title: Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: steps towards an international consensus.
abstract: Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.
authors.affiliation: Leiden University Medical Centre, The Netherlands.
authors.forename: E
authors.initials: E
authors.lastname: Krug
authors.forename: L
authors.initials: L
authors.lastname: Berg
authors.forename: C
authors.initials: C
authors.lastname: Lee
authors.forename: D
authors.initials: D
authors.lastname: Hudson
authors.forename: H
authors.initials: H
authors.lastname: Birke-Sorensen
authors.forename: M
authors.initials: M
authors.lastname: Depoorter
authors.forename: R
authors.initials: R
authors.lastname: Dunn
authors.forename: S
authors.initials: S
authors.lastname: Jeffery
authors.forename: F
authors.initials: F
authors.lastname: Duteille
authors.forename: A
authors.initials: A
authors.lastname: Bruhin
authors.forename: C
authors.initials: C
authors.lastname: Caravaggi
authors.forename: M
authors.initials: M
authors.lastname: Chariker
authors.forename: C
authors.initials: C
authors.lastname: Dowsett
authors.forename: F
authors.initials: F
authors.lastname: Ferreira
authors.forename: J M Francos
authors.initials: JM
authors.lastname: Martínez
authors.forename: G
authors.initials: G
authors.lastname: Grudzien
authors.forename: S
authors.initials: S
authors.lastname: Ichioka
authors.forename: R
authors.initials: R
authors.lastname: Ingemansson
authors.forename: M
authors.initials: M
authors.lastname: Malmsjo
authors.forename: P
authors.initials: P
authors.lastname: Rome
authors.forename: S
authors.initials: S
authors.lastname: Vig
authors.forename: N
authors.initials: N
authors.lastname: Runkel
authors.forename: R
authors.initials: R
authors.lastname: Martin
authors.forename: J
authors.initials: J
authors.lastname: Smith
mesh_terms: D002056:Burns / Q000628:therapy; D003161:Compartment Syndromes / Q000601:surgery; D032921:Consensus; D003646:Debridement; D019317:Evidence-Based Medicine; D006085:Graft Survival; D006801:Humans; D009336:Necrosis; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D017410:Practice Guidelines as Topic; D019651:Plastic Surgery Procedures; D016038:Skin Transplantation / Q000379:methods; D013524:Surgical Flaps; D058106:Wound Closure Techniques; D014945:Wound Healing / Q000502:physiology; D014947:Wounds and Injuries / Q000473:pathology / Q000628:therapy*