The incidence of wound complications related to negative pressure wound therapy power outage and interruption of treatment in orthopaedic trauma patients.
OBJECTIVE
Negative pressure wound therapy (NPWT) using the Vacuum Assisted Closure system is an invaluable tool for use on patients with complex limb and soft tissue problems. Recently, the manufacturer (Kinetic Concepts, Inc, San Antonio, TX) made significant modifications to the NPWT platform, including computer software, battery, alarming systems, electric cord and plug apparatus, and others. Since these modifications, we have seen several cases in which the NPWT device has powered off resulting in an unrecognized interruption of therapy. We sought to evaluate the conditions and clinical effects, if any, to orthopaedic trauma patients who experienced an interruption of NPWT therapy when the device powers off.


METHODS
Retrospective study of consecutive patients.


METHODS
Two neighboring regional trauma centers.


METHODS
One hundred twenty-three consecutive orthopaedic trauma patients treated with NPWT by two orthopaedic trauma surgeons between May and November 2008.


METHODS
Patient/injury, treatment, and perioperative clinical outcomes data (with emphasis on wound complications such as infection, graft loss, and unscheduled surgery) were collected from medical records and wound care databases.


RESULTS
Twelve patients (10%) had problems with the NPWT device powering off causing an unrecognized interruption of therapy. Eleven patients underwent early (less than 6 hours) wound débridement and reapplication of NPWT after detection, of which nine required unplanned surgery. Seven of the 12 patients recognized as having failed NPWT of this type ultimately experienced wound complications, including five deep infections and both patients being treated with an Integra graft (loss of graft).


CONCLUSIONS
We have seen substantial problems in orthopaedic trauma patients treated with the NPWT, in which the device has powered off resulting in an unrecognized interruption of therapy. This has resulted in atypically unhealthy-appearing wounds, unplanned surgeries for débridement, and most importantly, an increased incidence of wound complications, including infection and graft loss (P < 0.05).
Department of Orthopedic Trauma, Harris Methodist Fort Worth Hospital, University of North Texas, Fort Worth, TX, USA. ccollinge@msn.com
Cory
C
Collinge
Robert
R
Reddix
D000328:Adult; D015897:Comorbidity; D004868:Equipment Failure / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000295:instrumentation* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000601:surgery*