The Use of Negative-Pressure Wound Therapy (NPWT) in the Temporary Treatment of Soft-Tissue Injuries Associated With High-Energy Open Tibial Shaft Fractures

Dedmond, Barnaby T.; Kortesis, Bill G.; Punger, Kathleen; Simpson, Jordan; Argenta, Joseph; Kulp, Brenda; Morykwas, Michael J.; Webb, Lawrence X.

doi:10.1097/bot.0b013e31802cbc54

Cited by 143 publications

(112 citation statements)

References 20 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%

“…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.…”

Section: Introductionmentioning

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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Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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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Is delayed reconstruction using the latissimus dorsi free flap a worthy option in the management of open IIIB tibial fractures?

et al. 2015

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Early reconstruction of severe open fractures, performed within 7 days of the injury, has a better outcome than closure after 7 days. However, the uncertain demarcation of damaged tissue often results in delayed reconstruction. In this article, we report our surgical outcomes of delayed reconstruction using latissimus dorsi free flap with internal fixation. Twenty-three patients with Gustilo type IIIB open tibial fractures Between March 2009 and May 2012 were included in this study. There were 16 cases of distal 1/3 fracture of the tibia, 4 of midshaft fracture, 1 of proximal 1/3 fracture, and 2 of segmental fracture. Serial debridement with application of negative pressure wound therapy (NPWT) was performed before the final operation. All patients underwent internal fixation of the bone and reconstruction of soft tissue defect using latissimus dorsi free flap. The number of serial debridements, excluding those performed during emergency and finial operation, ranged from 1 to 5 (mean 2.69) times. Mean time from injury to final operation was 10.65 (range, 7-22) days. All flaps survived without complications. Three cases (13%) were infected, and three cases required further bone graft surgery to facilitate bone union (13%). Bone union was achieved after a mean 6.3 (range, 3-12) months. Mean follow-up period was 16.34 (range, 12-26) months. During follow-up, all patients were able to ambulate without use of an aid. In cases of severe open fracture, treatment should emphasize soft tissue coverage rather than rushing to achieve definitive fixation in the setting of poor surrounding tissues. When delayed reconstruction is inevitable, radical debridement is performed first, then NPWT is used as bridging therapy, and free flap could be considered for definite soft tissues coverage. © 2015 Wiley Periodicals, Inc. Microsurgery 36:453-459, 2016.

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Compartment Syndrome

Bowyer¹

2014

Essentials of Vascular Surgery for the General Surgeon

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The Use of Negative-Pressure Wound Therapy (NPWT) in the Temporary Treatment of Soft-Tissue Injuries Associated With High-Energy Open Tibial Shaft Fractures

Cited by 143 publications

References 20 publications

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

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

Is delayed reconstruction using the latissimus dorsi free flap a worthy option in the management of open IIIB tibial fractures?

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