Abstract
Introduction
Over the past decade, the use of negative pressure wound therapy (NPWT) devices has increased and expanded to include a wide variety of patients. However, the safety and efficacy of NPWT over skin in open fractures is still unknown. The purpose of this study was to evaluate the complication rate and outcome of open fractures treated by NPWT over closed wounds or flaps.
Materials and methods
We performed a retrospective review of prospectively collected data of 10 patients, with an average age of 37.9 years old, who underwent NPWT over surgically closed wounds or random pattern cutaneous flaps in open fractures. All wounds were debrided and closed, and NPWT was applied over the skin sequentially in emergency operations.
Results
The open fracture sites were lower leg (6), foot and ankle (3), and knee (1). The reasons for applying NPWT were the expectation of improved viability of local flaps in 4, impossibility of airtight skin approximation in 3, high risk for wound healing problems due to swelling in 2, and securing of degloved skin in 1. The mean duration of NPWT was 11.3 days. There were 3 skin macerations under foam, however, no flap or degloved skin necrosis occurred. All the fractures eventually united, and there were no deep infections.
Discussion and Conclusion
While skin macerations were sometimes seen, they did not affect the overall outcome. NPWT over the skin in open fractures is effective in preventing infection even in high-risk wounds.
