Negative-Pressure Wound Therapy over Surgically Closed Wounds in Open Fractures

Abstract

Purpose. To evaluate the outcome of open fracture surgery with negative-pressure wound therapy (NPWT) applied directly over surgical wounds. Methods. Medical records of 10 men and 4 women aged 6 to 70 (mean, 43.7) years who underwent internal fixation, external fixation, or splint application for open fractures of the lower leg (n=7), foot and ankle (n=5), or knee (n=2), and NPWT were reviewed. The NPWT was applied directly over the surgical wound without a non-adherent contact layer. The foam was changed every 3 days. The standard negative pressure was 125 mm Hg. The NPWT was stopped when the wound discharge became <50 ml per day. The duration of NPWT and the level of negative pressure were recorded, as were wound condition, reasons for NPWT, and outcome. Results. The mean duration of NPWT was 9.1 (range, 3-24) days. Four patients developed maceration of the skin under the foam, whereas 2 patients developed skin blisters under the drape. No necrosis of flap skin Negative-pressure wound therapy over surgically closed wounds in open fracturesTakashi Suzuki, Akihiro Minehara, Terumasa Matsuura, Tadashi Kawamura, Kazui Soma Emergency Medical Center, Kitasato University Hospital, Sagamihara, Japan Address correspondence and reprint requests to: Dr. Takashi Suzuki, Emergency Medical Center, Kitasato University Hospital, 1-15-1 Kitasato, Sagamihara, 252-0375, Japan. Email: takashisuzuki911@yahoo.co.jp Surgery 2014;22(1):30-4 or infection occurred, and all the fractures eventually united. Conclusions. Maceration of the skin was seen in some cases but did not affect the overall outcome. NPWT directly over the skin surface had no deleterious effect on wound and fracture healing. Journal of Orthopaedic

Effects of Negative Pressure Wound Therapy on Mesenchymal Stem Cells Proliferation and Osteogenic Differentiation in a Fibrin Matrix

“…This therapy can promote granulation tissue formation and improve wound healing through reducing tissue edema, removing factors that inhibit wound healing, increasing wound perfusion, and reducing incidence of infection [5]–[8]. However, controversy still remains regarding the benefits of NPWT on bone tissue, though there have been many clinic and basement reports about its application in treatment of open fracture or osseous defect combined with soft tissue injury, and these studies nearly all show that NPWT can effectively improve wound and bone healing or has no deleterious effect on fracture healing [9]–[12].…”

Negative pressure wound therapy promotes muscle‐derived stem cell osteogenic differentiation through MAPK pathway

“…To further investigate whether NPWT could promote osteogenic differentiation of MDSCs in vitro, we examined the expression of osteogenic markers. Related articles showed that NPWT could promote the healing of open fractures in clinical and experimental studies [9,26]. In our previous research, we also found that NPWT could promote MSC osteogenic differentiation [17].…”

Use of Negative Pressure Wound Therapy on Closed Surgical Incision After Total Ankle Arthroplasty

“…Therefore, when the VAC system is used on a closed wound, it is recommended that an additional nonadhesive wound contact layer be placed between the foam dressing and the skin to avoid direct contact. 3,35 We believe that our lack of local skin complications is due to the PICO system, which is uniquely designed to be a skin-friendly device placed over closed surgical incisions using a multilayer silicone dressing. 13 Hudson et al 13 reported that there was neither skin damage nor maceration to healthy skin by the application of negative pressure in the form of the PICO system and neither pain nor trauma to the wound on dressing removal.…”