Negative pressure wound therapy reduces deep infection rate in open tibial fractures

Martin L Blum, Max Esser, Martin Richardson, Eldho Paul, Franklin L Rosenfeldt
Journal of Orthopaedic Trauma 2012, 26 (9): 499-505

OBJECTIVES: To evaluate the effect of negative pressure wound therapy (NPWT) on deep infection rate in open tibial fractures.

DESIGN: Retrospective cohort study. Data was collected from medical records and radiographs.

SETTING: Two level-1 trauma centers.

PATIENTS/PARTICIPANTS: Patients who sustained an open tibial fracture which underwent delayed soft tissue coverage between January 2002 and December 2007 were included. Exclusion criteria included open fractures receiving a combination of NPWT and conventional dressings, fractures which were treated with a primary amputation, and fractures associated with mortality.

INTERVENTION: : NPWT with reticulated open cell foam or conventional dressings at surgeon's discretion.

MAIN OUTCOME MEASUREMENT: Deep infection rate.

RESULTS: A total of 229 open tibial fractures in 220 patients met the inclusion criteria and received either NPWT (166/229-72%) or conventional dressings (63/229-28%). There was a decreased rate of deep infection in the NPWT group compared with the conventional dressing group [8.4% (14/166) vs. 20.6% (13/63); P = 0.01]. Univariate predictors of deep infection included Gustilo type {odds ratio (OR): 3.13 [95% confidence interval (CI): 1.74-5.64]; P < 0.001} and use of NPWT [OR: 0.35 (95% CI: 0.16-0.80); P = 0.01]. When adjustment was performed for Gustilo type with multivariate analysis, use of NPWT was found to reduce the risk of deep infection by almost 80% [OR: 0.22 (95% CI: 0.09-0.55); P = 0.001].

CONCLUSIONS: These results suggest that NPWT reduces the rate of deep infection when used for the dressing of traumatic wounds in open tibial fractures.

LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

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