Delayed Flap Reconstruction With Vacuum-Assisted Closure Management of the Open IIIB Tibial Fracture

Hou, Zhiyong; Irgıt, Kaan; Strohecker, Kent; Matzko, Michelle E.; Wingert, Nathaniel C.; DeSantis, Joseph G.; Smith, Wade R.

doi:10.1097/ta.0b013e31822e2823

Cited by 85 publications

(114 citation statements)

References 22 publications

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“…Pediatric studies were not excluded. Thirteen studies remained [6,7,15,16,29,30,33,35,36,45,47,49,50] after reading the abstract and the full-length article as needed to ascertain data points. Twenty-two studies were eliminated from the final 35 articles identified because they were review articles (n = 8), articles regarding pilon fracture (n = 2), and articles with insufficient data or case reports (n = 12).…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…All publications were from 2006 and later, likely owing to FDA approval in 1997 and several years thereafter for clinicians to use negative pressure wound therapy and several more years for patient followup. One of the 13 studies was an RCT [49], and the remaining 12 were retrospective [6,7,15,16,29,30,33,35,36,45,47,50]. The RCT was not eliminated because of lack of study quality as defined by Moher et al [37] or by Detsky et al [17].…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…extended beyond 72 hours. Six studies [6,15,16,29,35,45] reported data on flap procedure rates when negative pressure wound therapy extended beyond 72 hours. For the purposes of this review, any patient treated with antibiotics alone or antibiotics and surgical incision and drainage or other procedure was considered to have an infection.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…Ten retrospective studies [6,15,16,29,30,33,35,36,47,50] reported data on extended use (beyond 72 hours) of negative pressure wound therapy in Grade IIIB tibia fractures. The combined infection rates ranged from 0% to 57%.…”

Section: Does Negative Pressure Wound Therapy Facilitate Late Flap Prmentioning

confidence: 99%

“…Use of negative pressure wound therapy in some centers extends long beyond the acute injury phase (weeks at a time with intermittent sponge changes). These centers have found an associated decreased rate of free or local flap procedures [6,15,16,29,35,45], and an increase in delayed primary closure or skin grafting. Whether the outcomes are as universally favorable for Grade IIIB tibia fractures needs to be determined.…”

Section: Introductionmentioning

confidence: 99%

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Negative Pressure Wound Therapy in Grade IIIB Tibial Fractures: Fewer Infections and Fewer Flap Procedures?

Schlatterer

Hirschfeld

Webb

2015

Clinical Orthopaedics &Amp; Related Research

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Background Grade IIIB open tibia fractures are devastating injuries. Some clinicians advocate wound closure or stable muscle flap coverage within 72 hours to limit complications such as infection. Negative pressure wound therapy was approved by the FDA in 1997 and has become an adjunct for many surgeons in treating these fractures. Opinions vary regarding the extent to which negative pressure wound therapy contributes to limb salvage. Evidence-based practice guidelines are limited for use of negative pressure wound therapy in Grade IIIB tibia fractures. This systematic literature review of negative pressure wound therapy in Grade IIIB tibia fractures may substantiate current use and guide future studies. Questions/purposes We sought to answer the following:(1) Does the use of negative pressure would therapy compared with gauze dressings lead to fewer infections? (2) Does it allow flap procedures to be performed safely beyond 72 hours without increased infection rates? (3) Is it associated with fewer local or free flap procedures? Methods We conducted a systematic review of six large databases (through September 1, 2013) for studies reporting use of negative pressure wound therapy in Grade IIIB open tibia fractures, including information regarding infection rates and soft tissue reconstruction. The systematic review identified one randomized controlled trial and 12 retrospective studies: four studies compared infection rates between negative pressure wound therapy and gauze dressings, 10 addressed infection rates with extended use, and six reported on flap coverage rates in relation to negative pressure wound therapy use beyond 72 hours. None of the 13 studies was eliminated owing to lack of study quality.

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