Subatmospheric Pressure Dressings in the Temporary Treatment of Soft Tissue Injuries Associated With Type III Open Tibial Shaft Fractures in Children

Abstract

A reduction in the need for major soft tissue coverage procedures with the use of negative-pressure dressings in this setting should result in decreased morbidity for these patients and in decreased social and financial costs.

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

“…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).…”

“…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].…”

“…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.…”

“…In some circumstances a flap is not placed for a week or more and a negative pressure wound therapy dressing is applied in the interim. Regardless when a flap is placed, negative pressure wound therapy has become preferred over traditional gauze dressings by some [15,16]. The expectations of negative pressure wound therapy are for it to decrease tissue edema, enhance local blood flow, limit or prevent infection, improve flap rates, and possibly reduce the overall need for flaps.…”

“…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.…”