Negative pressure wound therapy after severe open fractures: a prospective randomized study.

Academic Article

Abstract

  • OBJECTIVES: To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection. DESIGN: Prospective randomized study. SETTING: Academic level I trauma center. PATIENTS/PARTICIPANTS: Fifty-nine patients with 63 severe high-energy open fractures were enrolled in this study, with data available on 58 patients with 62 open fractures. INTERVENTION: Twenty-three patients with 25 fractures randomized to the control group and underwent initial irrigation and debridement followed by standard fine mesh gauze dressing, with repeat irrigation and debridement every 48-72 hours until wound closure. Thirty-five patients randomized to the NPWT group and had identical treatment except that NPWT was applied to the wounds between irrigation and debridement procedures until closure. MAIN OUTCOME MEASUREMENTS: The presence or absence of deep wound infection or osteomyelitis, wound dehiscence, and fracture union were primary outcome measures. RESULTS AND CONCLUSIONS: Control patients developed 2 acute infections (8%) and 5 delayed infections (20%), for a total of 7 deep infections (28%), whereas NPWT patients developed 0 acute infections, 2 delayed infections (5.4%), for a total of 2 deep infections (5.4%). There is a significant difference between the groups for total infections (P = 0.024). The relative risk ratio is 0.199 (95% confidence interval: 0.045-0.874), suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients randomized to the control group. NPWT represents a promising new therapy for severe open fractures after high-energy trauma.
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    Keywords

  • Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Combined Modality Therapy, Debridement, Female, Fractures, Open, Humans, Male, Middle Aged, Negative-Pressure Wound Therapy, Prospective Studies, Treatment Outcome, Wound Infection, Young Adult
  • Digital Object Identifier (doi)

    Author List

  • Stannard JP; Volgas DA; Stewart R; McGwin G; Alonso JE
  • Start Page

  • 552
  • End Page

  • 557
  • Volume

  • 23
  • Issue

  • 8