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Published on: May 2, 2025
The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection: A Systematic Review and
Susan Haidari1, Frank F A IJpma2, Willem-Jan Metsemakers3
1Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands.
Introduction:
Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management. Currently, negative-pressure wound therapy (NPWT) is often used as temporary coverage for traumatic and surgical wounds, also in cases of FRI. However, controversy exists about the impact of NPWT on the outcome in FRI, specifically on infection recurrence. Therefore, this systematic review qualitatively assesses the literature on the role of NPWT in the management of FRI.
Methods:
A literature search of the PubMed, Embase, and Web of Science database was performed. Studies that reported on infection recurrence related to FRI management combined with NPWT were eligible for inclusion. Quality assessment was done using the PRISMA statement and the Newcastle-Ottawa Quality Assessment Scale.
Results:
After screening and quality assessment of 775 unique identified records, eight articles could be included for qualitative synthesis. All eight studies reported on infection recurrence, which ranged from 2.8% to 34.9%. Six studies described wound healing time, varying from two to seven weeks. Four studies took repeated microbial swabs during subsequent vacuum dressing changes. One study reported newly detected pathogens in 23% of the included patients, and three studies did not find new pathogens.
Conclusion:
This review provides an assessment of current literature on the role of NPWT in the management of soft tissue defects in patients with FRI. Due to the lack of uniformity in included studies, conclusions should be drawn with caution. Currently, there is no clear scientific evidence to support the use of NPWT as definitive treatment in FRI. At this stage, we can only recommend early soft tissue coverage (within days) with a local or free flap. NPWT may be safe for a few days as temporarily soft tissue coverage until definitive soft tissue management could be performed. However, comparative studies between NPWT and early wound closure in FRI patients are needed.
Insights
Negative-pressure wound therapy (NPWT) is used for fracture-related infections (FRI), but evidence on its impact on infection recurrence is limited. This review suggests NPWT may be safe short-term but not definitive treatment for FRI.
Area of Science:
- Orthopedic Surgery
- Trauma Management
- Wound Care
Background:
- Fracture-related infection (FRI) is a serious complication in orthopedic trauma surgery.
- Negative-pressure wound therapy (NPWT) is commonly used for wound management, including in FRI cases.
- The efficacy of NPWT in managing FRI, particularly regarding infection recurrence, remains debated.
Purpose of the Study:
- To qualitatively assess the existing literature on the role of NPWT in the management of FRI.
- To evaluate the impact of NPWT on infection recurrence in patients with FRI.
Main Methods:
- A systematic literature search was conducted across PubMed, Embase, and Web of Science.
- Studies focusing on infection recurrence in FRI managed with NPWT were included.
- Quality assessment utilized PRISMA guidelines and the Newcastle-Ottawa Scale.
Main Results:
- Eight studies were included, with infection recurrence rates varying from 2.8% to 34.9%.
- Wound healing times ranged from two to seven weeks across six studies.
- Microbial swabs during NPWT showed new pathogens in one study (23%), but not in three others.
Conclusions:
- Current literature lacks uniform data, necessitating cautious interpretation of findings on NPWT for FRI.
- There is insufficient scientific evidence to support NPWT as a definitive treatment for FRI.
- Early soft tissue coverage (e.g., flaps) is recommended, with NPWT potentially serving as safe temporary coverage for a few days.
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