The use of negative pressure wound therapy for fracture-related infections following internal osteosynthesis of the extremity: A systematic review

Jensen, Niels Martin; Steenstrup, Signe; Ravn, Christen; Schmal, Hagen; Viberg, Bjarke

doi:10.1016/j.jcot.2021.101710

Cited by 7 publications

(5 citation statements)

References 33 publications

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“…Regarding negative pressure therapy, a number of studies have shown a decreased infection rate in open tibial fractures, the possibility of extending the time to definitive coverage, and a lower failure rate of definitive flaps (63,64). However, other studies have shown no clear evidence for the advantage of this type of system over classic coverage (65,66,67,68). There are authors who value its use only temporarily until definitive coverage and no longer than 1 week due to the risk of colonisation with resistant microorganisms (69).…”

Section: Risk Factors and Preventionmentioning

confidence: 99%

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

2022

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Open reduction and internal fixation is the gold standard treatment for tibial plateau fractures. However, the procedure is not free of complications such as knee stiffness, acute infection, chronic infection (osteomyelitis), malunion, non-union, and post-traumatic osteoarthritis. The treatment options for knee stiffness are mobilisation under anaesthesia (MUA) when the duration is less than 3 months, arthroscopic release when the duration is between 3 and 6 months, and open release for refractory cases or cases lasting more than 6 months. Early arthroscopic release can be associated with MUA. Regarding treatment of acute infection, if the fracture has healed, the hardware can be removed, and lavage and debridement can be performed along with antibiotic therapy. If the fracture has not healed, the hardware is retained, and lavage, debridement, and antibiotic therapy are performed (sometimes more than once until the fracture heals). Fracture stability is important not only for healing but also for resolving the infection. In cases of osteomyelitis, treatment should be performed in stages: aggressive debridement of devitalised tissue and bone, antibiotic spacing and temporary external fixation until the infection is resolved (first stage), followed by definitive surgery with grafting or soft tissue coverage depending on the bone defect (second stage). Intra-articular or extra-articular osteotomy is a good option to correct malunion in young, active patients without significant joint damage. When malunion is associated with extensive joint involvement or the initial cartilage damage has resulted in knee osteoarthritis, the surgical option is total knee arthroplasty.

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Section: Risk Factors and Preventionmentioning

confidence: 99%

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

2022

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“…New articles have recently appeared questioning the effectiveness of NPWT. The study by Jensen et al [15] did not recommend using of NPWT directly for internal osteosynthesis. The study by Älgå et al [16] found no economic benefit of NPWT for open lower extremity fractures in terms of wound management.…”

Section: Discussionmentioning

confidence: 97%

Effectiveness of negative pressure wound therapy: Minimum five-year follow-up and review of the literature

Révész

Altorjay

Montskó³

et al. 2022

Jt Dis Relat Surg

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In the last decades, negative pressure wound therapy (NPWT) treatment has opened great possibilities in wound management. First used in the Russo-Afghan War in 1985 by Nail Bagaoutdinov, [1] modern vacuum treatment was, then, introduced by Louis Aregenta [1] and Michael Morykwas [1] in 1990 using a combination of polyurethane foam and a mechanical vacuum machine. [1] Use of the technique in everyday care began in 1993. In 2017, the textbook Negative Pressure Therapy: Theory and Practice was published in Hungarian, and in 2019 in English, with clinical studies, but largely based on individual experiences. [2] Medical sites dealing with the technique include Web of Science 1,251, PubMed 4,590, Google Scholar 14,900 hits currently.Objectives: In this study, we aimed to assess the effectiveness of negative pressure wound therapy (NPWT) in a five-year patient cohort and to discuss the results in the light of literature data.Patients and methods: Between January 2012 and December 2016, a total of 74 patients (35 males, 39 females; median age: 60 years; range, 20 to 95 years) who received NPWT were retrospectively analyzed. The patients included 49 orthopedic and traumatology, 12 vascular surgery, and 13 general surgery patients. The efficacy of wound healing, bacterial load, and the impact of comorbidities on wound healing were examined. Results:The distribution of wound types varied very widely. Certain comorbidities affected wound healing. In orthopedictraumatology patients, we observed mainly skin flora infection (57.14%), while in surgical and vascular patients, mixed flora (80%) and in many cases poly-resistant pathogens were present (methicillin-resistant Staphylococcus aureus 24%) A total of 43.3% of wounds were completely closed, while 44.6% of patients had a wound healing. Successful skin grafting was performed in 75% of wounds. Conclusion:This technique may be used as widely and as early as possible. However, further large-scale, multi-center, randomized clinical trials are needed worldwide to find a place for this technique in wound care and even in primary care.

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“…Haidari et al concluded that NPWT may be used for a few days until definitive flap cover can be performed, and recommended that comparative studies should be performed to determine the role and safety of NPWT in the treatment of FRI. In a second systematic review on this topic by Jensen et al, seven of the ten included studies were case reports with less than ten patients [ 69 ]. The authors pointed out that the quality of the existing literature was low.…”

Section: Role Of Negative Pressure Wound Therapy (Npwt)mentioning

confidence: 99%

Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group

Marais,

Hungerer,

Eckardt

et al. 2023

Arch Orthop Trauma Surg

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A judicious, well-planned bone and soft tissue debridement remains one of the cornerstones of state-of-the-art treatment of fracture-related infection (FRI). Meticulous surgical excision of all non-viable tissue can, however, lead to the creation of large soft tissue defects. The management of these defects is complex and numerous factors need to be considered when selecting the most appropriate approach. This narrative review summarizes the current evidence with respect to soft tissue management in patients diagnosed with FRI. Specifically we discuss the optimal timing for tissue closure following debridement in cases of FRI, the need for negative microbiological culture results from the surgical site as a prerequisite for definitive wound closure, the optimal type of flap in case of large soft tissue defects caused by FRI and the role of negative pressure wound therapy (NPWT) in FRI. Finally, recommendations are made with regard to soft tissue management in FRI that should be useful for clinicians in daily clinical practice.Level of evidence Level V.

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The use of negative pressure wound therapy for fracture-related infections following internal osteosynthesis of the extremity: A systematic review

Cited by 7 publications

References 33 publications

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

Complications of the surgical treatment of fractures of the tibial plateau: prevalence, causes, and management

Effectiveness of negative pressure wound therapy: Minimum five-year follow-up and review of the literature

Key aspects of soft tissue management in fracture-related infection: recommendations from an international expert group

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