title: Effect of negative-pressure wound therapy on open fractures of the lower limb.
abstract: BACKGROUND
  Early debridement and coverage has long been regarded as the standard of care for open fractures of the lower limb, as infection is a serious complication. However, the best time for wound closure remains controversial. Negative-pressure wound therapy (NPWT) is thought to result in reduced flap infection and failure. To determine the effect of NPWT, we reviewed patients with open fractures of the lower limb and compared the rates of infection and flap failure in two time-based cohorts.
  
  
  METHODS
  Two cohorts of patients (periods 2003-2004 and 2008-2009) with Gustilo type IIIB open tibial fractures were recruited and their outcomes were compared. In the 2003-2004 cohort, wounds were dressed with occlusive dressing. In the 2008-2009 cohort, all patients underwent NPWT. Data was retrospectively analysed with regard to infection, failure, age, type of flap, comorbidities and defect size. The incidences of infection and flap failure were further analysed for any statistical difference between the different treatment protocols.
  
  
  RESULTS
  In the 2003-2004 cohort, 33% of patients developed infection and 11% had flap failure. However, in the 2008-2009 cohort, 10% of patients developed infection and 6% had flap failure. The difference in the incidence of infection was statistically significant between the two cohorts (p = 0.029).
  
  
  CONCLUSIONS
  Patients in the 2008-2009 cohort had better outcomes, and we are of the opinion that performing NPWT may have contributed to this result.
authors.affiliation: Department of Hand and Reconstructive Microsurgery, National University Health System, 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore 119228. Mark_E_Puhaindran@nuhs.edu.sg.
authors.forename: Janna
authors.initials: J
authors.lastname: Joethy
authors.forename: Sandeep J
authors.initials: SJ
authors.lastname: Sebastin
authors.forename: Alphonsus Khin Sze
authors.initials: AK
authors.lastname: Chong
authors.forename: Yeong Pin
authors.initials: YP
authors.lastname: Peng
authors.forename: Mark E
authors.initials: ME
authors.lastname: Puhaindran
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000379:methods; D005597:Fractures, Open / Q000175:diagnosis / Q000601:surgery*; D006084:Graft Rejection; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000175:diagnosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D011859:Radiography; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000098:blood supply*; D013530:Surgical Wound Infection / Q000175:diagnosis / Q000601:surgery*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult