Impact of negative pressure wound therapy on open diaphyseal tibial fractures: A prospective randomized trial

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• 作者：Siddharth R. Virani ; ^{siddharthvirani@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Aditya A. Dahapute^a ; ^{adityahapute1986@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; S.S. Bava^b ; Saurabh R. Muni
• 关键词：Negative pressure wound therapy ; Osteomyelitis ; Vacuum assisted closure ; Open fracture ; Infection
• 刊名：Journal of Clinical Orthopaedics and Trauma
• 出版年：2016
• 出版时间：October-December 2016
• 年：2016
• 卷：7
• 期：4
• 页码：256-259
• 全文大小：487 K

文摘

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.

Objectives and study design

To determine the effect of NPWT on incidence of deep infections/osteomyelitis after open tibial fractures using a prospective randomized study design.

Materials and 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.

Results and 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.