Negative pressure dressings are no better than standard dressings for open fractures

BMJ ◽  
2019 ◽  
pp. k4411
Author(s):  
Rob Cook ◽  
Vaughan Thomas ◽  
Rosie Martin
Keyword(s):  
Negative Pressure ◽  
Open Fracture ◽  
Negative Pressure Wound Therapy ◽  
Randomised Clinical Trial ◽  
Open Fractures ◽  
Wound Management ◽  
Wound Therapy ◽  
Health Technology Assessment Programme ◽  
Negative Pressure Dressings ◽  
Better Than

The study Effect of negative pressure wound therapy vs standard wound management on 12-month disability among adults with severe open fracture of the lower limb: the WOLLF randomised clinical trial. Costa ML, Achten J, Bruce J, et al; UK WOLLF Collaboration Published on 9 October 2018 JAMA 2018;319:2280-8. This project was funded by the National Institute for Health Research Health Technology Assessment Programme (project number 10/57/20). To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000655/negative-pressure-dressings-are-no-better-than-standard-dressings-for-open-fractures

scholarly journals Negative Pressure Wound Therapy (NPWT) in open wound management: A study of 16 Cases in Orthopaedic Department of Faridpur Medical College Hospital

2013 ◽  
Vol 7 (2) ◽  
pp. 63-66
Author(s):  
Nusrat Shaheed ◽  
A S M Jahangir Chowdhury ◽  
Anadi Ranjan Mondal ◽  
Amal Chandra Paul ◽  
Md Shahin Akhter ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Granulation Tissue ◽  
Negative Pressure ◽  
Open Fracture ◽  
Negative Pressure Wound Therapy ◽  
Soft Tissue Defect ◽  
Healing Time ◽  
Wound Management ◽  
Wound Therapy ◽  
College Hospital

Wound management is a major concern in open fracture cases. Negative Pressure Wound Therapy (NPWT) is an  advanced method for managing open wounds. It is a topical treatment using sub-atmospheric pressure to increase  blood flow, remove bacteria and increase growth of granulation tissue in the wound. The study was performed to  evaluate the results of NPWT in patients with open fracture in lower extremity. Using Aquarium pump as an NPWT  device, 16 patients were prospectly treated for open fractures in their inferior extremity. Mean patients' age range was  21 to 60 yrs. The patients under study either had suffered from trauma, fall or had post operative wound infection.  Many of them had wounds with underlying tendon or bone exposure. Necrotic tissues were debrided before applying  NPWT. Dressings were changed every 3rd or 4th day and treatments were continued for 07 to 28 days. Exposed  tendons and bones were successfully covered with healthy granulation tissue in all cases, depth of the wounds  reduced as well as surface areas. In 12 cases coverage of granulation tissue were achieved and further managed by  skin grafting, 4 cases with wound infections were closed with secondary suture. No significant complications were  noted regarding the treatment. NPWT was found to facilitate the rapid formation of healthy granulation tissue on  open wounds in lower extremity and thus to shorten healing time and minimize secondary soft tissue defect coverage  procedures. DOI: http://dx.doi.org/10.3329/fmcj.v7i2.13500 Faridpur Med. Coll. J. 2012;7(2):63-66

scholarly journals Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb

JAMA ◽  
2018 ◽  
Vol 319 (22) ◽  
pp. 2280 ◽  
Author(s):  
Matthew L. Costa ◽  
Juul Achten ◽  
Julie Bruce ◽  
Elizabeth Tutton ◽  
Stavros Petrou ◽  
...  
Keyword(s):  
Negative Pressure ◽  
Lower Limb ◽  
Open Fracture ◽  
Negative Pressure Wound Therapy ◽  
Wound Management ◽  
Wound Therapy

Negative pressure wound therapy versus conventional dressing for open fractures in lower extremity trauma

2020 ◽  
Vol 102-B (7) ◽  
pp. 912-917 ◽  
Author(s):  
Muhammad Tahir ◽  
Ejaz A. Chaudhry ◽  
Faridullah K. Zimri ◽  
Nadeem Ahmed ◽  
Saeed A. Shaikh ◽  
...  
Keyword(s):  
Wound Infection ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Mean Difference ◽  
Open Fractures ◽  
Life Assessment ◽  
Wound Therapy ◽  
Significant Difference ◽  
Gauze Dressing ◽  
Secondary Outcomes

Aims It has been generally accepted that open fractures require early skeletal stabilization and soft-tissue reconstruction. Traditionally, a standard gauze dressing was applied to open wounds. There has been a recent shift in this paradigm towards negative pressure wound therapy (NPWT). The aim of this study was to compare the clinical outcomes in patients with open tibial fractures receiving standard dressing versus NPWT. Methods This multicentre randomized controlled trial was approved by the ethical review board of a public sector tertiary care institute. Wounds were graded using Gustilo-Anderson (GA) classification, and patients with GA-II to III-C were included in the study. To be eligible, the patient had to present within 72 hours of the injury. The primary outcome of the study was patient-reported Disability Rating Index (DRI) at 12 months. Secondary outcomes included quality of life assessment using 12-Item Short-Form Health Survey questionnaire (SF-12), wound infection rates at six weeks and nonunion rates at 12 months. Logistic regression analysis and independent-samples t-test were applied for secondary outcomes. Analyses of primary and secondary outcomes were performed using SPSS v. 22.0.1 and p-values of < 0.05 were considered significant. Results A total of 486 patients were randomized between January 2016 and December 2018. Overall 206 (49.04%) patients underwent NPWT, while 214 (50.95%) patients were allocated to the standard dressing group. There was no statistically significant difference in DRI at 12 months between NPWT and standard dressing groups (mean difference 0.5; 95% confidence interval (CI) -0.08 to 1.1; p = 0.581). Regarding SF-12 scores at 12 months follow-up, there was no significant difference at any point from injury until 12 months (mean difference 1.4; 95% CI 0.7 to 1.9; p = 0.781). The 30-day deep infection rate was slightly higher in the standard gauze dressing group. The non-union odds were also comparable (odds ratio (OR) 0.90, 95% CI 0.56 to 1.45; p = 0.685). Conclusion Our study concludes that NPWT therapy does not confer benefit over standard dressing technique for open fractures. The DRI, SF-12 scores, wound infection, and nonunion rates were analogous in both study groups. We suggest surgeons continue to use cheaper and more readily available standard dressings. Cite this article: Bone Joint J 2020;102-B(7):912–917.

scholarly journals MnSOD is implicated in accelerated wound healing upon Negative Pressure Wound Therapy (NPWT): A case in point for MnSOD mimetics as adjuvants for wound management

Redox Biology ◽  
2019 ◽  
Vol 20 ◽  
pp. 307-320 ◽  
Author(s):  
Gregory Lucien Bellot ◽  
Xiaoke Dong ◽  
Amitabha Lahiri ◽  
Sandeep Jacob Sebastin ◽  
Ines Batinic-Haberle ◽  
...  
Keyword(s):  
Wound Healing ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Management ◽  
Wound Therapy

scholarly journals Cost-effectiveness of negative-pressure wound therapy in adults with severe open fractures of the lower limb: evidence from the WOLLF randomized controlled trial

2019 ◽  
Vol 101-B (11) ◽  
pp. 1392-1401 ◽  
Author(s):  
S. Petrou ◽  
B. Parker ◽  
J. Masters ◽  
J. Achten ◽  
J. Bruce ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Lower Limb ◽  
Negative Pressure Wound Therapy ◽  
Cost Effective ◽  
Open Fractures ◽  
Wound Management ◽  
Wound Therapy ◽  
Subgroup Analyses ◽  
The Cost

Aims The aim of this study was to estimate the cost-effectiveness of negative-pressure wound therapy (NPWT) in comparison with standard wound management after initial surgical wound debridement in adults with severe open fractures of the lower limb. Patients and Methods An economic evaluation was conducted from the perspective of the United Kingdom NHS and Personal Social Services, based on evidence from the 460 participants in the Wound Management of Open Lower Limb Fractures (WOLLF) trial. Economic outcomes were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires. Bivariate regression of costs (given in £, 2014 to 2015 prices) and quality-adjusted life-years (QALYs), with multiple imputation of missing data, was conducted to estimate the incremental cost per QALY gained associated with NPWT dressings. Sensitivity and subgroup analyses were undertaken to assess the impacts of uncertainty and heterogeneity, respectively, surrounding aspects of the economic evaluation. Results The base case analysis produced an incremental cost-effectiveness ratio of £267 910 per QALY gained, reflecting higher costs on average (£678; 95% confidence interval (CI) -£1082 to £2438) and only marginally higher QALYS (0.002; 95% CI -0.054 to 0.059) in the NPWT group. The probability that NPWT is cost-effective in this patient population did not exceed 27% regardless of the value of the cost-effectiveness threshold. This result remained robust to several sensitivity and subgroup analyses. Conclusion This trial-based economic evaluation suggests that NPWT is unlikely to be a cost-effective strategy for improving outcomes in adult patients with severe open fractures of the lower limb. Cite this article: Bone Joint J 2019;101-B:1392–1401.

The Effectiveness of Negative Pressure Wound Therapy Versus Conventional Dressing in the Treatment of Open Fractures: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 34 (5) ◽  
pp. 223-230 ◽  
Author(s):  
Marc C. Grant-Freemantle ◽  
Éanna J. Ryan ◽  
Sean O. Flynn ◽  
Darren P. Moloney ◽  
Michael A. Kelly ◽  
...  
Keyword(s):  
Systematic Review ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Meta Analysis ◽  
Open Fractures ◽  
Wound Therapy

scholarly journals Negative Pressure Wound Therapy Literature Review of Efficacy, Cost Effectiveness, and Impact on Patients' Quality of Life in Chronic Wound Management and Its Implementation in the United Kingdom

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Diaa Othman
Keyword(s):  
Cost Effectiveness ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Chronic Wound ◽  
National Standard ◽  
Wound Management ◽  
Care Providers ◽  
Wound Therapy ◽  
Patients Satisfaction ◽  
Chronic Wound Management

This is a paper reviewing the National Health Service (NHS) agenda in relation to the use of Negative Pressure Wound Therapy (NPWT) in chronic wound management and assesses the evidence behind it, its cost effectiveness and the outcome it has on patients’ satisfaction and life style. Multiple studies over the last 10 years looking at clinical efficacy of NPWT with its cost effectiveness and the implementation of this service in the UK were reviewed. NPWT has showed a reasonable body of evidence to support its usage in chronic wounds with potential positive outcomes on finance and patients’ satisfaction. However, the NHS system shows significant variations in the availability and implementation of this useful tool, depending on care providers and resources availabilities. The paper concluded that the NPWT can be a useful source of cutting down costs of chronic wound managements and saving money by its effect on expediting wound healing, which can address a part of the financial crises facing the NHS, however, has to be considered according to specific case needs. There should also be a national standard for the availability and indication of this tool to assure equal opportunities for different patients in different areas in the country.

Sign in / Sign up

Export Citation Format

Share Document