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Title: Negative pressure wound therapy reduces deep infection rate in open tibial fractures.
Epworth Authors: Richardson, Martin
Other Authors: Blum, Martin
Esser, Max
Eldho, Paul
Rosenfeldt, Franklin
Keywords: Dressings
Deep Infection Rate
Tibial Fractures
Fractures, Open
Open Tibial Fractures
Negative-Pressure Wound Therapy
Surgical Wound Infection
Tibial Fractures
Wounds and Injuries
Musculoskeletal Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Sep-2012
Publisher: Wolters Kluwer
Citation: Journal of Orthopaedic Trauma. 2012 Sep;26(9):499-505.
Abstract: OBJECTIVES: To evaluate the effect of negative pressure wound therapy (NPWT) on deep infection rate in open tibial fractures. DESIGN: Retrospective cohort study. Data was collected from medical records and radiographs. SETTING: Two level-1 trauma centers. PATIENTS/PARTICIPANTS: Patients who sustained an open tibial fracture which underwent delayed soft tissue coverage between January 2002 and December 2007 were included. Exclusion criteria included open fractures receiving a combination of NPWT and conventional dressings, fractures which were treated with a primary amputation, and fractures associated with mortality. INTERVENTION: NPWT with reticulated open cell foam or conventional dressings at surgeon's discretion. MAIN OUTCOME MEASUREMENT: Deep infection rate. RESULTS: A total of 229 open tibial fractures in 220 patients met the inclusion criteria and received either NPWT (166/229-72%) or conventional dressings (63/229-28%). There was a decreased rate of deep infection in the NPWT group compared with the conventional dressing group [8.4% (14/166) vs. 20.6% (13/63); P = 0.01]. Univariate predictors of deep infection included Gustilo type {odds ratio (OR): 3.13 [95% confidence interval (CI): 1.74-5.64]; P < 0.001} and use of NPWT [OR: 0.35 (95% CI: 0.16-0.80); P = 0.01]. When adjustment was performed for Gustilo type with multivariate analysis, use of NPWT was found to reduce the risk of deep infection by almost 80% [OR: 0.22 (95% CI: 0.09-0.55); P = 0.001]. CONCLUSIONS: These results suggest that NPWT reduces the rate of deep infection when used for the dressing of traumatic wounds in open tibial fractures.
DOI: 10.1097/BOT.0b013e31824133e3
PubMed URL:
ISSN: 0890-5339
Journal Title: Journal of Orthopaedic Trauma
Type: Journal Article
Affiliated Organisations: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
Type of Clinical Study or Trial: Retrospective studies
Appears in Collections:Musculoskeletal

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