Clinical outcome and cost analysis of negative pressure wound therapy in extremity wounds: a comparison to conventional wound management
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20205568Keywords:
Negative pressure wound therapy, Wound care, Musculoskeletal injury, Open fractureAbstract
Background: Open fractures and traumatic wounds constitute a major health problem. Amongst the armamentarium of wound care products available, negative pressure wound therapy (NPWT) is a modality that has transformed wound care and has been recommended for treating all kinds of acute and chronic wounds.
Methods: This prospective randomised comparative study was conducted at a tertiary care hospital in Northeast India. 30 patients were included in this study over a period of 24 months commencing from January 2018. The patients consisted of two groups of 15 each, the first group comprised patients who underwent treatment using NPWT and the second group was treated using standard wound therapy (SWT). The endpoint taken was a granulated wound or a wound ready for split skin grafting (SSG).
Results: The mean wound size difference between the NPWT group and the SWT group on day nine was 13±7.17 mm and 4.53±0.99 mm, respectively. Likewise, on day nine, 11 (73.3%) patients in the group treated using NPWT had no positive bacterial cultures compared to 8(53.3%) patients on SWT. The estimated cost of materials for each NPWT dressing change was roughly INR₹ 3446 (US$ 45.57).
Conclusions: NPWT is not a magic bullet and will not replace the basic methods of wound treatment such as wound debridement, infection control and ensuring adequate blood supply. Nevertheless, NPWT remains an integral part of the current scenario in wound care management and is cost effective under the condition that it accelerates wound healing when compared to traditional treatment.
References
Huang C, Leavitt T, Bayer LR, Orgill DP. Effect of negative pressure wound therapy on wound healing. Curr Probl Surg. 2014;51(7):301-31.
El-Sabbagh AH. Negative pressure wound therapy: An update. Chin J Traumatol. 2017;20(2):103-7.
Fay MF. Drainage systems. Their role in wound healing. AORN J. 1987;46(3):442-55.
Morykwas MJ, Argenta LC, Shelton-Brown EI, McGuirt W. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg. 1997;38(6):553-62.
Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg. 1997;38(6):563-76.
Vikatmaa P, Juutilainen V, Kuukasjärvi P, Malmivaara A. Negative Pressure Wound Therapy: a Systematic Review on Effectiveness and Safety. Eur J Vasc Endovasc Surg. 2008;36(4):438-48.
Maillard H. Negative pressure therapy: NPT. Ann Dermatol Venereol. 2015;142(8-9):498-501.
Harding K. Innovation and Wound Healing. J Wound Care. 2015;24(4b):7-13.
Joshipura M, Mock C, Goosen J, Peden M. Essential Trauma Care: strengthening trauma systems round the world. Injury. 2004;35(9):841-5.
Schaum KD. A new Medicare Part B wound care policy. Adv Skin Wound Care. 2001;14(5):238-40.
Robert N. Negative pressure wound therapy in orthopaedic surgery. Orthop Traumatol Surg Res OTSR. 2017;103(1S):99-103.
Banwell P, Withey S, Holten I. The use of negative pressure to promote healing. Br J Plast Surg. 1998;51(1):79.
Frost HM. Wolff’s Law and bone’s structural adaptations to mechanical usage: an overview for clinicians. Angle Orthod. 1994;64(3):175-88.
Urschel JD, Scott PG, Williams HT. The effect of mechanical stress on soft and hard tissue repair; a review. Br J Plast Surg. 1988;41(2):182-6.
Blum ML, Esser M, Richardson M, Paul E, Rosenfeldt FL. Negative pressure wound therapy reduces deep infection rate in open tibial fractures. J Orthop Trauma. 2012;26(9):499-505.
Kim JJ, Franczyk M, Gottlieb LJ, Song DH. Cost-effective Alternative for Negative-pressure Wound Therapy. Plast Reconstr Surg Glob Open. 2017;5(2).
Kamamoto F, Lima ALM, de Rezende MR, Mattar-Junior R, de Camargo Leonhardt M, Kojima KE et al. A new low-cost negative-pressure wound therapy versus a commercially available therapy device widely used to treat complex traumatic injuries: a prospective, randomized, non-inferiority trial. Clinics. 2017;72(12):737-42.
Dorafshar AH, Franczyk M, Gottlieb LJ, Wroblewski KE, Lohman RF. A prospective randomized trial comparing subatmospheric wound therapy with a sealed gauze dressing and the standard vacuum-assisted closure device. Ann Plast Surg. 2012;69(1):79-84.
Perez D, Bramkamp M, Exe C, von Ruden C, Ziegler A. Modern wound care for the poor: a randomized clinical trial comparing the vacuum system with conventional saline-soaked gauze dressings. Am J Surg. 2010;199(1):14-20.