SLR - December 2012 - Lindberg

Negative Pressure Wound Therapy Reduces Deep Infection Rate in Open Tibial Fractures

References:
Blum M, Esser M.  Negative Pressure Wound Therapy Reduces Deep Infection Rate in Open Tibial Fractures. Journal of Orthopedic Trauma. Volume 26, Number 9, September 2012. 499-505.

Scientific Literature Review

Reviewed by: Carl Brandon Lindberg, DPM
Residency Program: University Hospital, UMDNJ

Podiatric Relevance:
Open tibial fractures fractures are known to have a significant risk of developing complications, including infection. This article studied the use of negative pressure wound therapy vs. conventional dressings for open tibial fractures that had a soft tissue defect which was unable to be closed primarily. The long term outcomes of deep infection and nonunion were studied as primary outcome measures. As podiatric foot and ankle surgeons, we deal with the capability of seeing open fractures of the lower extremity. If initial primary closure is not possible, then any method to reduce complications for our patients should be used.

Methods:
The study design was a retrospective cohort study from two level one trauma centers consisting of 220 patients and 229 open tibial fractures that received either negative pressure wound therapy or conventional dressings between delayed soft tissue coverage. Patients were excluded from the study if both dressings were used, amputation or death took place and if there was insufficient documentation for review. The presence of deep infection, superficial infection, hospital stay, secondary procedures performed, delayed union, malunion and nonunion were then examined using the patient’s records and radiographs.

Results:
Of the 229 open tibial fractures, roughly two-thirds were treated with the negative pressure wound therapy dressing. The authors found that despite the unequal number between the two cohorts, there was no significant difference for patient comorbidities, patient demographics, mechanism of injury or injury severity score. However, there was a significantly higher portion of Gustilo Anderson Type III fractures and free flaps used in the negative pressure wound therapy group. Overall, the authors found an 87 percent reduction in deep infection for fractures treated with negative pressure wound therapy vs. conventional dressings. No difference was found between superficial infections, length of hospital stay, secondary procedures performed, nonunion, delayed union or malunion.

Conclusion:
Utilizing the patient’s medical records, there was a clear decrease in deep infection rate for open tibial fractures treated with negative pressure wound therapy between delayed soft tissue coverage.

 

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