title: Negative pressure wound therapy after severe open fractures: a prospective randomized study.
abstract: 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.
authors.affiliation: 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
authors.forename: James P
authors.initials: JP
authors.lastname: Stannard
authors.forename: David A
authors.initials: DA
authors.lastname: Volgas
authors.forename: Rena
authors.initials: R
authors.lastname: Stewart
authors.forename: Gerald
authors.initials: G
authors.lastname: McGwin
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Alonso
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents