Negative pressure wound therapy reduces infection and dehiscence in lower extremity trauma

Incisional negative pressure wound therapy after high-risk lower extremity fractures               

 

Stannard JP, Volgas DA, McGwin G 3rd, Stewart RL, Obremskey W, Moore T, Anglen JO

J Orthop Trauma. 2012 Jan;26(1):37-42. doi: 10.1097/BOT.0b013e318216b1e5

 

Funding:              Industry funded

Sponsor:              Kinetic Concepts, Inc.

Conflicts:             None disclosed

Therapy Level II – Randomized Trial

Aims

To investigate negative pressure wound therapy (NPWT) to prevent wound dehiscence and infection after high-risk lower extremity trauma.

DESIGN:

Prospective randomized multicenter clinical trial.

SETTING:

Four Level I trauma centers.

Population

Blunt trauma patients with one of three high-risk fracture types (tibial plateau, pilon, calcaneus) requiring surgical stabilization.

INTERVENTION:

• Incisional NPWT (Group B) was applied to the closed surgical incisions of patients randomized to the study arm of this trial,

CONTROLS

• standard postoperative dressings (Group A) were applied to the control patients.

Outcomes

Acute and chronic wound dehiscence and infection.

RESULTS:

• Two hundred forty-nine patients with 263 fractures have enrolled in this study with 122 randomized to Group A (controls) and 141 to Group B (NPWT).
• There was no difference between the groups in the distribution of calcaneus (39%), pilon (17%), or tibial plateau (44%) fractures. There were a total of 23 infections in Group A and 14 in Group B, which represented a significant difference in favor of NPWT (P = 0.049).
• The relative risk of developing an infection was 1.9 times higher in control patients than in patients treated with NPWT (95% confidence interval, 1.03-3.55).

CONCLUSIONS:

• NPWT is an effective prophylactic treatment to prevent infection and wound dehiscence of high-risk surgical incisions.
• These surgeons have found a decreased incidence of wound dehiscence and total infections after high-risk fractures when patients have NPWT applied to their surgical incisions after closure.
• There is also a decrease in acute infections after NPWT
• NPWT should be used in high risk wounds after surgery

Ref:

1. http://www.ncbi.nlm.nih.gov/pubmed/21804414

2. http://journals.lww.com/jorthotrauma/pages/articleviewer.aspx?year=2012&issue=01000&article=00007&type=abstract