USE OF TOPICAL NEGATIVE PRESSURE THERAPY (TNPT) IN PATIENTS WITH HIGH ENERGY, COMBAT WOUNDS – A CASE SERIES

Abstract

Topical Negative Pressure Therapy (TNPT) has gained increasing acceptance as a useful tool in wound management. Since 2002, the Royal Centre for Defence Medicine (RCDM) in South Birmingham has gained considerable experience with managing complex combat trauma with TNPT. The mainstay of managing high-energy combat wounds has changed little over the last century of conflict and remains early debridement, wound lavage, fracture stabilisation and delayed closure. Over the last 10 years the use of TNPT has proved to be a useful adjunct in promoting delayed primary and secondary closure, and is now common practise in the US and UK military medical services. There is however, little level 1 evidence to support the use of TNPT in military trauma.

All military patients admitted to Selly Oak Hospital between April 2007 and March 2008 that were treated with TNPT were identified, those whose notes were available were included.

37 cases were included. There was a strong correlation between ISS, NISS, and antibiotic use during TNPT use and the total duration of secondary care. However, we found no correlation between delay to first TNPT application, the frequency or location of TNPT dressing changes and any of our surrogate markers of outcome.

TNPT is just one of a number of techniques for managing military high-energy injuries and should not be seen as an alternative to the established principles. The high frequency of TNPT dressing changes is not supported by this research and this should be reflected in the clinical management of patients requiring prolonged TNPT.