Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: A systematic review and meta-analysis

Liu, Xi; Zhang, Hui; Cen, Shiqiang; Huang, Fuguo

doi:10.1016/j.ijsu.2018.02.064

Cited by 82 publications

(60 citation statements)

References 26 publications

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“…In this study, the timing of wound closure of the infection group was longer than that recommended, as some patients required NPWT to improve their wound conditions. Previous metaanalyses have concluded that NPWT not only reduces the infection rate but also reduces flap necrosis and flap revision rates [21,22]. By contrast, the WOLLF trial demonstrated that there was no improvement in wounds with NPWT and that delays in covering the fracture should be avoided [23].…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

et al. 2020

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Background: Open fractures are among the most severe injuries observed in orthopedic patients. Treating open fractures is difficult because such patients with infections may require multiple operations and amputations. Furthermore, only a few studies have focused on antibiotic prophylaxis in open fractures and evaluated how to cover lost soft tissue to increase the success rate of reconstruction. We evaluated the risk factors for deep infection in lower limb Gustilo-Anderson (G-A) type III fractures. Materials and methods: This retrospective study investigated patients who underwent surgical procedures for lower limb G-A type III fractures between January 2007 and January 2017 at our institution. We enrolled 110 patients with 114 lower limb G-A type III fractures (77 G-A type IIIA fractures and 37 G-A type IIIB fractures) who were followed up for at least 2 years. We compared patients presenting infections with those without infections by assessing the following factors: severe contamination, diabetes, smoking, Injury Severity Scale, segmental fracture, location of fracture, G-A classification, damage control surgery, methods of surgery, timing of fixation, combination of antibiotics used, duration of antibiotic prophylaxis, timing of wound closure, and soft-tissue reconstruction failure. Results: Eighteen fractures presented deep infections. Compared with patients without infections, patients developing infections differed significantly in terms of severe contamination (P < 0.01), G-A classification (P < 0.01), duration of antibiotic prophylaxis (P < 0.01), timing of wound closure (P < 0.01), and incidence of soft-tissue reconstruction failure (P < 0.01). Skin grafting was associated with significantly higher failure rates than muscle and free flap reconstructions (P = 0.04). Treatment with antibiotics was significantly longer in patients with drug-resistant bacterial infections than in those without infections (P < 0.01). Conclusion: Early flaps rather than skin grafting should be used to cover G-A type IIIB fractures, because skin grafting resulted in the highest failure rate among soft-tissue reconstructions in open fractures. Longer duration of antibiotic use had a significant impact not only on deep infection rates but also on the presence of drug-resistant bacteria. These findings suggest that prolonged use of antibiotics should be avoided in cases of open fractures.

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Section: Discussionmentioning

confidence: 99%

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

et al. 2020

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“…Only 13 analysed wound closure, the key outcome for this type of intervention. Of these, 10 came to a positive conclusion [163][164][165][166][167][168][169][170][171][172], while 3 did not [173][174][175]. More importantly, only 14 [163-166, 168, 169, 171, 173, 175-180] of the 30 previous systematic reviews at least mentioned the risk of publication bias and none implemented any consequences for their conclusions in the event of this type of bias.…”

Section: Comparison With Previous Researchmentioning

confidence: 99%

Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials

Zens

Barth²,

Bucher

et al. 2020

Syst Rev

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Background Negative pressure wound therapy (NPWT) is a widely used method of wound treatment. We performed a systematic review of randomised controlled trials (RCTs) comparing the patient-relevant benefits and harms of NPWT with standard wound therapy (SWT) in patients with wounds healing by secondary intention. Methods We searched for RCTs in MEDLINE, Embase, the Cochrane Central Register of Controlled Trials, and study registries (last search: July 2018) and screened reference lists of relevant systematic reviews and health technology assessments. Manufacturers and investigators were asked to provide unpublished data. Eligible studies investigated at least one patient-relevant outcome (e.g. wound closure). We assessed publication bias and, if feasible, performed meta-analyses, grading the results into different categories (hint, indication or proof of a greater benefit or harm). Results We identified 48 eligible studies of generally low quality with evaluable data for 4315 patients and 30 eligible studies with missing data for at least 1386 patients. Due to potential publication bias (proportion of inaccessible data, 24%), we downgraded our conclusions. A meta-analysis of all wound healing data showed a significant effect in favour of NPWT (OR 1.56, 95% CI 1.15 to 2.13, p = 0.008). As further analyses of different definitions of wound closure did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. A meta-analysis of hospital stay (in days) showed a significant difference in favour of NPWT (MD − 4.78, 95% CI − 7.79 to − 1.76, p = 0.005). As further analyses of different definitions of hospital stay/readmission did not contradict that analysis, we inferred an indication of a greater benefit of NPWT. There was neither proof (nor indication nor hint) of greater benefit or harm of NPWT for other patient-relevant outcomes such as mortality and adverse events. Conclusions In summary, low-quality data indicate a greater benefit of NPWT versus SWT for wound closure in patients with wounds healing by secondary intention. The length of hospital stay is also shortened. The data show no advantages or disadvantages of NPWT for other patient-relevant outcomes. Publication bias is an important problem in studies on NPWT, underlining that all clinical studies need to be fully reported.

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“…The use of negative pressure wound therapy has been widely practised in the last two decades, in the USA and many countries [13], probably because of the increased understanding of its mechanism of action and also larger studies which support its critical role in wound management as compared to conventional dressings [14]. In the early nineties, Prof. S.A. Malik (unpublished data) introduced a local made version of negative pressure therapy in Pakistan to overcome the cost and burden of patients and hospitals.…”

Section: Discussionmentioning

confidence: 99%

Negative Pressure Wound Therapy (NPWT): Our Experience in Pakistan With Locally Made Dressing

Rashid¹,

Rashid²,

Sarwar³

et al. 2020

Cureus

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Introduction Worldwide numbers of patients suffering from complex wounds appear to increase annually. These patients present with acute, sub-acute and chronic wounds which can be difficult to manage. Management of these patients typically requires a multidisciplinary approach by a plastic surgeon, orthopaedic surgeon and infectious disease control team. Despite the advent of numerous new techniques and technologies, negative pressure wound therapy (NPWT) remains a cornerstone to the management of complex wounds. We present our experience with NPWT in this study. Methods This is a retrospective study of 380 patients who were treated with NPWT in the last 10 years at a single center. We receive hundreds of infected wounds of limbs each year which are either post-traumatic or post-debridement. Frequency of dressing change, C-reactive protein levels, bacterial cultures, complication rate and cost of apparatus in each case were noted. All patients received systemic antibiotics during the treatment.

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Negative pressure wound therapy versus conventional wound dressings in treatment of open fractures: A systematic review and meta-analysis

Cited by 82 publications

References 26 publications

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

Retrospective analysis of risk factors for deep infection in lower limb Gustilo–Anderson type III fractures

Negative pressure wound therapy in patients with wounds healing by secondary intention: a systematic review and meta-analysis of randomised controlled trials

Negative Pressure Wound Therapy (NPWT): Our Experience in Pakistan With Locally Made Dressing

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