Stannard, J Orthop Trauma 2009 - Negative Pressure Wound Therapy after Severe Open Fractures: A Prospective Randomized Study - Article Summary

Negative Pressure Wound Therapy after Severe Open Fractures: A Prospective Randomized Study

Stannard, Alonso, et al.·J Orthop Trauma·2009·342 citations·RCT

Purpose

To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection.

Methods

Design: Prospective randomized study.

Setting: Academic level I trauma center.

Patients: 59 patients with 63 severe high-energy open fractures were enrolled in this study, with data available on 58 patients with 62 open fractures.

Intervention: 23 patients with 25 fractures randomized to the control group and underwent initial irrigation and debridement followed by standard fine mesh gauze dressing, with repeat irrigation and debridement every 48-72 hours until wound closure. 35 patients randomized to the NPWT group and had identical treatment except that NPWT was applied to the wounds between irrigation and debridement procedures until closure.

Main Outcome Measures: The presence or absence of deep wound infection or osteomyelitis, wound dehiscence, and fracture union were primary outcome measures.

Results and Conclusions

Control patients developed 2 acute infections (8%) and 5 delayed infections (20%), for a total of 7 deep infections (28%), whereas NPWT patients developed 0 acute infections, 2 delayed infections (5.4%), for a total of 2 deep infections (5.4%).
There is a significant difference between the groups for total infections (P = 0.024).
The relative risk ratio is 0.199 (95% confidence interval: 0.045-0.874), suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients randomized to the control group.
NPWT represents a promising new therapy for severe open fractures after high-energy trauma.

Supplemental

Negative Pressure Wound Therapy after Severe Open Fractures: A Prospective Randomized Study.

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Negative Pressure Wound Therapy after Severe Open Fractures: A Prospective Randomized Study

Stannard, Alonso, et al.·J Orthop Trauma·2009·342 citations·RCT

DOI·PubMed

Purpose

To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection.

Methods

Design: Prospective randomized study.

Setting: Academic level I trauma center.

Patients: 59 patients with 63 severe high-energy open fractures were enrolled in this study, with data available on 58 patients with 62 open fractures.

Main Outcome Measures: The presence or absence of deep wound infection or osteomyelitis, wound dehiscence, and fracture union were primary outcome measures.

Results and Conclusions

Control patients developed 2 acute infections (8%) and 5 delayed infections (20%), for a total of 7 deep infections (28%), whereas NPWT patients developed 0 acute infections, 2 delayed infections (5.4%), for a total of 2 deep infections (5.4%).
There is a significant difference between the groups for total infections (P = 0.024).
The relative risk ratio is 0.199 (95% confidence interval: 0.045-0.874), suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients randomized to the control group.
NPWT represents a promising new therapy for severe open fractures after high-energy trauma.

Purpose

To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection.

Methods

Design: Prospective randomized study.

Setting: Academic level I trauma center.

Patients: 59 patients with 63 severe high-energy open fractures were enrolled in this study, with data available on 58 patients with 62 open fractures.

Main Outcome Measures: The presence or absence of deep wound infection or osteomyelitis, wound dehiscence, and fracture union were primary outcome measures.

Results and Conclusions

Control patients developed 2 acute infections (8%) and 5 delayed infections (20%), for a total of 7 deep infections (28%), whereas NPWT patients developed 0 acute infections, 2 delayed infections (5.4%), for a total of 2 deep infections (5.4%).
There is a significant difference between the groups for total infections (P = 0.024).
The relative risk ratio is 0.199 (95% confidence interval: 0.045-0.874), suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients randomized to the control group.
NPWT represents a promising new therapy for severe open fractures after high-energy trauma.

Purpose

To evaluate the impact of negative pressure wound therapy (NPWT) after severe open fractures on deep infection.

Methods

Design: Prospective randomized study.

Setting: Academic level I trauma center.

Patients: 59 patients with 63 severe high-energy open fractures were enrolled in this study, with data available on 58 patients with 62 open fractures.

Main Outcome Measures: The presence or absence of deep wound infection or osteomyelitis, wound dehiscence, and fracture union were primary outcome measures.

Results and Conclusions

Control patients developed 2 acute infections (8%) and 5 delayed infections (20%), for a total of 7 deep infections (28%), whereas NPWT patients developed 0 acute infections, 2 delayed infections (5.4%), for a total of 2 deep infections (5.4%).
There is a significant difference between the groups for total infections (P = 0.024).
The relative risk ratio is 0.199 (95% confidence interval: 0.045-0.874), suggesting that patients treated with NPWT were only one-fifth as likely to have an infection compared with patients randomized to the control group.
NPWT represents a promising new therapy for severe open fractures after high-energy trauma.