
     In other embodiments, one pump or a first pump may provide the reduced-pressure source  136  and another pump or a second pump (not shown) may provide the positive-pressure source  140 . Further, in other embodiments, the reduced-pressure source  136  may be any suitable device for providing reduced pressure, such as, for example, a wall suction source, a hand pump, or other source. Similarly, in other embodiments, the positive-pressure source  140  may be any suitable device for providing positive pressure, such as, for example, a compressor, compressed air cylinder, peristaltic pump, or similar source. 
     The reduced-pressure source  136  and the positive-pressure source  140  may be configured to supply reduced pressure and positive pressure, respectively, to the dressing  114  and the tissue site  116  in any combination or manner suitable for a particular application. For example, the controller  146  may be electrically coupled in any suitable manner to the reduced-pressure valve  150 , the positive-pressure valve  148 , and the pump  156 . The controller  146  may include software or user programmable settings for controlling the reduced-pressure valve  150 , the positive-pressure valve  148 , and the pump  156  in relation to one another. In embodiments using a first pump for the reduced-pressure source  136  and a second pump for the positive-pressure source  140 , the first pump and the second pump may be controlled by the controller  146  analogous to the reduced-pressure valve  150  and the positive-pressure valve  148  as described herein. In other embodiments, the reduced-pressure valve  150  and the positive-pressure valve  148  may be opened and closed or otherwise controlled manually by a user. Similarly, the pump  156  may be manually controlled. 
     In some embodiments, the pump  156  may be activated and the reduced-pressure valve  150  may be opened or otherwise activated simultaneously with the positive-pressure valve  148  for communicating reduced pressure and positive pressure to the tissue site  116  at the same time. The activation of the reduced-pressure valve  150  for reduced pressure delivery and the positive-pressure valve  148  for positive pressure delivery may be intermittent or continuous. In other embodiments, the pump  156  may activated and the reduced-pressure valve  150  may be configured to operate cyclically in relation to the positive-pressure valve  148 . For example, the reduced-pressure valve  150  may be opened or activated to communicate reduced pressure to the dressing  114  and the tissue site  116  during a reduced-pressure therapy cycle. During the reduced-pressure therapy cycle, the positive-pressure valve  148  may be closed or inactive. During an instillation fluid cycle, the positive-pressure valve  148  may be opened or activated to communicate positive pressure to the dressing  114  and the tissue site  116 . The reduced-pressure valve  150  may be closed or inactive during the instillation fluid cycle. The reduced-pressure valve  150  may have a reduced-pressure vent  162  for venting reduced pressure to the atmosphere, for example, when the reduced-pressure valve  150  is closed or inactive during the instillation fluid cycle. Similarly, the positive-pressure valve  148  may have a positive-pressure vent  164  for venting positive pressure to the atmosphere, for example, when the positive-pressure valve  148  is closed or inactive during the reduced-pressure therapy cycle. 
     Reduced pressure may be applied to the tissue site  116  from the reduced-pressure source  136  to promote removal of ascites, exudates, or other fluids from the tissue site  116 . The fluid removed from the tissue site  116  by operation of reduced pressure being applied to the tissue site  116  may be about 5 liters or more per day. Further, reduced pressure may be applied to stimulate the growth of additional tissue, and to enhance the distribution of instillation fluids to the tissue site  116 , if applicable. In the case of a wound at the tissue site  116 , the growth of granulation tissue, removal of exudates, or removal of bacteria may promote healing. In the situation of a non-wounded or non-defective tissue, reduced pressure may promote the growth of tissue that may be harvested and transplanted to another tissue site. 
     As used herein, “reduced pressure” may refer to a pressure less than the ambient pressure at a tissue site being subjected to treatment. In some embodiments, the reduced pressure may be less than the atmospheric pressure. The reduced pressure may also be less than a hydrostatic pressure at a tissue site. Unless otherwise indicated, values of pressure stated herein are gauge pressures. The reduced pressure delivered may be a constant pressure, varied pressure, intermittent pressure, or continuous pressure. Although the terms “vacuum” and “negative pressure” may be used to describe the pressure applied to a tissue site, the actual pressure applied to the tissue site may be more than the pressure normally associated with a complete vacuum. An increase in reduced pressure may correspond to a reduction in pressure (more negative relative to ambient pressure) and a decrease in reduced pressure may correspond to an increase in pressure (less negative relative to ambient pressure). While the amount and nature of reduced pressure applied to a tissue site may vary according to the application, in some embodiments, the reduced pressure may be between about −5 mm Hg to about −500 mm Hg. In other embodiments, the reduced pressure may be between about −100 mm Hg to about −200 mm Hg. In yet other embodiments, the reduced pressure may be between about −50 mm Hg to about −300 mm Hg. 
     Further, in some embodiments, components of the treatment system  102 , such as, without limitation, the reduced-pressure source  136 , the therapy device  104 , or the controller  146 , may include preset selectors for −100 mm Hg, −125 mm Hg, and −150 mm Hg of reduced pressure. Further, the treatment system  102  may also include a number of alarms, such as, for example, a blockage alarm, a leakage alarm, or a battery-low alarm. 
     The dressing sealing member  106  may be adapted to cover the dressing  114  and the tissue site  116  and to provide a fluid seal and a sealed space  166  between the dressing sealing member  106  and the tissue site  116 . A portion of the dressing sealing member  106  may overlap tissue surrounding the tissue site  116 , such as the epidermis  118 . The dressing  114  and the distribution manifold  108  may be sized or otherwise adapted to be positioned in the sealed space  166 . For example, the dressing sealing member  106  may include an interior facing side  168  and an exterior facing side  170  positioned opposite the interior facing side  168 . The sealed space  166  may be provided between the interior facing side  168  of the dressing sealing member  106  and the tissue site  114 . In some embodiments, the dressing sealing member  106  may comprise a liquid impermeable material adapted to cover the tissue site  116  and tissue surrounding the tissue site  116 . 
     The dressing sealing member  106  may be formed from any material that may allow for a fluid seal. A fluid seal may be a seal adequate to maintain reduced pressure, if applicable, at a desired site. The dressing sealing member  106  may comprise, for example, one or more of the following materials: hydrophilic polyurethane; cellulosics; hydrophilic polyamides; polyvinyl alcohol; polyvinyl pyrrolidone; hydrophilic acrylics; hydrophilic silicone elastomers; an INSPIRE 2301 material from Expopack Advanced Coatings of Wrexham, United Kingdom having, for example, a moisture vapor transmission rate or MVTR (inverted cup technique) of 14400 g/m2/24 hours and a thickness of about 30 microns; a thin, uncoated polymer drape; natural rubbers; polyisoprene; styrene butadiene rubber; chloroprene rubber; polybutadiene; nitrile rubber; butyl rubber; ethylene propylene rubber; ethylene propylene diene monomer; chlorosulfonated polyethylene; polysulfide rubber; polyurethane (PU); EVA film; co-polyester; silicones; a silicone drape; a 3M Tegaderm® drape; a polyurethane (PU) drape such as one available from Avery Dennison Corporation of Pasadena, Calif.; polyether block polyamide copolymer (PEBAX), for example, from Arkema, France; Expopack 2327; or other appropriate material. 
     The dressing sealing member  106  may be vapor permeable and liquid impermeable, thereby allowing vapor and inhibiting liquids from exiting the sealed space  166 . In some embodiments, the dressing sealing member  106  may be a flexible, breathable film, membrane, or sheet having a high MVTR of, for example, at least about 300 g/m2 per 24 hours. The use of a high MVTR material for the dressing sealing member  106  may permit moisture vapor to pass through the dressing sealing member  106 , external to the sealed space  166 , while maintaining the fluid seal described above. In other embodiments, a low or no vapor transfer drape might be used. In some embodiments, the dressing sealing member  106  may comprise a range of medically suitable films having a thickness between about 15 microns (μm) to about 50 microns (μm). 
     In some embodiments, an attachment device or interface adhesive  172  may be adapted to be positioned between the dressing sealing member  106  and the tissue site  116 . For example, the interface adhesive  172  may be positioned on or applied to the interior facing side  168  of the dressing sealing member  106  for facing the tissue site  116 . In some embodiments, the dressing sealing member  106  may be sealed directly against tissue surrounding the tissue site  116 , such as the epidermis  118 , by the interface adhesive  172 . In other embodiments, the interface adhesive  172  may seal the dressing sealing member  106  against a gasket or drape (not shown) adapted to be positioned between the interface adhesive  172  and the epidermis  118 . 
     The interface adhesive  172  may be a medically-acceptable adhesive and may take numerous forms, such as an adhesive sealing tape, drape tape, paste, hydrocolloid, hydrogel, or other suitable sealing device. The interface adhesive  172  may also be flowable. Further, the interface adhesive  172  may comprise, without limitation, an acrylic adhesive, rubber adhesive, high-tack silicone adhesive, polyurethane, or other adhesive substance. In some embodiments, the interface adhesive  172  may be a pressure-sensitive adhesive comprising an acrylic adhesive with coat weight, for example, of about 15 grams/m2 (gsm) to about 70 grams/m2 (gsm). The pressure-sensitive adhesive may be applied on a side of the dressing sealing member  106  adapted to face the epidermis  118  and the tissue site  116 , such as the interior facing side  168  of the dressing sealing member  106 . In some embodiments, the interface adhesive  172  may be a layer or coating applied to or positionable on the interior facing side  168  of the dressing sealing member  106 . In some embodiments, the interface adhesive  172  may be continuous or discontinuous. 
     The distribution manifold  108  may be for positioning between the dressing sealing member  106  and the dressing  114 . The distribution manifold  108  may be adapted to be positioned proximate to, adjacent to, or in direct contact with the dressing  114  at the tissue site  116 , such as, for example, by cutting or otherwise shaping the distribution manifold  108  in any suitable manner to fit the tissue site  116  and the sealed space  166 . In some embodiments, the distribution manifold  108  may be positioned proximate to, adjacent to, or in direct contact with a portion of the tissue site  116 . The distribution manifold  108  may have a distribution manifold opening  174  disposed through the distribution manifold  108  and adapted to receive a portion of the dressing  114 , for example, for coupling the dressing  114  in direct fluid communication with the fluid supply lumen  110 . Further, the distribution manifold  108  may be adapted to be in fluid communication with the dressing  114  and the tissue site  116  for distributing reduced pressure to the dressing  114  and the tissue site  116 . 
     The distribution manifold  108  may be formed from any manifold material or flexible bolster material that provides a vacuum space, or treatment space, such as, for example, a porous and permeable foam or foam-like material, a member formed with pathways, a graft, or a gauze. In some embodiments, any material or combination of materials may be used as a manifold material for the distribution manifold  108  provided that the manifold material is operable to distribute or collect fluid. For example, the term manifold may refer to a substance or structure capable of delivering fluids to or removing fluids from a tissue site through a plurality of pores, pathways, or flow channels. The plurality of pores, pathways, or flow channels may be interconnected to improve distribution of fluids provided to and removed from an area around the manifold. Examples of such manifolds may include, without limitation, devices that have structural elements arranged to form flow channels, cellular foam, such as open-cell foam, porous tissue collections, and liquids, gels, and foams that include or cure to include flow channels. Further, the distribution manifold  108  may be biocompatible. In some embodiments, the distribution manifold  108  may comprise a porous, hydrophobic material. In such an embodiment, the hydrophobic characteristics of the distribution manifold  108  may prevent the distribution manifold  108  from directly absorbing fluid, but may allow the fluid to pass through. 
     In some embodiments, the distribution manifold  108  may be a reticulated, open-cell polyurethane or polyether foam that is fluid permeable. One such material may be the VAC® GranuFoam® material available from Kinetic Concepts, Inc. of San Antonio, Tex. However, a material with a higher or lower density than GranuFoam® material may be desirable for the distribution manifold  108  depending on the application. Among the many possible materials, the following may be used without limitation: GranuFoam® material, Foamex® technical foam (www.foamex.com), a molded bed of nails structure, a patterned grid material such as those manufactured by Sercol Industrial Fabrics, 3D textiles such as those manufactured by Baltex of Derby, U.K., a gauze, a flexible channel-containing member, and a graft. 
     In other embodiments, the distribution manifold  108  may comprise a material including closed cells. The closed cells may not be fluidly connected to adjacent cells in the distribution manifold  108 . The closed cells may be selectively disposed in the distribution manifold  108  to, for example, prevent transmission of fluids through perimeter surfaces of the distribution manifold  108 . Other layers may be included in or on the distribution manifold  108 , such as absorptive materials, wicking materials, hydrophobic materials, and hydrophilic materials. In some embodiments, the distribution manifold  108  may be enhanced with ionic silver and anti-microbial agents. 
     The dressing  114  may include an instillation assembly  182  and a reduced-pressure assembly  186  that may be coupled to the instillation assembly  182 . The instillation assembly  182  may permit various fluids, such as, without limitation, medicines, irrigation fluids, instillation fluids, or therapeutic fluids, to be delivered to the tissue site  116  as shown by delivery arrows  188 . After being delivered to the tissue site  114 , these fluids and other fluids may be removed or extracted from the tissue site  114  by the reduced-pressure assembly  186  as shown by extraction arrows  190 . 
     Referring to  FIG. 2 , the instillation assembly  182  may include at least one fluid distribution lumen  202  and a fluid hub  206 . In some embodiments, the at least one fluid distribution lumen  202  may be a plurality of fluid distribution lumens  202  as shown in  FIG. 2 . In other embodiments, the instillation assembly  182  may include any number of the fluid distribution lumens  202 , without limitation, to suit a particular application. The fluid distribution lumens  202  may be sized or otherwise adapted to be positioned in the sealed space  166  at the tissue site  116 . 
     Each of the fluid distribution lumens  202  may have a length or branch  208  extending lengthwise and opposing sides  210  that may be positioned substantially normal to the length or the branch  208 . The fluid distribution lumens  202  may be defined between or by a first film layer  212  and a second film layer  214 . The first film layer  212  may be sealingly coupled to the second film layer  214  at the opposing sides  210  and along the length or the branch  208  of the fluid distribution lumens  202  in any suitable manner, such as, without limitation, welding, bonding, adhesives, cements, or similar bonding devices. The first film layer  212  may be adapted to be positioned between the second film layer  214  and the tissue site  116 . 
     Further, each of the fluid distribution lumens  202  may include at least one delivery aperture  216  in fluid communication with the fluid distribution lumen  202  carrying the delivery aperture  216 . In some embodiments, the at least one delivery aperture  216  may be a plurality of delivery apertures  216  as shown in  FIG. 2 . The fluid distribution lumens  202  may include any number of the delivery apertures  216 , without limitation, to suit a particular application. Further, the delivery apertures  216  may be sized, shaped, or positioned in a configuration for delivering fluids to the tissue site  116  in a substantially even manner. The delivery apertures  216  may be disposed through the first film layer  212  into the fluid distribution lumen  202 , and the first film layer  212  may be adapted to face the tissue site  116 . 
     The first film layer  212  and the second film layer  214  may comprise a non-adherent material, such as a medical drape, capable of inhibiting tissue from adhering to the medical drape. In some embodiments, the first film layer  212  and the second film layer  214  may comprise a breathable polyurethane film. Further, in some embodiments, the first film layer  212  and the second film layer  214  may comprise any of the materials recited above for the dressing sealing member  106 . Even further, in some embodiments, at least a portion of the first film layer  212  may be hydrophilic. For example, the first film layer  212  may comprise a plasma treatment that may impart hydrophilic properties to the first film layer  212 . Such hydrophilic properties may encourage or improve fluid coverage over a greater surface of the first film layer  212  rather than, for example, being drawn to a low point at the tissue site  116  by operation of gravitational forces. 
     In some embodiments, the first film layer  212  and the second film layer  214  may include a plurality of openings or film fenestrations  218 . The film fenestrations  218  may take a variety of shapes, such as, without limitation, circular openings, rectangular openings, polygon-shaped openings, slits, or linear cuts. Further, the film fenestrations  218  may have a variety of sizes to suit a particular application for providing a desired fluid flow, pressure delivery, or other parameters. The film fenestrations  218  may provide or enhance fluid communication between and among the tissue site  116 , the reduced-pressure assembly  186 , and the distribution manifold  108 . The fluid delivery lumens  202  and the fluid delivery hub  206  may be free of the film fenestrations  218 . 
     Further, in other embodiments, the instillation assembly  182  may be free of the film fenestrations  218 . In such an embodiment, a surface area of the instillation assembly  182  may be reduced in size relative to the reduced-pressure assembly  186 , for example, by decreasing a circumference, perimeter, or diameter of the instillation assembly  182 . Reducing the surface area of the instillation assembly  182  may permit a periphery of the reduced-pressure assembly  186  to extend beyond a periphery of the instillation assembly  182  for positioning the reduced-pressure assembly  186  in direct fluid communication or contact with the tissue site  116 . 
     The fluid hub  206  may have a height and may be positioned in fluid communication with the fluid distribution lumens  202 . The height of the fluid hub  206  may extend outward from a surface of the second film layer  214  and the instillation assembly  182 . The fluid hub  206  may be positioned between the first film layer  212  and the second film layer  214 . A fluid hub port  220  may be disposed through the second film layer  214 , and may provide fluid communication between the fluid supply lumen  110  and the fluid hub  206 . The fluid distribution lumens  202  may be positioned circumferentially and substantially symmetric about the fluid hub  206 . The fluid hub  206  and the fluid distribution lumens  202  may define a fluid instillation pathway  222 . The instillation assembly  182  may be positioned between the tissue site  116  and the reduced-pressure assembly  186 . As shown in  FIG. 2 , the fluid distribution lumens  202  may extend outward from the fluid hub  206  and across an oval or circular area having a maximum lengthwise dimension between about 260 millimeters to about 300 millimeters. In other embodiments, the fluid distribution lumens  202  may extend across an area having any desired dimensions and shape, for example, circular, oval, square, rectangular, or other. 
     As shown in  FIG. 2 , the fluid hub  206  may comprise a porous or fluid permeable material, such as, for example, a foam. Further, the fluid hub  206  may be elongate and cylindrical in shape. However, the fluid hub  206  may have other shapes without limitation. In other embodiments, the fluid hub  206  may comprise a fitting, such as a tube, tubular fitting, pipe, barbed connection, or similar structure. In such embodiments, the fitting may be pre-bonded or molded directly to the first film layer  212  or the second film layer  214  and configured to be fluidly coupled between the fluid supply lumen  110  and the fluid distribution lumens  202 . 
     The fluid instillation pathway  222  may be adapted to deliver fluids to the tissue site  116  in a substantially uniform manner. For example, each of the fluid distribution lumens  202  and the delivery apertures  216  on the fluid instillation pathway  222  may be adapted to provide substantially the same back-pressure. Such a configuration may prevent fluid from traveling more freely through or otherwise favoring one of the fluid distribution lumens  202  over another of the fluid distribution lumens  202 , or one of the delivery apertures  216  over another of the delivery apertures  216 . Herein, back-pressure may refer a resistance to fluid flow, such as through the confined space of a lumen or aperture. Back-pressure may result from the geometric configuration and material properties of the confined space, such as, without limitation, the size of the space, the presence and shape of bends or joints in the space, surface finishes within the space, and other characteristics. 
     Fluids may tend to follow a path of least resistance, and thus, poor fluid distribution may result from one of the fluid distribution lumens  202  having less back-pressure or resistance to fluid flow than another of the fluid distribution lumens  202 . Similarly, poor fluid distribution may result from one of the fluid delivery apertures  216  having less back-pressure or resistance to fluid flow than another of the fluid delivery apertures  216 . Consistency among the size and configuration of the fluid distribution lumens  202 , and the number and size of the delivery apertures  216  in each of the fluid distribution lumens  202 , for example, may enhance the uniformity of fluid delivery to the tissue site  116 . Thus, in some embodiments, the delivery apertures  216  may be substantially equal in number and size on each of the fluid distribution lumens  202 . Further, each of the fluid distribution lumens  202  may have substantially the same dimensions. 
     For example, in some embodiments, the fluid distribution lumens  202  may have an internal diameter between about 2 millimeters to about 6 millimeters. Further, in some embodiments, the fluid distribution lumens  202  may have an internal diameter of about 4 millimeters. The delivery apertures  216 , in some embodiments, may have a diameter between about 0.1 millimeters to about 0.8 millimeters. Sizing the internal diameter or cross-section of the fluid distribution lumens  202  substantially larger than the size, cross-section, or diameter of the fluid delivery apertures  216 , as described herein, may provide a substantially uniform pressure within each of the fluid distribution lumens  202 . In such an embodiment, fluid flow velocity within the distribution lumens  202  may be substantially low or substantially static relative to the high fluid flow velocity through the delivery apertures  216 . 
     In some embodiments, each of the fluid distribution lumens  202  may have six (6) of the delivery apertures  216  disposed through the first film layer  212  in fluid communication with the fluid distribution lumen  202 . Each of the six delivery apertures  216  may have a diameter of about 0.5 millimeters. In other embodiments, each of the fluid distribution lumens  202  may have twelve (12) of the delivery apertures  216  disposed through the first film layer  212  in fluid communication with the fluid distribution lumen  202 . Each of the twelve (12) delivery apertures  216  may have a diameter of about 0.35 millimeters. Such configurations may provide sufficient back-pressure, for example, for a fluid instillation or delivery rate to the instillation assembly  182  that may be between about 80 cc/min to about 120 cc/min. Other configurations and fluid delivery rates are possible. In general, an increase in the number of the delivery apertures  216  may correspond to a decrease in the diameter of each of the delivery apertures  216  that may be required for maintaining a desired amount or range of back-pressure. 
     Continuing with  FIG. 2 , the reduced-pressure assembly  186  may include at least one leg member  232  and a reduced-pressure hub  234 . In some embodiments, the at least one leg member  232  may be a plurality of leg members  232  as shown in  FIG. 2 . The reduced-pressure assembly  186  may include any number of the leg members  232  to suit a particular application without limitation. The leg members  232  may be sized or otherwise adapted to be positioned in the sealed space  166 . Further, in some embodiments, the reduced-pressure assembly  186  may include a central opening  236  disposed through or at the reduced-pressure hub  234  and sized or otherwise adapted to receive the fluid hub  206 . The height of the fluid hub  206  may be sized or otherwise adapted to extend through the central opening  236 . In other embodiments, the central opening  236  may have any shape, size, or configuration suitable to provide access for direct physical coupling or direct fluid coupling of the fluid supply lumen  110  to the second film layer  214  and/or the fluid hub  206  of the instillation assembly  182 . 
     Each of the leg members  232  may include a leg manifold  238  and a leg encapsulating material  240  that may cover the leg manifold  238  while permitting fluid communication with the leg manifold  238 . In other embodiments, the leg manifold  238  or the leg encapsulating material  240  may be omitted. The leg manifold  238  may comprise a porous or fluid permeable material, such as, for example, a foam. In some embodiments, the leg manifold  238  may comprise any of the materials recited above for the distribution manifold  108 . The leg encapsulating material  240  may cover the leg manifold  238  and may preclude tissue from adhering to the leg manifold  238  or otherwise coming into contact with the leg manifold  238 . Precluding such contact between tissue and the leg manifold  238  may, for example, provide for a broader range of materials to be used for the leg manifold  238  and treatment applications for the dressing  114 . 
     Referring to  FIGS. 2-5 , and particularly to the detail view of  FIGS. 4A-4B , the leg encapsulating material  240  may define an interior  242  and an exterior  244  of the leg member  232 . The leg manifold  238  may be positioned within the interior  242  of the leg member  232 , and may be encapsulated by the leg encapsulating material  240  in any suitable manner. For example, the leg encapsulating material  240  may include a first encapsulating layer  246  and a second encapsulating layer  248 . The leg manifold  238  may be positioned between the first encapsulating layer  246  and the second encapsulating layer  248 . The first encapsulating layer  246  may be coupled to the second encapsulating layer  248  around perimeter edges  250  of the leg manifold  238  by a leg bond  252 , such as, without limitation, a weld, adhesive, cement, or similar bonding device. A length of the leg bond  252  may be discontinuous, and thus, may enhance fluid communication with the leg members  232  and the leg manifold  238  through the first encapsulating layer  246  and the second encapsulating layer  248 . 
     Referring to  FIG. 5 , the first encapsulating layer  246  may have a first periphery  254  sized or otherwise adapted to mate with a second periphery  256  of the second encapsulating layer  248 . The first periphery  254  may be coupled to the second periphery  256  in any suitable manner, such as, without limitation, by any of the bonding devices described above for the leg bond  252 . In other embodiments, the leg encapsulating material  240  may be a single layer sized and shaped to wrap around or cover the leg manifold  238 , or otherwise form the leg member  232 . Further, in other embodiments, the leg encapsulating material  240  may be multiple layers coupled to one another around or covering the leg manifold  238 , or otherwise forming the leg member  232 . 
     Continuing with  FIGS. 2-5 , a plurality of leg fenestrations  258  may be disposed through the leg encapsulating material  240  in fluid communication between the leg manifold  238  and the exterior  244  of the leg member  232 . The leg fenestrations  258  may take a variety of shapes, such as, without limitation, circular openings, rectangular openings, polygon-shaped openings, slits, or linear cuts. Further, the leg fenestrations  258  may have a variety of sizes to suit a particular application for providing a desired fluid flow, pressure delivery, or other parameters. The leg fenestrations  258  may provide or enhance fluid communication, without limitation, between and among the tissue site  116 , the reduced-pressure assembly  186 , the distribution manifold  108 , and the reduced-pressure lumen  112 . 
     The leg encapsulating material  240  may comprise a non-adherent material, such as a medical drape, capable of inhibiting tissue from adhering to the medical drape. In some embodiments, the leg encapsulating material  240  may comprise a breathable polyurethane film. Further, in some embodiments, the leg encapsulating material  240  may comprise any of the materials recited above for the dressing sealing member  106 . 
     The leg members  232  may extend outward from the reduced-pressure hub  234  and be positioned in fluid communication with the reduced-pressure hub  234  in any suitable shape or configuration. As shown in  FIGS. 2-3 , the leg members  232  may extend radially outward from the reduced-pressure hub  234 . The reduced-pressure hub  234  may be a region of the reduced-pressure assembly  186  where the leg members  232  are gathered, coupled, or otherwise directed toward one another. The region of the reduced-pressure assembly  186  providing the reduced-pressure hub  234  may, for example, be a center region of the reduced-pressure assembly  186 . 
     As shown in  FIGS. 2-3 , in some embodiments, the leg members  232  may be coupled together, for example, with the leg encapsulating material  240  that may extend between each of the leg members  232 . Further, in some embodiments, a portion of the leg encapsulating material  240  between the adjacent leg members  232  may be expandable, stretchable, flexible, elastic, or otherwise deformable for permitting movement among distal ends of the leg members  232 . In other embodiments, the distal ends of the leg members  232  may be independently movable relative to one another while proximal ends of the leg members  232  may be coupled or gathered at the reduced-pressure hub  234 . 
     The leg members  232  may take a number of different lengths and shapes, such as elongate shapes, rectangular, elliptical, and other shapes. As shown in  FIGS. 2-5 , in some embodiments, the leg members  232  may include a plurality of leg modules  270  positioned along the length of the leg members  232 . A manipulation zone  272  may be positioned between each of the adjacent leg modules  270  along the length of the leg members  232 . The manipulation zones  272  may provide regions having a reduced size relative to the leg modules  270  that may enhance separation or removal the leg modules  270  for sizing the dressing  114 . In some embodiments, the manipulation zones  272  may include a weakened or perforated area to facilitate sizing of the dressing  114 , for example, by cutting or tearing. The leg modules  270  on each of the leg members  232  may be in fluid communication with one another. In some embodiments, a clinician may cut through the manipulation zones  272 , or tear through the manipulation zones  272  by pulling, to size the dressing  114 . Further, as shown in  FIG. 3 , in some embodiments, visual indicia  276  may be applied on a surface of the dressing  114  or the leg members  232  as a guide for sizing the dressing  114 . The visual indicia  276  may comprise, for example, cut lines or size graduations that may cross through the manipulation zones  272  to provide convenience in cutting, tearing, or otherwise sizing the dressing  114 . In such embodiments, the fluid distribution lumens  202  may reside within or inbound of the visual indicia  276  indicating the smallest size possible for the dressing  114  to, for example, preclude severing the fluid distribution lumens  202  when sizing the dressing  114 . In other embodiments, where sizing the dressing  114  may not be a feature or concern, for example, the fluid distribution lumens  202  may extend into or reside within any area of the dressing  114  as desired. 
     The reduced-pressure hub  234  and the leg members  232  may define a reduced-pressure pathway  280 , shown, for example, in  FIGS. 1, 2, and 4B , that is separate from the fluid instillation pathway  222 . Fluid may flow from the leg members  232  towards the reduced-pressure hub  234 . The fluid may enter the leg fenestrations  258  and flow into the leg members  232  and toward the reduced-pressure hub  234  as shown by the fluid extraction arrows  190  in  FIG. 1 . The first film layer  212  and the second film layer  214  of the instillation assembly  182  may separate the fluid distribution lumens  202  and the fluid hub  206  from the leg members  232  and the reduced-pressure hub  234  of the reduced-pressure assembly  186 . The fluid distribution lumens  202  may be positioned between the tissue site  116  and the leg members  232 . Further, the second film layer  214  may be positioned between the first film layer  212  and the reduced-pressure pathway  280 . 
     As shown in  FIGS. 3-4B , the reduced-pressure assembly  186  may be coupled to the instillation assembly  182  by an assembly bond  282  that may comprise, without limitation, any of the bonding devices described above in connection with the leg bond  252 . Thus, the assembly bond  282  may couple the first film layer  212 , the second film layer  214 , the first encapsulating layer  246 , and the second encapsulating layer  248  together. 
     The distribution manifold  108  may be adapted to be positioned adjacent to the reduced-pressure hub  234  of the reduced-pressure assembly  186  and between the dressing sealing member  106  and the leg members  232  of the reduced-pressure assembly  186 . The distribution manifold  108  may be adapted to distribute reduced pressure to the leg members  232 . In some embodiments, the distribution manifold  108  may be adapted to distribute reduced pressure to the leg members  232  through the reduced-pressure hub  234 . 
     In some embodiments, the distribution manifold opening  174  disposed through the distribution manifold  108  may receive the fluid hub  206  of the instillation assembly  182 . The height of the fluid hub  206  may be sized or otherwise adapted to extend through the distribution manifold opening  174 . 
     The fluid supply lumen  110  may be for positioning in fluid communication with the instillation assembly  182 . For example, the fluid supply lumen  110  may be adapted to be coupled in fluid communication with the fluid hub  206  at a fluid supply connection  284 , shown in  FIG. 1 , that may be on or extending through the dressing sealing member  106 . 
     The reduced-pressure lumen  112  may be for positioning in fluid communication with the reduced-pressure assembly  186 . For example, the reduced-pressure lumen  112  may be adapted to be coupled in fluid communication with the reduced-pressure hub  234  at a reduced-pressure connection  286  that may be on or extending through the dressing sealing member  106 , as shown in  FIG. 1 . In some embodiments, the reduced-pressure lumen  112  may be adapted to be coupled in fluid communication with the reduced-pressure hub  234  through the distribution manifold  108 . The reduced-pressure lumen  112  may have a length between the reduced-pressure connection  286  and the reduced-pressure source  136  that is fluidly isolated from an entire length of the fluid supply lumen  110 . The length of the fluid supply lumen  110  may be between the fluid supply connection  284  and the fluid instillation reservoir  142 . Further, the reduced-pressure lumen  112  and the reduced-pressure connection  286  may be fluidly isolated from the fluid supply lumen  110  and the fluid supply connection  284 . 
     Referring to  FIGS. 1-2 , a conduit interface  290  may provide the reduced-pressure connection  286  and the fluid supply connection  284 . The conduit interface  290  may be sized, shaped, or otherwise adapted to fluidly connect the reduced-pressure lumen  112  and the fluid supply lumen  110  to the dressing  114  through the dressing sealing member  106  in any suitable manner. For example, one or more sealing member aperture  292  may be disposed through the dressing sealing member  106  to provide fluid communication and access to the distribution manifold  108 , the dressing  114 , and other components positioned in the sealed space  166 . The sealing member aperture  292  may facilitate the fluid connection, without limitation, of the fluid supply lumen  110 , the reduced-pressure lumen  112 , and the conduit interface  290  with the distribution manifold  108  and the dressing  114 . Further, portions of the dressing sealing member  106  proximate the sealing member aperture  292  may be coupled to the distribution manifold  108  and the dressing  114  with, for example, an adhesive, such as the interface adhesive  172 , as necessary for fluidly isolating the reduced-pressure connection  286  from the fluid supply connection  284 . 
     In some embodiments, the conduit interface  290  may be formed or molded as part of the reduced-pressure lumen  112  and the fluid supply lumen  110 . In other embodiments, the reduced-pressure lumen  112  and the fluid supply lumen  110  may be, for example, bonded or secured by an interference fit to the conduit interface  290 . A portion of the conduit interface  290 , such as a flange  294 , may be coupled to the dressing sealing member  106  for positioning the conduit interface  290  in fluid communication with the dressing  114  through the dressing sealing member  106 . The conduit interface  290  may be coupled to the dressing sealing member  106  in any suitable manner, such as, for example, by an adhesive or other bonding device. In some embodiments, the adhesive for coupling the conduit interface  290  to the dressing sealing member  106  may be the interface adhesive  172  used for the dressing sealing member  106  described above. 
     In some embodiments, as shown in  FIGS. 1-2 , the conduit interface  290  may be a multi-port interface  290   a  providing both the reduced-pressure connection  286  and the fluid supply connection  284  as individual, fluidly isolated ports within the multi-port interface  290   a.  In such an embodiment, a dividing wall  296  within the multi-port interface  290   a  may be coupled to the fluid hub  206  and/or the second film layer  214  by an adhesive, such as the interface adhesive  172 , for fluidly isolating the fluid supply connection  284  from the reduced-pressure connection  286 . Other configurations for fluidly isolating the reduced-pressure connection  286  from the fluid supply connection  284  are possible. 
     In other embodiments, as shown in  FIG. 6 , the conduit interface  290  may be a single-port interface  290   b  that may provide either the reduced-pressure connection  286  or the fluid supply connection  284 . Thus, a first single-port interface  290   b  may provide the fluid supply connection  284 , and a second single-port interface  290   b  may provide the reduced-pressure connection  286 . In other embodiments, the fluid supply lumen  110  may be fluidly coupled directly to the fluid hub  206 , and the reduced-pressure lumen  112  may be fluidly coupled directly to the distribution manifold  108  through the dressing sealing member  106  without the conduit interface  290 . 
     Referring generally to  FIGS. 1-4B , in some illustrative embodiments of operation of the treatment system  102 , the dressing  114  may be sized to fit the tissue site  116  and disposed at or within the tissue site  116 , such as the abdominal cavity  124 . If sizing the dressing  114  is necessary, excess portions of the dressing  114  may be removed, for example, by cutting or tearing through the dressing  114  proximate the visual indicia  276  for a desired size. In some embodiments, the dressing  114  may be cut or torn through the leg modules  270  outboard of the visual indicia  276  for a desired size. The cut or torn portion of the leg modules  270  remaining attached to the dressing  114  may include a portion of the leg manifold  238  and a portion of the leg encapsulating material  240 . The remaining portion of the leg manifold  238  may be separated from the dressing  114  at the adjacent or inbound manipulation zone  272  and removed from within the leg encapsulating material  240 . In this manner, a portion of the leg encapsulating material  240  may remain attached to the dressing  114  extending beyond an edge of the leg manifold  238  for preventing contact between the leg manifold  238  and the tissue site  116 . 
     The dressing  114  may be positioned in contact with the abdominal contents  126 , and the leg members  232  may be positioned in or proximate to the first paracolic gutter  128  and the second paracolic gutter  130 . When deployed, the dressing  114  may cover all exposed viscera and may separate the viscera from contact with the walls of the abdominal cavity  126 . The dressing  114  may be sized and shaped to permit such coverage. 
     When the dressing  114  is disposed at the tissue site  116 , the instillation assembly  182  may be positioned facing the tissue site  116  and between the tissue site  116  and the reduced-pressure assembly  186 . The distribution manifold  108  may be positioned adjacent to or in contact with the dressing  114  at the tissue site  116 . For example, the distribution manifold  108  may be positioned adjacent to or in contact with the reduced-pressure hub  234  of the dressing  114 . Further, the distribution manifold opening  174  may be positioned to engage or receive the fluid hub  206  of the instillation assembly  182 . The height of the fluid hub  206  may extend through the thickness of the distribution manifold  108  for contacting, without limitation, the dressing sealing member  106 , the conduit interface  290 , or the fluid supply lumen  110  for making the fluid supply connection  284  as described herein. 
     The distribution manifold  108  and the dressing  114  may be covered at the tissue site  116  with the dressing sealing member  106  to provide the sealed space  166  with the distribution manifold  108  and the dressing  114  positioned within the sealed space  166 . The dressing sealing member  106  may be positioned and fluidly sealed about the tissue site  116  with the interface adhesive  172  as described above. The sealing member apertures  292  may be cut or otherwise disposed through the dressing sealing member  106  as necessary, if not already provided on the dressing sealing member  106 . The reduced-pressure connection  286  and the fluid supply connection  284  may be made, for example, with the conduit interface  290  or through direct coupling of the reduced-pressure lumen  112  to the distribution manifold  108  and the fluid supply lumen  110  to the instillation assembly  182 . 
     Activating the reduced-pressure source  136  may provide reduced pressure to the reduced-pressure assembly  186  through the reduced-pressure lumen  112  and the distribution manifold  108 . The instillation fluid reservoir  142  may provide instillation fluid to the instillation assembly  182  through the fluid supply lumen  110 , for example, by activating the positive-pressure source  140  or by operation of gravitational forces acting on the instillation fluid. Reduced pressure and instillation fluid may be provided to the dressing  114  simultaneously, at the same time, or cyclically, at alternate times. Further, reduced pressure and instillation fluid may be applied to the dressing  114  intermittently or continuously. 
     When the reduced-pressure source  136  is activated, the distribution manifold  108  may distribute the reduced pressure to reduced-pressure hub  234  and to the leg members  232  of the reduced-pressure pathway  280  through the reduced-pressure hub  234 . As shown in  FIG. 1  by the extraction arrows  190 , fluid from the tissue site  116  may be drawn or extracted through the film fenestrations  218  in the instillation assembly  182  and the leg fenestrations  258  in the reduced-pressure assembly  186 , entering the leg members  232 . Fluid in the leg members  232  may be communicated through the leg members  232  and into the reduced-pressure hub  234  and the distribution manifold  108  where the fluid may be drawn into the reduced-pressure lumen  112  and the canister  138 . 
     When the positive-pressure source is activated or instillation fluid is otherwise being delivered to the dressing  114 , the instillation fluid may pass into the fluid hub  206  of the instillation fluid pathway  222  through fluid hub port  220  as shown by the delivery arrows  188  in  FIG. 1 . From the fluid hub  206 , the instillation fluid may be communicated to the tissue site  116  through the fluid distribution lumens  202  and the delivery apertures  216  in the fluid distribution lumens  202 . The configuration of the fluid instillation pathway  222  and the associated back-pressure as described above may facilitate delivery of the instillation fluid to the tissue site  116  in a substantially uniform manner. 
     Fluid being instilled or delivered to the tissue site  116  through the fluid instillation pathway  222  may remain physically and fluidly separate from the reduced-pressure pathway  280  until reaching or coming into direct contact with the tissue site  116 . Once delivered to the tissue site  116 , the instillation fluid may become comingled with, for example, previously instilled fluids, wound fluid, tissue fluids, and other fluids that may be considered waste fluid. When reduced pressure is being applied to the dressing  114 , tissue or wound fluids from the tissue site  116  and any instillation fluid previously delivered to the tissue site  116  may be extracted through the separate reduced-pressure pathway  280 . Fluid being extracted from the tissue site  116  through the reduced-pressure pathway  280  may remain physically and fluidly separate from the instillation fluid pathway  222 . Such separation between the reduced-pressure pathway  280  and the fluid instillation pathway  222  may prevent fluids that may remain, for example, in the leg members  232 , the reduced-pressure hub  234 , and the distribution manifold  108 , after or during extraction from the tissue site  116 , from being forced back into the tissue site  116  during fluid instillation. 
     Further, the separation of the reduced-pressure pathway  280  from the fluid instillation pathway  222  may promote efficient use of instillation fluid. For example, as described above, the distribution manifold  108 , the reduced-pressure hub  234 , and the leg manifold  238  may comprise a porous, fluid permeable material, such as a foam. This fluid permeable material may include fluid flow passageways that may remain open or fluid permeable while under reduced pressure for extracting fluid from the tissue site  116 . Further, fluid extracted from the tissue site  116  may be stored within the reduced-pressure assembly  186  of the dressing  114  before being drawn into the reduced-pressure lumen  112 . The capability to provide fluid storage and permeability while under reduced pressure may require the distribution manifold  108  and the reduced-pressure assembly  186  to have a higher volume or fluid capacity compared to the fluid instillation pathway  222  that may be under positive pressure. Fluid being instilled or delivered to the tissue site  116  through the separate fluid instillation pathway  222  may not be required to pass through portions of the treatment system  102 , such as the distribution manifold  108  and the reduced-pressure assembly  186 , that may be higher volume. Such a configuration may enhance the distribution and efficient use of the instillation fluid. 
     Continuing generally with  FIGS. 1-4B , further described are methods for providing fluid instillation and reduced pressure treatment at a tissue site. In some embodiments, a method for providing fluid instillation and reduced pressure treatment at a tissue site may include positioning the dressing  114  adjacent to the tissue site  116 . The dressing  114  may include the fluid instillation pathway  222  and the reduced-pressure pathway  280  separate from the fluid instillation pathway  222 . The method may further include coupling the fluid instillation reservoir  142  in fluid communication with the fluid instillation pathway  222 , and coupling the reduced-pressure source  136  in fluid communication with the reduced-pressure pathway  280 . The coupling of the reduced-pressure source  136  with the reduced-pressure pathway  280  may be separate from the coupling of the fluid instillation source  142  with the fluid instillation pathway  222 . The method may further include supplying instillation fluid from the fluid instillation reservoir  142  to the tissue site  116  through the fluid instillation pathway  222 . Additionally, the method may include providing reduced pressure from the reduced-pressure source  136  to the tissue site  116  through the reduced-pressure pathway  280 , and extracting fluid from the tissue site  116  through the reduced-pressure pathway  280 . 
     In some embodiments, the tissue site  116  may be the abdominal cavity  124 , and positioning the dressing  114  adjacent to the tissue site  116  may include placing at least a portion of the dressing  114  proximate a paracolic gutter in the abdominal cavity  124 , such as the first and/or the second paracolic gutter  128 ,  130 . 
     In some embodiments, the method may further include disposing the distribution manifold  108  proximate to the dressing  114 . Further, in some embodiments, the method may include covering the dressing  114  with the dressing sealing member  106  to provide the sealed space  166  between the dressing sealing member  106  and the tissue site  116 . The distribution manifold  108  may be positioned within the sealed space  166 . Providing reduced pressure from the reduced-pressure source  136  to the tissue site  116  through the reduced-pressure pathway  280  may include distributing the reduced pressure to the reduced-pressure pathway  280  through distribution manifold  108 . 
     In some embodiments, the method may include sizing the dressing  114  for placement at the tissue site  116 . Sizing the dressing  114  may include cutting or tearing the dressing  114  proximate the visual indicia  276  for a desired size. 
     Referring to  FIGS. 3-5 , further described are methods for manufacturing a treatment system for treating a tissue site. In some embodiments, a method of manufacturing the treatment system  102  for treating the tissue site  116  may include defining the plurality of fluid distribution lumens  202  between the first film layer  212  and the second film layer  214 , and disposing the delivery aperture  216  into each of the fluid distribution lumens  202 . The delivery aperture  216  in each of the fluid distribution lumens  202  may be in fluid communication with the fluid distribution lumen  202  carrying the delivery aperture  216 . The method may further include positioning the fluid hub  206  in fluid communication with the fluid distribution lumens  202 , forming the plurality of leg members  232 , and positioning the leg members  232  in fluid communication with the reduced-pressure hub  234 . 
     In some embodiments, defining the plurality of fluid distribution lumens  202  between the first film layer  212  and the second film layer  214  may include coupling the first film layer  212  to the second film layer  214  along the opposing sides  210  and the length of each of the fluid distribution lumens  202 . The first film layer  212  may be adapted to face the tissue site  116 . In some embodiments, the delivery aperture  216  disposed in each of the fluid distribution lumens  202  may be a plurality of delivery apertures  216 . Thus, the method may further include disposing the plurality of delivery apertures  216  into each of the fluid distribution lumens  202 . At least one of the delivery apertures  216  may be disposed through the first film layer  212  into each of the fluid distribution lumens  202 . In some embodiments, the delivery apertures  216  may be equal in number and size, and each of the fluid distribution lumens  202  may have substantially the same dimensions. Further, the fluid distribution lumens  202  may be positioned circumferentially and substantially symmetric about the fluid hub  206 . In some embodiments, positioning the fluid hub  206  in fluid communication with the fluid distribution lumens  202  may include positioning the fluid hub  206  between the first film layer  212  and the second film layer  214  before defining the fluid distribution lumens  202  or coupling the first film layer  212  to the second film layer  214 . 
     In some embodiments, for each of the leg members  232 , forming the plurality of leg members  232  may include encapsulating the leg manifold  238  within the leg encapsulating material  240 , and disposing the plurality of leg fenestrations  258  through the leg encapsulating material  240  in fluid communication with the leg manifold  238 . 
     In some embodiments, the leg encapsulating material  240  may include the first encapsulating layer  246  and the second encapsulating layer  248 , and the method may further include positioning the leg manifold  238  between the first encapsulating layer  246  and the second encapsulating layer  248 , and coupling the first encapsulating layer  246  to the second encapsulating layer  248  around the leg manifold  238 . 
     In some embodiments, the method may further include disposing the central opening  236  through the reduced-pressure hub  234 . The central opening  236  may be sized to receive the fluid hub  206 . Further, the method may include positioning the fluid hub  206  within the central opening  236 . The fluid hub  206  may have a height configured to extend through the central opening  236 . 
     In some embodiments, the method may include positioning the second film layer  214  between the first film layer  212  and the plurality of leg members  232 . The fluid distribution lumens  202  may be adapted to be positioned between the tissue site  116  and the plurality of leg members  232 . 
     The method may additionally include coupling the first film layer  212 , the second film layer  214 , the first encapsulating layer  246 , and the second encapsulating layer  248  together by the assembly bond  282 . In some embodiments, coupling the first film layer  212  to the second film layer  214  and forming the plurality of leg members  232  may occur before coupling the first film layer  212 , the second film layer  214 , the first encapsulating layer  248 , and the second encapsulating layer  248  together. 
     Referring to  FIGS. 7A-7B , provided is another illustrative embodiment of a dressing  714  suitable for use with the treatment system  102 . The dressing  714  may include similar components having similar structure and operation as the dressing  114 , and thus, the same element numbers appearing in  FIGS. 7A-7B  may refer to the same components of the dressing  114 . 
     Compared to the dressing  114 , the dressing  714  may omit the first encapsulating layer  246 . Further, the dressing  714  may include a first film layer  712  that may be smaller in size than the than the second film layer  214 , and may be free of the film fenestrations  218  described in connection with the dressing  114 . For example, the first film layer  712  may have, without limitation, a smaller diameter, perimeter, or circumference than the second film layer  214  such that a periphery of the second film layer  214  is adapted to extend beyond a periphery of the first film layer  712 . In such a configuration, when the first film layer  712  is coupled or positioned relative to the second film layer  214  as described herein, the film fenestrations  218  and the second film layer  214  may be positioned in direct fluid communication or contact with the tissue site  116 . Similar to the first film layer  212 , the first film layer  712  may be adapted to face the tissue site  116 , and may comprise similar materials as those recited above for the first film layer  212 . 
     Further, the dressing  714  may include a plurality of fluid distribution lumens  702  and a plurality of delivery apertures  716 . The fluid distribution lumens  702  may have a straight longitudinal shape with opposing sides  710  that differs from the previously described fluid distribution lumens  202 . The first film layer  712  may be sealingly coupled to the second film layer  214  at the opposing sides  710  to form the fluid distribution lumens  702  analogous to the fluid distribution lumens  202 . Similarly, the delivery apertures  716  may be positioned along a common longitudinal axis that differs from the positioning of the delivery apertures  216 . However, the fluid distribution lumens  702  and the delivery apertures  716  may otherwise be analogous in operation to the fluid distribution lumens  202  and the delivery apertures  216 , respectively. 
     Continuing with  FIGS. 7A-7B , also provided is another illustrative embodiment of a method of manufacturing the dressing  714  for use with the treatment system  102  in treating the tissue site  116 . In some embodiments, the leg encapsulating material  240  may include the second film layer  214  and the second encapsulating layer  248 , and the method may include positioning the leg manifold  238  between the second film layer  214  and the second encapsulating layer  248 , and coupling the second film layer  214  to the second encapsulating layer  248  around the leg manifold  238 . The leg bond  252  may couple the second film layer  214  to the second encapsulating layer  248  without crossing into the distribution lumens  702 . In some embodiments, the first film layer  712  may be coupled to the second film layer  214  for defining the plurality of fluid distribution lumens  702  before coupling the second film layer  214  to the second encapsulating layer  248  around the leg manifold  238 . 
     Referring to  FIGS. 8A-8B , provided is another illustrative embodiment of a dressing  814  suitable for use with the treatment system  102 . The dressing  814  may include similar components having similar structure and operation as the dressing  114 , and thus, the same element numbers appearing in  FIGS. 8A-8B  may refer to the same components of the dressing  114 . 
     Compared to the dressing  114 , the dressing  814  may omit the first encapsulating layer  246  and the second encapsulating layer  248 . Further, the dressing  814  may include a plurality of leg members  832  and a reduced-pressure hub  834  that may be analogous in operation to the leg members  232  and the reduced-pressure hub  234 , respectively, of the dressing  114 . However, as shown, the leg members  832  may be gathered at or oriented toward the reduced-pressure hub  834  without being coupled together or formed from a continuous piece of material. Each of the leg members  832  may include a leg manifold  838  and the leg encapsulating material  240 . The leg manifold  838  may be comprised of any of the materials recited above for the leg manifold  238 . Although the leg members  832  may be gathered rather than coupled at the reduced-pressure hub  834 , when the dressing  814  is positioned at the tissue site  116  with the distribution manifold  108  in a manner analogous to the dressing  114 , the distribution manifold  108  may overlap the leg members  832  at the reduced-pressure hub  834  for providing or enhancing fluid communication among the leg members  832 . 
     Continuing with  FIGS. 8A-8B , also provided is another illustrative embodiment of a method of manufacturing the dressing  814  for use with the treatment system  102  in treating the tissue site  116 . In some embodiments, the leg encapsulating material  240  may be the first film layer  212  and the second film layer  214 , and the method may include positioning the leg manifold  838  between the first film layer  212  and the second film layer  214 , and coupling the first film layer  212  to the second film layer  214  around the leg manifold  838 . The leg bond  252  may couple the first film layer  212  to the second film layer  214  without crossing into the distribution lumens  202 . 
     Although this specification discloses advantages in the context of certain illustrative, non-limiting embodiments, various changes, substitutions, permutations, and alterations may be made without departing from the scope of the appended claims. Further, any feature described in connection with any one embodiment may also be applicable to any other embodiment.