Negative Pressure Wound Therapy After Severe Open Fractures: A Prospective Randomized Study

Stannard, James P.; Volgas, David A.; Stewart, Rena L.; McGwin, Gerald; Alonso, Jorge E.

doi:10.1097/bot.0b013e3181a2e2b6

Cited by 293 publications

(199 citation statements)

References 40 publications

Supporting

Mentioning

184

Contrasting

Unclassified

Order By: Relevance

“…The infection rates were equivalent at 14% for gauze dressings and 15% for negative pressure wound therapy in their study [45]. The patients in the two studies [7,49] with decreased and the one [45] with equivalent infection rates and negative pressure wound therapy dressings all had wound closure within 7 days. Liu et al, in a retrospective study [35], reported increased infection rates with negative pressure wound therapy.…”

Section: Negative Pressure Wound Therapy and Infection Reduction In Gmentioning

confidence: 94%

“…One hundred were excluded based on their titles most commonly because of inclusion of chronic or diabetic wounds. We reviewed the abstracts of the seven remaining studies and only one [49] included Grade IIIB tibia fractures, negative pressure wound therapy, and any of our outcome questions. A second search protocol was used with the databases of MEDLINE 1 , Embase, and Google Scholar (Fig.…”

Section: Search Strategy and Criteriamentioning

confidence: 99%

“…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%

“…Negative pressure wound therapy versus gauze dressings showed a decrease in infection rates for negative pressure wound therapy in two [7,49] This second period was chosen specifically because it bypassed their earliest clinical experiences with negative pressure wound therapy. That period was 1997 to 2000 which abuts the 1997 FDA approval of negative pressure wound therapy.…”

Section: Negative Pressure Wound Therapy and Infection Reduction In Gmentioning

confidence: 99%

See 4 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

View full text Add to dashboard Cite

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.

show abstract

Section: Negative Pressure Wound Therapy and Infection Reduction In Gmentioning

confidence: 94%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Search Strategy and Criteriamentioning

confidence: 99%

Section: Negative Pressure Wound Therapy and Infection Reduction In Gmentioning

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

View full text Add to dashboard Cite

show abstract

Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb

Costa

Achten

Bruce

et al. 2018

JAMA

155

124

View full text Add to dashboard Cite

show abstract

The Fragility Index in Randomized Clinical Trials as a Means of Optimizing Patient Care

2019

View full text Add to dashboard Cite

andomizedclinicaltrials(RCTs)serveasthegoldstandardand represent the highest level of evidence for the determination of optimal and effective treatment strategies in evidencebased medicine for patients, particularly in terms of statistical reliability. Methods used in RCTs decrease selection bias and minimize confounding, which promote their ability to establish causation.Clinicians evaluating RCT results in an effort to provide optimal patient care frequently rely on rejection of the null hypothesis, with a P value threshold of less than .05 and appropriate 95% CIs used to determine statistical significance and confirm a positive outcome. These positive findings from RCTs frequently lead to substantial changes in clinical practice and patient care. Yet methodologists have noted that medical research studies should not be interpreted from P values alone, [1][2][3][4] noting that a "high rate of non-replication (lack of confirmation) of research discoveries is a consequence of the convenient, yet ill-founded strategy of claiming conclusive research findings solely on the basis of a single study assessed by formal statistical significance, typically for a p-value less than 0.05." 2(pe124) The Fragility Index (FI) is an important aid in the interpretation of clinical trial results. 5 The FI aids in determination of when statistical sig-nificance in a clinical trial may be lost as a result of a shift of a few additional events from the experimental group to the control group. 6 No matter what threshold P value is chosen, the FI score will still serve as an additional metric to demonstrate how easily statistical significance may be exceeded. Use of the FI can aid physicians in identifying trials that may be at risk of being overturned by future studies and avoiding overestimating the significance of RCT results. This narrative review discusses the definition and calculation of the FI and Fragility Quotient (FQ) scores, use in the interpretation of medical and surgical RCTs, a detailed review of FI scores in trauma RCTs, and discussion of the importance of this statistic in the development of national clinical guidelines. It provides a framework for surgeons to use the FI in the assessment of RCTs to ultimately provide optimal surgical patient care.

show abstract

Negative Pressure Wound Therapy After Severe Open Fractures: A Prospective Randomized Study

Cited by 293 publications

References 40 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?

Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb

The Fragility Index in Randomized Clinical Trials as a Means of Optimizing Patient Care

Contact Info

Product

Resources

About