Prophylactic negative pressure wound therapy after lower extremity fracture surgery: a pilot study

Abstract

Purpose Infectious complications following lower extremity fracture surgery are a major concern and account for a substantial socio-economic burden to society. The aim of this pilot study was to investigate the feasibility of a new portable single-use negative pressure wound therapy device in patients undergoing major foot ankle surgery. Methods Patients undergoing major foot ankle fracture surgery at a single level 1 trauma centre were eligible for this prospective case series. Patient characteristics were collected, as were fracture and surgical characteristics. Primary outcome was surgical site infection within 30 days as classified by the criteria from the Centers for Disease Control and Prevention. Patients in the prospective cohort were case-matched with a historical cohort from the same institution. Results Sixty patients were included. In seven patients, the NPWT failed and treatment was ceased. Mean age was 44 years and 85% was ASA 1; 43% of the patients were actively smoking. Indications for surgery were midfoot, calcaneal, talar, and ankle fractures. In 53 patients, four (7.5%) surgical site infections occurred, two superficial (3.3%) and two (3.3%) deep infections. For 47 patients, a match was available. The incidence of surgical site infection did not statistically significantly differ between the prospective cohort and retrospective matched cohort (4.3 versus 14.9%, p = 0.29, respectively). This was also the case when looking at superficial and deep surgical site infections separately (0 versus 8.5%, p = 0.08, and 4.3 versus 6.4%, respectively). Conclusion We have observed surgical site infections in 7.5% of the patients with the use of prophylactic negative pressure wound therapy. The incidence of surgical site infections was not statistically significantly lower compared to a matched historical cohort.

Negative pressure wound therapy for closed incisions in orthopedic trauma surgery: a meta-analysis

“…Superficial SSIs were reported in 2 studies [17, 18], with 69 NPWT and 101 conventional wound dressings. The NPWT resulted in 1.4% of patients having superficial SSIs, compared with conventional wound dressings where 14.9% of patients had superficial SSIs.…”

The use of negative-pressure wound therapy after total knee arthroplasty is effective for reducing complications and the need for reintervention

“…One of the recent alternatives that has been used to improve wound healing after TKA and to minimize wound complications and the incidence of infection is the use of negative-pressure therapy [ 14 , 15 ]. This type of therapy has been used successfully in several fields of medicine, such as plastic surgery, colorectal surgery and caesarean, and has achieved excellent results in the orthopaedic field, especially in cases of open fractures or open wounds [ 16 – 18 ]. In closed wounds, as is the case of postoperative use after arthroplasties, its benefit is still controversial, with a lack of agreement among existing studies regarding its actual benefit [ 19 , 20 ].…”

The use of negative-pressure wound therapy after total knee arthroplasty is effective for reducing complications and the need for reintervention.

“…One of the recent alternatives that has been used to improve wound healing after TKA and to minimize wound complications and the incidence of infection is the use of negative-pressure therapy [14,15]. This type of therapy has been used successfully in several fields of medicine, such as plastic surgery, colorectal surgery and caesarean, and has achieved excellent results in the orthopaedic field, especially in cases of open fractures or open wounds [16][17][18]. In closed wounds, as is the case of postoperative use after arthroplasties, its benefit is still controversial, with a lack of agreement among existing studies regarding its actual benefit [19,20].…”