title: Impact of negative pressure wound therapy on open diaphyseal tibial fractures: A prospective randomized trial.
abstract: BACKGROUND
  Open tibial fractures are associated with a high incidence of mainly osteomyelitis. Negative pressure wound therapy (NPWT) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing.
  
  
  OBJECTIVE
  To determine the effect of NPWT on incidence of deep infections/osteomyelitis after open tibial fractures using a prospective randomized study design.
  
  
  METHODS
  Ninety-three open tibial fractures were randomized into two groups receiving NPWT and the second group undergoing periodic irrigation, cleaning and debridement respectively. The wounds were closed or covered on shrinkage in size and sufficient granulation. Evidence of infection was sought during the course of treatment and follow up. Also serial cultures were sent every time the wound was cleaned.
  
  
  CONCLUSIONS
  Patients in the control group developed a total of 11 infections (22%) as opposed to only 2 (4.6%) in the NPWT group (p< 0.05). The relative risk was 5.5 (95% confidence interval) suggesting patients who received NPWT were 5.5 times less likely to develop infection. Twenty patients developed positive growth when samples were sent for culture with 3 (6.9%) in the NPWT group and 17 (34%) in the control group (p< 0.05). Only 5 patients (25%) went on the develop osteomyelitis, all being a part of the control group. Thus negative pressure wound therapy is indeed beneficial for preventing the incidence of both acute infections and osteomyelitis in open fractures. However a significant difference was not seen in the time required for the wound to be ready for delayed primary closure or coverage.
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
authors.forename: Siddharth R
authors.initials: SR
authors.lastname: Virani
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
authors.forename: Aditya A
authors.initials: AA
authors.lastname: Dahapute
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Bava
authors.affiliation: Department of Orthopaedics, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, India.
authors.forename: Saurabh R
authors.initials: SR
authors.lastname: Muni
keywords: Infection; Negative pressure wound therapy; Open fracture; Osteomyelitis; Vacuum assisted closure