Negative Pressure Wound Therapy Reduces Deep Infection Rate in Open Tibial Fractures

作者：Blum Martin L^*; Esser Max; Richardson Martin; Paul Eldho; Rosenfeldt Franklin L

来源：Journal of Orthopaedic Trauma, 2012, 26(9): 499-505.

DOI：10.1097/BOT.0b013e31824133e3

• negative pressure wound therapy
• open fractures
• open tibial fractures
• deep infection

Objectives: To evaluate the effect of negative pressure wound therapy (NPWT) on deep infection rate in open tibial fractures. %26lt;br%26gt;Design: Retrospective cohort study. Data was collected from medical records and radiographs. %26lt;br%26gt;Setting: Two level-1 trauma centers. %26lt;br%26gt;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. %26lt;br%26gt;Intervention: NPWT with reticulated open cell foam or conventional dressings at surgeon%26apos;s discretion. %26lt;br%26gt;Main Outcome Measurement: Deep infection rate. %26lt;br%26gt;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]. %26lt;br%26gt;Conclusions: These results suggest that NPWT reduces the rate of deep infection when used for the dressing of traumatic wounds in open tibial fractures.

• 出版日期2012-9