Impact of negative pressure wound therapy on open diaphyseal tibial fractures: A prospective randomized trial
Abstract Introduction Open tibial fractures are associated with a high incidence of mainly osteomyelitis. Negative pressure wound therapy (NPWT) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing. Objectives and study design To determine the effect of NPWT o...
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Veröffentlicht in: | Journal of clinical orthopaedics and trauma 2016-10, Vol.7 (4), p.256-259 |
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description | Abstract Introduction Open tibial fractures are associated with a high incidence of mainly osteomyelitis. Negative pressure wound therapy (NPWT) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing. Objectives and study design To determine the effect of NPWT on incidence of deep infections/osteomyelitis after open tibial fractures using a prospective randomized study design. Materials and methods Ninety-three open tibial fractures were randomized into two groups receiving NPWT and the second group undergoing periodic irrigation, cleaning and debridement respectively. The wounds were closed or covered on shrinkage in size and sufficient granulation. Evidence of infection was sought during the course of treatment and follow up. Also serial cultures were sent every time the wound was cleaned. Results and conclusions Patients in the control group developed a total of 11 infections (22%) as opposed to only 2 (4.6%) in the NPWT group ( p < 0.05). The relative risk was 5.5 (95% confidence interval) suggesting patients who received NPWT were 5.5 times less likely to develop infection. Twenty patients developed positive growth when samples were sent for culture with 3 (6.9%) in the NPWT group and 17 (34%) in the control group ( p < 0.05). Only 5 patients (25%) went on the develop osteomyelitis, all being a part of the control group. Thus negative pressure wound therapy is indeed beneficial for preventing the incidence of both acute infections and osteomyelitis in open fractures. However a significant difference was not seen in the time required for the wound to be ready for delayed primary closure or coverage. |
doi_str_mv | 10.1016/j.jcot.2016.05.007 |
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Negative pressure wound therapy (NPWT) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing. Objectives and study design To determine the effect of NPWT on incidence of deep infections/osteomyelitis after open tibial fractures using a prospective randomized study design. Materials and methods Ninety-three open tibial fractures were randomized into two groups receiving NPWT and the second group undergoing periodic irrigation, cleaning and debridement respectively. The wounds were closed or covered on shrinkage in size and sufficient granulation. Evidence of infection was sought during the course of treatment and follow up. Also serial cultures were sent every time the wound was cleaned. Results and conclusions Patients in the control group developed a total of 11 infections (22%) as opposed to only 2 (4.6%) in the NPWT group ( p < 0.05). The relative risk was 5.5 (95% confidence interval) suggesting patients who received NPWT were 5.5 times less likely to develop infection. Twenty patients developed positive growth when samples were sent for culture with 3 (6.9%) in the NPWT group and 17 (34%) in the control group ( p < 0.05). Only 5 patients (25%) went on the develop osteomyelitis, all being a part of the control group. Thus negative pressure wound therapy is indeed beneficial for preventing the incidence of both acute infections and osteomyelitis in open fractures. However a significant difference was not seen in the time required for the wound to be ready for delayed primary closure or coverage.</description><identifier>ISSN: 0976-5662</identifier><identifier>EISSN: 2213-3445</identifier><identifier>DOI: 10.1016/j.jcot.2016.05.007</identifier><identifier>PMID: 27857499</identifier><language>eng</language><publisher>India: Elsevier B.V</publisher><subject>Infection ; Negative pressure wound therapy ; Open fracture ; Original ; Orthopedics ; Osteomyelitis ; Vacuum assisted closure</subject><ispartof>Journal of clinical orthopaedics and trauma, 2016-10, Vol.7 (4), p.256-259</ispartof><rights>Delhi Orthopedic Association</rights><rights>2016 Delhi Orthopedic Association</rights><rights>2016 Delhi Orthopedic Association. All rights reserved. 2016 Delhi Orthopedic Association</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4257-141407e13549aa8796bde01a322392ecfb0bdac37be797ce9dec27d8a713394e3</citedby><cites>FETCH-LOGICAL-c4257-141407e13549aa8796bde01a322392ecfb0bdac37be797ce9dec27d8a713394e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5106468/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jcot.2016.05.007$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,3550,27924,27925,45995,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27857499$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Virani, Siddharth R</creatorcontrib><creatorcontrib>Dahapute, Aditya A</creatorcontrib><creatorcontrib>Bava, S.S</creatorcontrib><creatorcontrib>Muni, Saurabh R</creatorcontrib><title>Impact of negative pressure wound therapy on open diaphyseal tibial fractures: A prospective randomized trial</title><title>Journal of clinical orthopaedics and trauma</title><addtitle>J Clin Orthop Trauma</addtitle><description>Abstract Introduction Open tibial fractures are associated with a high incidence of mainly osteomyelitis. Negative pressure wound therapy (NPWT) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing. Objectives and study design To determine the effect of NPWT on incidence of deep infections/osteomyelitis after open tibial fractures using a prospective randomized study design. Materials and methods Ninety-three open tibial fractures were randomized into two groups receiving NPWT and the second group undergoing periodic irrigation, cleaning and debridement respectively. The wounds were closed or covered on shrinkage in size and sufficient granulation. Evidence of infection was sought during the course of treatment and follow up. Also serial cultures were sent every time the wound was cleaned. Results and conclusions Patients in the control group developed a total of 11 infections (22%) as opposed to only 2 (4.6%) in the NPWT group ( p < 0.05). The relative risk was 5.5 (95% confidence interval) suggesting patients who received NPWT were 5.5 times less likely to develop infection. Twenty patients developed positive growth when samples were sent for culture with 3 (6.9%) in the NPWT group and 17 (34%) in the control group ( p < 0.05). Only 5 patients (25%) went on the develop osteomyelitis, all being a part of the control group. Thus negative pressure wound therapy is indeed beneficial for preventing the incidence of both acute infections and osteomyelitis in open fractures. However a significant difference was not seen in the time required for the wound to be ready for delayed primary closure or coverage.</description><subject>Infection</subject><subject>Negative pressure wound therapy</subject><subject>Open fracture</subject><subject>Original</subject><subject>Orthopedics</subject><subject>Osteomyelitis</subject><subject>Vacuum assisted closure</subject><issn>0976-5662</issn><issn>2213-3445</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><recordid>eNp9kktv1DAUhSMEoqPSP8ACeckmwa_EMUKVqopHpUosgLXl2Dcdh8QOdjJo-PU4TKmABd5cSz7ns6_PLYrnBFcEk-bVUA0mLBXN-wrXFcbiUbGjlLCScV4_LnZYiqasm4aeFRcpDTivuiGStE-LMyraWnApd8V0M83aLCj0yMOdXtwB0BwhpTUC-h5Wb9Gyh6jnIwoehRk8sk7P-2MCPaLFdS6XPmZENqTX6Cq7Q5rB_CJF7W2Y3A_IlJiVz4onvR4TXNzX8-LLu7efrz-Utx_f31xf3ZaG01qUhBOOBRBWc6l1K2TTWcBEM0qZpGD6DndWGyY6EFIYkBYMFbbVgjAmObDz4vLEndduAmvAL1GPao5u0vGognbq7xPv9uouHFRNcMObNgNe3gNi-LZCWtTkkoFx1B7CmhRpOWkx5qTJUnqSmtx4itA_XEOw2qJSg9qiUltUCtcqR5VNL_584IPldzBZ8OYkgPxNBwdRJePAG7Au5s9VNrj_8y__sZvReWf0-BWOkIawRp8DUEQlqrD6tA3LNiu5nzwmWLKfS0G87A</recordid><startdate>20161001</startdate><enddate>20161001</enddate><creator>Virani, Siddharth R</creator><creator>Dahapute, Aditya A</creator><creator>Bava, S.S</creator><creator>Muni, Saurabh R</creator><general>Elsevier B.V</general><general>Elsevier</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20161001</creationdate><title>Impact of negative pressure wound therapy on open diaphyseal tibial fractures: A prospective randomized trial</title><author>Virani, Siddharth R ; Dahapute, Aditya A ; Bava, S.S ; Muni, Saurabh R</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4257-141407e13549aa8796bde01a322392ecfb0bdac37be797ce9dec27d8a713394e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Infection</topic><topic>Negative pressure wound therapy</topic><topic>Open fracture</topic><topic>Original</topic><topic>Orthopedics</topic><topic>Osteomyelitis</topic><topic>Vacuum assisted closure</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Virani, Siddharth R</creatorcontrib><creatorcontrib>Dahapute, Aditya A</creatorcontrib><creatorcontrib>Bava, S.S</creatorcontrib><creatorcontrib>Muni, Saurabh R</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical orthopaedics and trauma</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Virani, Siddharth R</au><au>Dahapute, Aditya A</au><au>Bava, S.S</au><au>Muni, Saurabh R</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of negative pressure wound therapy on open diaphyseal tibial fractures: A prospective randomized trial</atitle><jtitle>Journal of clinical orthopaedics and trauma</jtitle><addtitle>J Clin Orthop Trauma</addtitle><date>2016-10-01</date><risdate>2016</risdate><volume>7</volume><issue>4</issue><spage>256</spage><epage>259</epage><pages>256-259</pages><issn>0976-5662</issn><eissn>2213-3445</eissn><abstract>Abstract Introduction Open tibial fractures are associated with a high incidence of mainly osteomyelitis. Negative pressure wound therapy (NPWT) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing. Objectives and study design To determine the effect of NPWT on incidence of deep infections/osteomyelitis after open tibial fractures using a prospective randomized study design. Materials and methods Ninety-three open tibial fractures were randomized into two groups receiving NPWT and the second group undergoing periodic irrigation, cleaning and debridement respectively. The wounds were closed or covered on shrinkage in size and sufficient granulation. Evidence of infection was sought during the course of treatment and follow up. Also serial cultures were sent every time the wound was cleaned. Results and conclusions Patients in the control group developed a total of 11 infections (22%) as opposed to only 2 (4.6%) in the NPWT group ( p < 0.05). The relative risk was 5.5 (95% confidence interval) suggesting patients who received NPWT were 5.5 times less likely to develop infection. Twenty patients developed positive growth when samples were sent for culture with 3 (6.9%) in the NPWT group and 17 (34%) in the control group ( p < 0.05). Only 5 patients (25%) went on the develop osteomyelitis, all being a part of the control group. Thus negative pressure wound therapy is indeed beneficial for preventing the incidence of both acute infections and osteomyelitis in open fractures. However a significant difference was not seen in the time required for the wound to be ready for delayed primary closure or coverage.</abstract><cop>India</cop><pub>Elsevier B.V</pub><pmid>27857499</pmid><doi>10.1016/j.jcot.2016.05.007</doi><tpages>4</tpages><oa>free_for_read</oa></addata></record> |
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subjects | Infection Negative pressure wound therapy Open fracture Original Orthopedics Osteomyelitis Vacuum assisted closure |
title | Impact of negative pressure wound therapy on open diaphyseal tibial fractures: A prospective randomized trial |
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