This study by a team from the University of Warwick, presented in JAMA and which focused specifically on the management of open fractures of the leg, suggests similar healing and patient recovery results, with wound treatment by negative pressure (NPWT) or the use of standard dressings.
This randomized clinical trial conducted by researchers from the University of Warwick and the University of Oxford in 24 hospitals with specialist trauma services compared the results of negative pressure therapy vs standard support in patients with "open" fracture of the leg, the bone having passed through the skin. In this type of fracture, the broken bone is exposed to contamination and the risk of wound complications is higher. Thus, in this type of severe and open fractures, infection rates can reach 27%. The infection not only affects the patient's recovery, but increases healthcare costs due to longer hospitalization or additional treatments.
Negative pressure wound therapy (NPWT) is a relatively new device that may be indicated after certain surgeries. The device creates a vacuum using a suction pump that removes blood and exudates, which is believed to promote the formation of granulation tissue and thus the healing process. However, the dressings associated with this technique and the devices themselves are considerably more expensive than traditional dressing devices.
The researchers compare here:
- the level of incapacity,
- infection rate,
- and quality of life
in 460 patients with an average age of 45.3 years, 73% of them men, all victims of severe open fractures of the leg. The surgical and health care team was not involved in evaluating the results. The patients filled in the various criteria by questionnaire, one year after the injury.
The analysis shows no evidence of difference on the different items, between NPWT and traditional dressing care :
- in particular, no difference was observed between the 2 types of care, in terms of disability, invalidity and therefore patient recovery at 12 months.
- in terms of day-to-day “functioning”, the results of the questionnaire amount to 45.5 for NPWT vs. 42.4 for standard dressings, with 0 representing normal function and 100 total incapacity;
- these results also suggest that considerable progress remains to be made;
- photographs of the wounds taken at 6 weeks, reviewed by independent clinicians who were not told which dressing was used, showed no difference in the rate of deep infection, healing, or patient quality of life.
TPN or standard dressings, overall similar results: thus, and specifically for the management of severe open fractures, the study does not identify any advantage to using TPN, concludes the main author, Dr. Matt Costa, professor of surgery Trauma Orthopedics in the Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences at Nuffield. Julie Bruce, co-author, professor at Warwick Medical School recalls the publication of a small randomized clinical trial, on 59 patients only, comparing standard dressings to NPWT, suggesting that negative pressure wound therapy can lead to best results.
The researchers therefore recommend that further research be conducted, when despite strong evidence, clinical guidelines around the world recommended the use of these devices for open fractures.
Obviously, the study does not call into question the interest of NPWT for certain highly exuding wounds and only deals here with its interest for open fracture wounds.
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