Top

Published in:

Open Access 01-04-2018 | Original Paper

Prophylactic negative pressure wound therapy after lower extremity fracture surgery: a pilot study

Authors: Siem A. Dingemans, Merel F. N. Birnie, Manouk Backes, Vincent M. de Jong, Jan S. Luitse, J. Carel Goslings, Tim Schepers

Published in: International Orthopaedics | Issue 4/2018

Abstract

Purpose

Infectious complications following lower extremity fracture surgery are a major concern and account for a substantial socio-economic burden to society. The aim of this pilot study was to investigate the feasibility of a new portable single-use negative pressure wound therapy device in patients undergoing major foot ankle surgery.

Methods

Patients undergoing major foot ankle fracture surgery at a single level 1 trauma centre were eligible for this prospective case series. Patient characteristics were collected, as were fracture and surgical characteristics. Primary outcome was surgical site infection within 30 days as classified by the criteria from the Centers for Disease Control and Prevention. Patients in the prospective cohort were case-matched with a historical cohort from the same institution.

Results

Sixty patients were included. In seven patients, the NPWT failed and treatment was ceased. Mean age was 44 years and 85% was ASA 1; 43% of the patients were actively smoking. Indications for surgery were midfoot, calcaneal, talar, and ankle fractures. In 53 patients, four (7.5%) surgical site infections occurred, two superficial (3.3%) and two (3.3%) deep infections. For 47 patients, a match was available. The incidence of surgical site infection did not statistically significantly differ between the prospective cohort and retrospective matched cohort (4.3 versus 14.9%, p = 0.29, respectively). This was also the case when looking at superficial and deep surgical site infections separately (0 versus 8.5%, p = 0.08, and 4.3 versus 6.4%, respectively).

Conclusion

We have observed surgical site infections in 7.5% of the patients with the use of prophylactic negative pressure wound therapy. The incidence of surgical site infections was not statistically significantly lower compared to a matched historical cohort.

Stannard JP, Volgas DA, McGwin G et al (2012) Incisional negative pressure wound therapy after high-risk lower extremity fractures. J Orthop Trauma 26:37–42. https://doi.org/10.1097/BOT.0b013e318216b1e5 CrossRefPubMed

Whitehouse J, Friedman N (2002) The impact of surgical-site infections following orthopedic surgery at a community hospital and a university hospital: adverse quality of life, excess length of stay. Infect Control Hosp Epidemiol 23:183–189CrossRefPubMed

Backes M, Schep NWL, Luitse JSK et al (2015) The effect of postoperative wound infections on functional outcome following intra-articular calcaneal fractures. Arch Orthop Trauma Surg 135:1045–1052. https://doi.org/10.1007/s00402-015-2219-5 CrossRefPubMedPubMedCentral

Schepers T, De Vries MR, Van Lieshout EMM, Van der Elst M (2013) The timing of ankle fracture surgery and the effect on infectious complications; a case series and systematic review of the literature. Int Orthop 37:489–494. https://doi.org/10.1007/s00264-012-1753-9 CrossRefPubMedPubMedCentral

Metsemakers WJ, Smeets B, Nijs S, Hoekstra H (2017) Infection after fracture fixation of the tibia: analysis of healthcare utilization and related costs. Injury 48:1204–1210. https://doi.org/10.1016/j.injury.2017.03.030 CrossRefPubMed

Schrieck-de Loos E, van der Wille J (2009) Sneller beter Doorbraakproject postoperatieve wondinfecties 2004–2008. Best Pract Zorg 242–246

de Lissovoy G, Fraeman K, Hutchins V et al (2009) Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control 37:387–397. https://doi.org/10.1016/j.ajic.2008.12.010 CrossRefPubMed

Berríos-Torres SI, Umscheid CA, Bratzler DW, et al (2017) Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg 1–8. doi:https://doi.org/10.1001/jamasurg.2017.0904

Stannard JP, Robinson JT, Anderson ER et al (2006) Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma. J Trauma 60(6):1301. https://doi.org/10.1097/01.ta.0000195996.73186.2e CrossRefPubMed

10.

Karlakki S, Brem M, Giannini S et al (2013) Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery: a review of evidence and mechanisms for an emerging indication. Bone Jt Res 22:276–284. https://doi.org/10.1302/2046-3758.212.2000190 CrossRef

11.

Masters JPM, Nanchahal J, Costa ML (2016) Negative pressure wound therapy and orthopaedic trauma: where are we now? Bone Joint J 98–B:1011–1013. https://doi.org/10.1302/0301-620X.98B8.BJJ-2016-0373 CrossRefPubMed

12.

Vandenbroucke JP, von Elm E, Altman DG et al (2014) Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 12:1500–1524. https://doi.org/10.1016/j.ijsu.2014.07.014 CrossRefPubMed

13.

Mangram AJ, Horan TC, Pearson ML et al (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–278-80. https://doi.org/10.1086/501620 CrossRefPubMed

14.

Niven D, Berthiaume LR, Fick GH, Laupland KB (2012) Matched case-control studies: a review of reported statistical methodology. Clin Epidemiol 4:99. https://doi.org/10.2147/CLEP.S30816 CrossRefPubMedPubMedCentral

15.

Boxma H, Broekhuizen T, Patka P, Oosting H (1996) Randomised controlled trial of single-dose antibiotic prophylaxis in surgical treatment of closed fractures: the Dutch Trauma Trial. Lancet 347:1133–1137. https://doi.org/10.1016/S0140-6736(96)90606-6 CrossRefPubMed

16.

Gans I, Jain A, Sirisreetreerux N et al (2017) Current practice of antibiotic prophylaxis for surgical fixation of closed long bone fractures: a survey of 297 members of the Orthopaedic Trauma Association. Patient Saf Surg 11:2. https://doi.org/10.1186/s13037-016-0118-5 CrossRefPubMedPubMedCentral

17.

Schepers T (2011) The sinus tarsi approach in displaced intra-articular calcaneal fractures: a systematic review. Int Orthop 35:697–703. https://doi.org/10.1007/s00264-011-1223-9 CrossRefPubMedPubMedCentral

18.

De Vries FEE, Wallert ED, Solomkin JS et al (2016) A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery. Medicine (Baltimore) 95:e4673. https://doi.org/10.1097/MD.0000000000004673 CrossRef

19.

Crist BD, Oladeji LO, Khazzam M et al (2017) Role of acute negative pressure wound therapy over primarily closed surgical incisions in acetabular fracture ORIF: a prospective randomized trial. Injury. https://doi.org/10.1016/j.injury.2017.04.055

20.

Dingemans SA, Backes M, Goslings JC et al (2016) Predictors of nonunion and infectious complications in patients with posttraumatic subtalar arthrodesis. J Orthop Trauma. https://doi.org/10.1097/BOT.0000000000000644

Title: Prophylactic negative pressure wound therapy after lower extremity fracture surgery: a pilot study
Authors: Siem A. Dingemans
Merel F. N. Birnie
Manouk Backes
Vincent M. de Jong
Jan S. Luitse
J. Carel Goslings
Tim Schepers
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-3781-6

At a glance: The STEP trials

Springer Medicine

Prophylactic negative pressure wound therapy after lower extremity fracture surgery: a pilot study

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2018

Evaluation of risk factors for stiffness after distal humerus plating

High bacterial contamination rate of electrocautery tips during total hip and knee arthroplasty

Arthroscopic versus open treatment of cam-type femoro-acetabular impingement: retrospective cohort clinical study

The role of suture cutout in the failure of meniscal root repair during the early post-operative period: a biomechanical study

Outcomes of the Bryan cervical disc replacement: fifteen year follow-up

Natural history of the ossification of cervical posterior longitudinal ligament: a three dimensional analysis