Negative pressure wound therapy after severe open fractures: a prospective randomized study.
OBJECTIVE
To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection.


METHODS
Prospective randomized study.


METHODS
Academic level I trauma center.


METHODS
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.


METHODS
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.


METHODS
The presence or absence of deep wound infection or osteomyelitis, wound dehiscence, and fracture union were primary outcome measures.


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.
Stannard
James P
JP
Division of Orthopaedic Surgery, University of Alabama at Birmingham, 950 Faculty Office Tower, 510 South 20th St, Birmingham, AL 35294-3409, USA. james.stannard@ortho.uab.edu
Volgas
David A
DA
Stewart
Rena
R
McGwin
Gerald
G
Alonso
Jorge E
JE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D003646:Debridement / Q000009:adverse effects*; D005260:Female; D005597:Fractures, Open / Q000150:complications* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation* / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome; D014946:Wound Infection / Q000209:etiology* / Q000517:prevention & control*; D055815:Young Adult
D000900:Anti-Bacterial Agents