Negative Pressure Wound Therapy Assisted Closure: An Effective Mode of Management for Infected and Contaminated Wound With Non-Union Fracture Femur

Abstract

High-energy open fractures are often associated with significant soft tissue damage and can have contamination. Infection of a fracture can be the most detrimental factor for fracture union. Control of infection and soft tissue coverage over exposed bone plays a vital role in its overall outcome. Negative pressure wound therapy (NPWT) assisted closure has depicted encouraging results for helping control of infection and wound closure. NPWT assisted closure promotes reduction of bacterial load in the wound, facilitates removal of secretion from the wound, promotes the formation of granulation tissue, and decreases wound size. We present a case of open fracture femur with severe infection and exposed bone. Along with infection and comminution of fracture, there was collection of necrotic tissue at the fracture site. Infection settled with debridement of wound and application of NPWT. With the application of NPWT, there was formation of granulation tissue and a decrease in wound size. The wound healed completely following application of secondary sutures. Any form of plastic procedures, such as muscle pedicle graft and split-thickness skin grafting, was not required for wound closure. NPWT-assisted closure is a promising mode of wound management in grossly infected wounds and obviates the need for further plastic procedures. The effect can be extrapolated to all open wounds with infection but must follow a thorough debridement and lavage.

The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection: A Systematic Review and Critical Appraisal

“…The quality differed between studies. Eight studies were of high quality [ 30 – 37 ] (≥7 stars) and four of low quality [ 38 – 41 ] (<7 stars). Case reports were not assessable and therefore considered as low quality.…”

“…It is argued that NPWT can significantly reduce the wound surface area [ 39 , 41 , 51 ] and provide stable wound healing [ 52 ]. Although this might well apply for soft tissue defects only, in case of FRI, expert opinion strongly advises against the prolonged use of NPWT in this patient population [ 53 ].…”

An Update in Reconstructive Surgery

“…Improved clinical outcomes after NPT was used in soft tissue sarcomas in irradiated subjects have been reported [3]. NPT was also reported as useful for healing open infected wounds in fractured femur bone [6]. Remote ischemic preconditioning (rIPC) was recently tested to prevent ischemia reperfusion injury in soft tissue flaps by performing cycles of 5 min of occlusion and 5 min of reperfusion using a tourniquet in the hind limb of a rat.…”