SLR - May 2012 - Kyle Scholnick
Reference: Stannard JP, Volgas DA, McGwin G, Stewart RL, Obremskey W, Moore T, Anglen JO. Incisional Negative Pressure Wound Therapy After High-Risk Lower Extremity Fractures. J Orthop Trauma. 2012 Jan: 26(1): 37-42
Scientific Literature Review
Reviewed by: Kyle Scholnick, DPM
Residency Program: Yale University, New Haven CT
Podiatric Relevance:
Tibial plateau, pilon and calcaneal fractures are particularly notorious for complications related to infections and wound healing problems. Negative pressure wound therapy (NPWT) is a relatively new treatment method to aid in the treatment of chronic wounds, however the use of NPWT in the treatment of extremity trauma to prevent wound complications is a new concept. The purpose of this study was to investigate the use of NPWT to prevent wound dehiscence and infection after high-risk lower extremity trauma.
Methods:
The study design consisted of a multicenter, prospective randomized controlled trial evaluating wound healing and complications using NPWT after high-energy tibial plateau, pilon and calcaneus fractures. Patients were randomized to receive either standard postoperative dressings (control) or NPWT (study) over the surgical incision after ORIF of their fracture. 249 patients with 263 fractures were randomized into this study. 119 patients with 122 fractures were randomized to the control group, whereas 130 patients with 141 fractures were randomized to the NPWT group. The distribution of the three fracture types was similar between the control and study groups.
Results:
Control patients developed five (4 percent) acute and 18 (15 percent) late infections for a total of 23 infections. NPWT patients had 1 (0.7 percent) acute and 13 (9 percent) delayed infections for a total of 14 infections. Wound dehiscence after discharge was observed to be 20 (16.5 percent) in the control and 12 (8.6 percent) in the NPWT-treated fractures. On average patients in the NPWT group were ready for discharge in 2.5 days compared to three days in the control group.
Conclusions:
There is a decreased incident of wound dehiscence and total infections after high-risk fractures when patients have NPWT applied to their surgical incisions after closure. The relative risk of developing an infection was 1.9 times higher in control patients than in patients treated with NPWT. Application of NPWT to the surgical incisions immediately after surgical fixation and closure should be considered after high-risk traumatic fractures below the knee.