Session X - Polytrauma II

Sat., 10/22/05 Polytrauma II, Paper #45, 9:30 am

Negative Pressure Wound Therapy (NPWT) following Severe Open Fractures: A Prospective Randomized Study

James P. Stannard, MD (a-Kinetic Concepts, Inc.); Robert C. Baird, MD (n); David A. Volgas, MD (n); Gerald McGwin, Jr., PhD (n); Jorge E. Alonso, MD (n);
University of Alabama at Birmingham, Birmingham, Alabama, USA

Purpose: This study was conducted to evaluate the use of NPWT using the Vacuum Assisted Closure (VAC) system following high-energy open fractures.

Methods: Forty patients enrolled to date with open fractures have been entered into a prospective, randomized, IRB-approved study using NPWT as an adjunct for wound care in open fractures. Inclusion criteria were a high-energy open fracture that required at least one return trip to the operating room prior to definitive closure or coverage. Group A patients underwent initial irrigation and debridement (I & D) followed by a standard fine mesh gauze dressing in the open wound, with repeat I & D every 48 to 72 hours until closure. Group B patients had identical treatment except that NPWT was applied to the wounds between I & Ds. Patients were evaluated for infection, wound dehiscence, nutritional status, smoking, time to wound closure, and need for flap coverage.

Results: 40 patients have been enrolled with mean follow-up of 13 months (range, 6 to 25)18 in Group A and 22 in Group B. 93% of Group A and 90% of Group B patients had a type III (A, B, or C) fracture using the Gustillo classification. Control patients (Group A) developed 2 (11%) acute infections and 4 (22%) delayed infections, for a total of 6 infections (33%). NPWT (Group B) patients developed 0 acute infections and 2 (9%) delayed infections, for a total of 2 infections (9%). The difference between the two groups for total infections is borderline significant with a P value of 0.055. Three (17%) patients in Group A are smokers compared to 11 (50%) in Group B. Days to closure or coverage were similar, with a mean of 5.2 for Group A and 5.1 for Group B.

Conclusion: NPWT is a relatively new therapy thought to be associated with increased blood flow, decreased edema, and decreased infections in wounds based on basic science studies. NPWT following severe open fractures not amenable to immediate closure has been associated with a decreased infection rate. The results are near significant in this prospective randomized study. NPWT represents a promising new therapy for severe open fractures following high-energy trauma.

If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.