Evolution of Negative Pressure Wound Therapy in Orthopaedic Trauma

Negative Pressure Wound Therapy (NPWT) has evolved from open wound management to now include closed incision management. It has been a major advance in the management of open wounds and closed incisional wounds especially in orthopaedic trauma surgery. Because of the success of NPWT in the late 1990s and early 2000s, surgeons began using NPWT with adjuncts on closed incisions as a way to help prevent surgical wound dehiscence especially in at-risk patients for wound problems. It has been well established that obesity, diabetes, and smoking in addition to other comorbidities increase the risk of wound dehiscence and surgical site infections in orthopaedic patients. It is widely used for open wound management, often associated with open fractures, and in the mitigation of risk of surgical site infections over closed incisions (incisional negative pressure wound therapy). Newer systems allow the use of various topical wound solutions to be instilled in conjunction with NPWT, termed NPWTi-d. This has shown promising results in difficult wounds that may be resistant to standard NPWT. This article reviews the evolution and use of NPWT in orthopaedic trauma.