A systemic review and a meta‐analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings

Abstract

We performed a meta‐analysis to evaluate the influences of closed incisions in orthopaedic trauma surgery (OTS) by negative pressure wound treatment (NPWT) compared with conventional dressings. A systematic literature search up to March 2022 was done and 14 studies included 3935 subjects with OTS at the start of the study; 2023 of them used NPWT and 1912 were conventional dressings. They were reporting relationships between the influences of closed incisions in OTS by NPWT compared with conventional dressings. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the influences of closed incisions in OTS by NPWT compared with conventional dressings using the dichotomous methods with a random or fixed‐effect model. NPWT had significantly lower deep surgical site infections (SSIs) (OR, 0.65; 95% CI, 0.48‐0.87, P = .004), superficial SSIs (OR, 0.34; 95% CI, 0.19‐0.61, P < .001), and wound dehiscence (OR, 0.41; 95% CI, 0.21‐0.80, P = .009) compared with conventional dressings in subjects with closed incisions in OTS. NPWT showed a beneficial effect on deep SSIs, superficial SSIs, and wound dehiscence compared with conventional dressings in subjects with closed incisions in OTS. Further studies are required to validate these findings.

Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

“…Wound dehiscence has been shown to cause significant morbidity, including decreased patient quality of life, prolonged hospital stays, and increased care costs. 17,27,[31][32][33][34][35][36][37][38][39][40][41][42] Our finding is congruent with other studies examining ciNPWT in orthopedic trauma, 5,43 breast surgery, 11,14,15,44 abdominal wall reconstruction, 34,45 laparotomy, 46,47 ventral hernia repair, 48 and reviews combing multiple types of procedures. 36,41,45,[49][50][51][52] However, results in the literature are mixed, and other studies do not show this relationship.…”

“…This contradicts several studies demonstrating decreased surgical site infection rates with ciNPWT. [5][6][7][8][9]11,13,14,30,33,36,41,[43][44][45][46][47][48][49][50][51][52][54][55][56][57][58][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] However, the occurrence of infection in DIEP flaps is infrequent, with a recent meta-analysis reporting a donor site infection rate of 4.79%. 77 Mechanistically, ciNPWT acts as a barrier that prevents contamination of the surgical site with bacteria before reepithelization, encourages drainage of excess interstitial fluid, increases lymphatic flow, improves blood flow, and induces angiogenesis, theoretically decreasing the risk of infection and expediting healing.…”

Effect of individualized comfortable nursing on prognosis of vacuum sealing drainage in patients with orthopedic trauma

“…Orthopedic trauma is a common type of trauma in clinic, which includes not only bone trauma, but also skin, muscle and other soft tissue trauma injuries, such as no good treatment and nursing after trauma, or can cause a series of complications such as fever, infection, venous thrombosis, and even death. [16,17] VSD plays an important role in the treatment of orthopedic trauma infection, with the following advantages: [18] It can reduce the work intensity, thus preventing cross infection; Under negative pressure, it can suck out bacteria, accumulate blood and necrotic tissue, and avoid wound infection; It is beneficial to the growth of healthy granulation; Negative pressure is not conducive to the viability of bacteria. The application of VSD technology has expanded to a variety of wounds caused by trauma.…”