title: Negative pressure wound therapy in acute, contaminated wounds: documenting its safety and efficacy to support current global practice.
abstract: Negative pressure wound therapy (NPWT) is in widespread use and its role in wound care is expanding worldwide. It is estimated that 300 million acute wounds are treated globally each year. Currently, sporadic data exist to support NPWT in acutely contaminated wounds. Despite lack of data, use of negative pressure wound therapy in such cases is increasing across the globe. We retrospectively reviewed 86 consecutive patients, totalling 97 contaminated wounds. All wounds were Class IV based on US Center for Disease Control criteria. Sepsis criteria were present in 78/86 (91%) of patients. All patients were managed with NPWT. Wound type, degree of tissue destruction, presence of infection, wound dimension, timing of initial NPWT, type and timing of wound closure and patient comorbidities were recorded. Outcome endpoints included durability of wound closure and death. Wound location was 41/97 (42%) in the torso; 56/97 (58%) at the extremities. Tissue necrosis was present in 84/97 (87%) of wounds. Infection was present in 86/97 (89%) of wounds. Average wound size was 619 cm(2)  when square surface area measured; 786 cm(3)  when volume measurements taken. Mean time to wound closure was 17 days, median 10 days and mode 6 days. Durability of wound closure 73/79 (92%). Deaths were noted in 6/86 (7%) of patients. No deaths appeared related to NPWT. Contemporary NPWT related acute wound care is expanding empirically, in quantity and scope across the globe. However, several areas of concern are known regarding this contemporary use of NPWT in acute wounds. Thus, it is important to assess the safety and efficacy of such expanded empiric NPWT practice. Based on our findings with NPWT in the largest known patient cohort of this type, NPWT appears safe and effective in managing acute, contaminated wounds including patients meeting sepsis criteria. These findings provide evidence-based support for current worldwide empiric NPWT-related acute wound care.
authors.affiliation: Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Ehyal
authors.initials: E
authors.lastname: Shweiki
authors.forename: Kathy E
authors.initials: KE
authors.lastname: Gallagher
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D019317:Evidence-Based Medicine; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D054843:Negative-Pressure Wound Therapy / Q000009:adverse effects; D012449:Safety; D018805:Sepsis / Q000453:epidemiology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014945:Wound Healing; D014946:Wound Infection / Q000453:epidemiology / Q000209:etiology / Q000473:pathology / Q000628:therapy*