Does negative pressure wound therapy with irrigation improve clinical outcomes? A randomized clinical trial in patients with diabetic foot infections

Lavery, Lawrence A.; Davis, Kathryn E.; Fontaine, Javier La; Farrar, J. David; Bhavan, Kavita; Öz, Orhan K.; Crisologo, Peter A.

doi:10.1016/j.amjsurg.2020.02.044

Cited by 26 publications

(49 citation statements)

References 17 publications

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“…Only two studies used higher pressures, 300 to 450 mm Hg 16 and 300 to 600 mmHg. 31 Nine studies 12,13,17–19,27–29,31 reported the frequency of dressing changes, all falling between 2 and 4 days (Table 2).…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis of two randomized controlled trials 19,27 showed no significant difference in length of stay (n = 240; mean difference, −0.81 day; 95 percent CI, −3.44 to 1.82; I² = 0 percent). Four observational studies that compared negativepressure wound therapy with instillation to negative-pressure wound therapy alone investigated length of stay.…”

Section: Length Of Hospital Staymentioning

confidence: 94%

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The Effect of Negative-Pressure Wound Therapy with Instillation Compared to Current Standard Care on Wound Closure Time of Infected Wounds: A Systematic Review and Meta-Analysis

Timmer

Zwanenburg

Hompes

et al. 2022

Plastic &Amp; Reconstructive Surgery

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Section: Resultsmentioning

confidence: 99%

Section: Length Of Hospital Staymentioning

confidence: 94%

The Effect of Negative-Pressure Wound Therapy with Instillation Compared to Current Standard Care on Wound Closure Time of Infected Wounds: A Systematic Review and Meta-Analysis

Timmer

Zwanenburg

Hompes

et al. 2022

Plastic &Amp; Reconstructive Surgery

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“…Recently, in a systematic review, Dehghan et al (3) and Yovera-Aldana et al (4) described that NPWT efficacy is associated with increased granulation tissue formation, a low incidence of amputation, and reduction of wound area and depth. Similarly, Lavery et al (5) compared the efficacy of NPWT+saline irrigation with that of NPWT+polyhexanide-betaine 0.1% irrigation in patients with infected DF, finding that the latter did not demonstrate significant improvements in wound healing relative to saline. In our case, NPWT was applied for four weeks and, then, we proceeded to ambulatory healing for approximately ten months-these periods have been the subject of multiple studies, such as the one described by Węgrzynowski et al (6) , who evaluated NPWT for "extended time" (±4 weeks) in patients with DF and observed a significant decrease of 92% in the risk of amputation compared to that seen in the short-time NPWT group.…”

Section: Discussionmentioning

confidence: 99%

“…The role of antibiotic therapy directed to the micro-organism identified by culture is one of the main therapeutic weapons available and, together with surgical debridement, has demonstrated cure rates of up to 72%. However, it is necessary to add further curative strategies such as NPWT, the use of sponges, and, if necessary, after vascular assessment, the coverage of extensive lesions with skin grafts (5,8) .…”

Section: A B C Dmentioning

confidence: 99%

Diabetic foot salvage: breaking paradigms through a case report

Callupe¹,

Quiroz²,

Manrique³

et al. 2022

J Foot Ankle

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Diabetic foot (DF) is one of the most frequent and disabling complications of diabetes mellitus 2 (DM2). This study presents the case of a 66-year-old female patient with DM2 and DF complicated by extensive infected necrosis involving more than 50% of the foot. She was not a candidate for revascularization and, due to the poorly controlled septic focus and the extent of necrosis, infracondylar amputation was indicated. However, as the patient refused to undergo amputation, the case was re evaluated at another health institution and a multidisciplinary therapeutic plan for DF salvage was proposed. The protocol included antibiotic therapy, surgical debridement, periodic outpatient dressing, and negative pressure wound therapy (NPWT). After ten months of treatment, the limb showed almost complete healing, and amputation was not necessary. Management of complicated DF is currently one of the greatest clinical-surgical challenges, requiring a highly trained multidisciplinary team to propose an optimal limb salvage program. Level of Evidence V; Case Report; Expert Opinion.

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“…Firstly, the effectiveness of continuous irrigation in NPWT over standard NPWT remains disputed. Recent randomised controlled trials (RCTs) have directly compared standard NPWT with antiseptic or saline irrigation in complex foot infections and found no significant difference in outcomes [13,14]. Conversely, another RCT reported improved granulation tissue, reduced wound surface area and reduced bacterial load in extremity ulcers in NPWT with saline instillation over standard NPWT [4].…”

Section: Discussionmentioning

confidence: 99%

Modified negative pressure wound therapy as an adjunct to antibiotics in the treatment of orthopaedic infected metalwork

Summers

Daniels

Thahir

et al. 2021

Eur J Orthop Surg Traumatol

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Purpose Infected orthopaedic metalwork is challenging to treat. Negative pressure wound therapy (NPWT) with irrigation is an emerging therapy for infected wounds as an adjunct to antibiotic therapy. The senior author had devised a modified technique to augment its efficacy, utilising high-flow rate irrigation and skin closure over the standard NPWT dressing. This novel technique was originally evaluated in a different centre and produced 100% success in metalwork retention. The present study is a reproducibility test of the same technique. Methods A retrospective review was performed on 24 patients with infected orthopaedic metalwork, including 3 upper limb and 21 lower limb cases, for outcomes relating to implant retention and infection resolution. Patients underwent a modified NPWT technique as an adjunct to antibiotic therapy and surgical debridement. Detailed medical and microbiology information were obtained from the patient records. Results 23 of 24 (96%) patients had successful metalwork retainment with healed wounds and resolution of infection, allowing fracture union. 27 infective organisms were identified in this cohort, and the antibiotic regimens for each patient are provided. The average follow-up was 663 days. No adverse effects were observed. Conclusion This series supports the modified NPWT technique as a safe, reliable and effective adjunct therapy to resolve metalwork infection. The same results have been reproduced as the previous cohort in a different centre.

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Does negative pressure wound therapy with irrigation improve clinical outcomes? A randomized clinical trial in patients with diabetic foot infections

Cited by 26 publications

References 17 publications

The Effect of Negative-Pressure Wound Therapy with Instillation Compared to Current Standard Care on Wound Closure Time of Infected Wounds: A Systematic Review and Meta-Analysis

The Effect of Negative-Pressure Wound Therapy with Instillation Compared to Current Standard Care on Wound Closure Time of Infected Wounds: A Systematic Review and Meta-Analysis

Diabetic foot salvage: breaking paradigms through a case report

Modified negative pressure wound therapy as an adjunct to antibiotics in the treatment of orthopaedic infected metalwork

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