Results of negative pressure wound therapy in compound grade 3 tibial fractures

Atul Kantilal Patil, Ansari Muqtadeer Abdul Aziz, Rahul Devale


Background: Open fractures constitute major chunk of orthopaedic trauma in a busy tertiary hospital and involve lot of morbidity, efforts, cost and time. Negative pressure wound therapy (NPWT) is a relatively new treatment that has proven beneficial in various types of complex wounds. The purpose of our study is to see the utility of NPWT in compound type III tibial fractures and its impact on the outcome of the patients.

Methods: 30 patients were included in the study with a mean age of 40.27 years ranging from 13 years to 62 years. There were 26 male patients and 4 female patients with 22 right sided fractures and 8 left sided fractures. The patients were then distributed into VAC/NPWT (study) group and control group using table of random numbers. Each group had 15 patients each. Scoring was carried out at before the first debridement.

Results: In the study NPWT group it was estimated that 5 patients may need amputation or but of these only 1 (20%) patient went on to have amputation of the involved limb while the rest (80%) could be salvaged. In the control group, 1 patient was predicted to need amputation which indeed resulted in amputation. Of the 7 predicted to need flap cover in study group, 4 (57.1%) eventually needed flap cover while the 3 (42.9%) were covered with skin grafting. Contrary in the control group all the 8 patients predicted to need flap cover, all ended up having the same. In the control group, of the 6 patients who were prognosticated to needed skin grafting, 2 (33.3%) worsened and needed flap cover while in the rest 4 (66.7%) skin grafting sufficed.

Conclusions: NPWT resulted in healthy granulation of the wound. The study undertaken was a prospective randomised control trial. However, the main drawbacks were the sample size and the inability to have long term follow up. More studies with larger sample size and a long term follow up are necessary to substantiate the findings of the study.


Compound fractures, NPWT, VAC

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