Araştırma Makalesi
Effect of negative pressure wound therapy applied in the emergency center on postoperative infection rates in patients with orthopedic open wounds
Öz
Objectives: This study aimed to evaluate the effect of Negative Pressure Wound Therapy (NPWT) applied in the emergency department on postoperative infection rates in patients with orthopedic open injuries.
Methods: This prospective randomized controlled study included 80 patients who presented with orthopedic open injuries. Patients were divided into two groups: NPWT group (n=40) and control group receiving standard wound care (n=40). An average pressure of 125±25 mmHg was applied in the NPWT group. Demographic characteristics, wound characteristics, infection rates, length of hospital stay, and treatment outcomes were evaluated.
Results: The infection rate in the NPWT group (7.5%) was significantly lower compared to the control group (25.0%) (P=0.034). The NPWT group showed significantly lower numbers of surgical debridement (1.3±0.6 vs 2.1±0.8, P=0.008), shorter antibiotic use duration (10±3 vs 14±4 days, P=0.003), and shorter hospital stay (8±2 vs 14±3 days, P<0.001). Primary closure rate was significantly higher in the NPWT group (70%) compared to the control group (30%) (P=0.002).
Conclusions: NPWT applied in the emergency department significantly reduces postoperative infection rates, accelerates wound healing, and shortens hospital stay in orthopedic open injuries. These findings suggest that NPWT may have an important role in the early treatment protocol of open injuries.
Anahtar Kelimeler
Negative pressure wound therapy open fracture infection emergency department orthopedic trauma wound healing
Etik Beyan
This study was approved by the Adana City Training and Reserach Hospital Scientific Research Ethics Committee (Decision No: 2025-12/447; date: 10.04.2025). All procedures were conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments. Written informed consent was obtained from all individual participants included in the study.
Kaynakça
- 1. Rupp M, Popp D, Alt V. Prevention of infection in open fractures: Where are the pendulums now? Injury. 2020;51 Suppl 2:S57-S63. doi: 10.1016/j.injury.2019.10.074.
- 2. Zaver V, Kankanalu P. Negative Pressure Wound Therapy. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
- 3. Wang B, Xiao X, Zhang J, Han W, Hersi SA, Tang X. Epidemiology and microbiology of fracture-related infection: a multicenter study in Northeast China. J Orthop Surg Res. 2021;16(1):490. doi: 10.1186/s13018-021-02629-6.
- 4. Van Rysselberghe NL, Gonzalez CA, Calderon C, Mansour A, Oquendo YA, Gardner MJ. Negative Pressure Wound Therapy for Extremity Open Wound Management: A Review of the Literature. J Orthop Trauma. 2022;36(Suppl 4):S6-S11. doi: 10.1097/BOT.0000000000002430.
- 5. Hollins AW, Mithani SK. Advances in Soft Tissue Injuries Associated with Open Fractures. Hand Clin. 2023;39(4):605-616. doi: 10.1016/j.hcl.2023.05.008.
- 6. Dvorak JE, Lasinski AM, Romeo NM, Hirschfeld A, Claridge JA. Fracture related infection and sepsis in orthopedic trauma: A review. Surgery. 2024;176(2):535-540. doi: 10.1016/j.surg.2024.04.031.
- 7. Wu L, Wen B, Xu Z, Lin K. Research progress on negative pressure wound therapy with instillation in the treatment of orthopaedic wounds. Int Wound J. 2022;19(6):1449-1455. doi: 10.1111/iwj.13741.
- 8. Patro BP, Khuntia S, Sahu NK, Das G, Patra SK. Negative Pressure Wound Therapy Assisted Closure: An Effective Mode of Management for Infected and Contaminated Wound With Non-Union Fracture Femur. Cureus. 2020;12(7):e9037. doi: 10.7759/cureus.9037.
- 9. Axelrod D, Comeau-Gauthier M, Prada C, et al. Change in Gustilo-Anderson classification at time of surgery does not increase risk for surgical site infection in patients with open fractures: A secondary analysis of a multicenter, prospective randomized controlled trial. OTA Int. 2022;6(1):e231. doi: 10.1097/OI9.0000000000000231.
- 10. Costa ML, Achten J, Knight R, et al; WHIST Trial Collaborators. Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma: The WHIST Randomized Clinical Trial. JAMA. 2020;323(6):519-526. doi: 10.1001/jama.2020.0059.
- 11. Atwan Y, Sprague S, Slobogean GP, et al; FLOW Investigators. Does negative pressure wound therapy reduce the odds of infection and improve health-related quality of life in patients with open fractures? Bone Jt Open. 2022;3(3):189-195. doi: 10.1302/2633-1462.33.BJO-2021-0199.R1.
- 12. Messori M, Touloupakis G, Gilli A, et al. The risk of infection in open distal tibial fracture: the DANGER score. Eur J Orthop Surg Traumatol. 2023;33(7):2965-2970. doi: 10.1007/s00590-023-03517-x.
- 13. Garner MR, Sethuraman SA, Schade MA, Boateng H. Antibiotic Prophylaxis in Open Fractures: Evidence, Evolving Issues, and Recommendations. J Am Acad Orthop Surg. 2020;28(8):309-315. doi: 10.5435/JAAOS-D-18-00193.
- 14. Tait MA, Bracey JW, Roulette P, Lewis DR. Infection Rates in Open Hand Fractures: Can Surgical Treatment Be Delayed? J Surg Orthop Adv. 2024;33(4):222-224.
- 15. Reátiga Aguilar J, Gonzalez Edery E, Guzmán Badrán J, et al. Open tibial plateau fractures: Infection rate and functional outcomes. Injury. 2023;54 Suppl 6:110720. doi: 10.1016/j.injury.2023.04.007.
- 16. Gardezi M, Roque D, Barber D, et al. Wound Irrigation in Orthopedic Open Fractures: A Review. Surg Infect (Larchmt). 2021;22(3):245-252. doi: 10.1089/sur.2020.075.
- 17. Dwivedi AK. How to write statistical analysis section in medical research. J Investig Med. 2022;70(8):1759-1770. doi: 10.1136/jim-2022-002479.
- 18. Kim Y, Kong CG, Park HY, Lee KS, Sur YJ. Clinical and radiographic outcomes of negative pressure wound therapy combined with polymethylmethacrylate sealant for wound management of Gustilo type III open tibia fractures. Acta Orthop Traumatol Turc. 2023;57(6):366-371. doi: 10.5152/j.aott.2023.22104.
- 19. Qian H, Lei T, Hu Y. Negative pressure wound therapy versus gauze dressings in managing open fracture wound of lower limbs: A meta-analysis of randomized controlled trials. Foot Ankle Surg. 2022;28(7):1120-1128. doi: 10.1016/j.fas.2022.03.012.
- 20. De Pellegrin L, Feltri P, Filardo G, et al. Effects of negative pressure wound therapy with instillation and dwell time (NPWTi-d) versus NPWT or standard of care in orthoplastic surgery: A systematic review and meta-analysis. Int Wound J. 2023;20(6):2402-2413. doi: 10.1111/iwj.14072.
- 21. Cortez A, Urva M, Subramanian A, et al. Delays in Debridement of Open Femoral and Tibial Fractures Increase Risk of Infection. J Bone Joint Surg Am. 2023;105(20):1622-1629. doi: 10.2106/JBJS.23.00074.
- 22. von Rüden C, Wunder J, Schirdewahn C, Augat P, Hackl S. Initial treatment of severe soft-tissue injuries in closed and open fractures to prevent fracture-related infection. Injury. 2024;55 Suppl 6:111935. doi: 10.1016/j.injury.2024.111935.
- 23. Loh B, Lim JA, Seah M, Khan W. Perioperative management of open fractures in the lower limb. J Perioper Pract. 2022;32(5):100-107. doi: 10.1177/17504589211012150.
- 24. Winstanley RJH, Hadfield JN, Walker R, et al; Open-Fracture Patient Evaluation Nationwide (OPEN) collaborators. The Open-Fracture Patient Evaluation Nationwide (OPEN) study: the management of open fracture care in the UK. Bone Joint J. 2022;104-B(9):1073-1080. doi: 10.1302/0301-620X.104B9.BJJ-2022-0202.R1.
- 25. Jia B, Xue R, Li J, Guo J, Liu J. Novel insights into vancomycin-loaded calcium sulfate and negative pressure wound therapy in preventing infections in open fractures. J Orthop Surg Res. 2024;19(1):517. doi: 10.1186/s13018-024-04931-5.
Yıl 2025,
EARLY ONLINE, 1 - 9
Öz
Kaynakça
- 1. Rupp M, Popp D, Alt V. Prevention of infection in open fractures: Where are the pendulums now? Injury. 2020;51 Suppl 2:S57-S63. doi: 10.1016/j.injury.2019.10.074.
- 2. Zaver V, Kankanalu P. Negative Pressure Wound Therapy. 2023 Sep 4. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–.
- 3. Wang B, Xiao X, Zhang J, Han W, Hersi SA, Tang X. Epidemiology and microbiology of fracture-related infection: a multicenter study in Northeast China. J Orthop Surg Res. 2021;16(1):490. doi: 10.1186/s13018-021-02629-6.
- 4. Van Rysselberghe NL, Gonzalez CA, Calderon C, Mansour A, Oquendo YA, Gardner MJ. Negative Pressure Wound Therapy for Extremity Open Wound Management: A Review of the Literature. J Orthop Trauma. 2022;36(Suppl 4):S6-S11. doi: 10.1097/BOT.0000000000002430.
- 5. Hollins AW, Mithani SK. Advances in Soft Tissue Injuries Associated with Open Fractures. Hand Clin. 2023;39(4):605-616. doi: 10.1016/j.hcl.2023.05.008.
- 6. Dvorak JE, Lasinski AM, Romeo NM, Hirschfeld A, Claridge JA. Fracture related infection and sepsis in orthopedic trauma: A review. Surgery. 2024;176(2):535-540. doi: 10.1016/j.surg.2024.04.031.
- 7. Wu L, Wen B, Xu Z, Lin K. Research progress on negative pressure wound therapy with instillation in the treatment of orthopaedic wounds. Int Wound J. 2022;19(6):1449-1455. doi: 10.1111/iwj.13741.
- 8. Patro BP, Khuntia S, Sahu NK, Das G, Patra SK. Negative Pressure Wound Therapy Assisted Closure: An Effective Mode of Management for Infected and Contaminated Wound With Non-Union Fracture Femur. Cureus. 2020;12(7):e9037. doi: 10.7759/cureus.9037.
- 9. Axelrod D, Comeau-Gauthier M, Prada C, et al. Change in Gustilo-Anderson classification at time of surgery does not increase risk for surgical site infection in patients with open fractures: A secondary analysis of a multicenter, prospective randomized controlled trial. OTA Int. 2022;6(1):e231. doi: 10.1097/OI9.0000000000000231.
- 10. Costa ML, Achten J, Knight R, et al; WHIST Trial Collaborators. Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma: The WHIST Randomized Clinical Trial. JAMA. 2020;323(6):519-526. doi: 10.1001/jama.2020.0059.
- 11. Atwan Y, Sprague S, Slobogean GP, et al; FLOW Investigators. Does negative pressure wound therapy reduce the odds of infection and improve health-related quality of life in patients with open fractures? Bone Jt Open. 2022;3(3):189-195. doi: 10.1302/2633-1462.33.BJO-2021-0199.R1.
- 12. Messori M, Touloupakis G, Gilli A, et al. The risk of infection in open distal tibial fracture: the DANGER score. Eur J Orthop Surg Traumatol. 2023;33(7):2965-2970. doi: 10.1007/s00590-023-03517-x.
- 13. Garner MR, Sethuraman SA, Schade MA, Boateng H. Antibiotic Prophylaxis in Open Fractures: Evidence, Evolving Issues, and Recommendations. J Am Acad Orthop Surg. 2020;28(8):309-315. doi: 10.5435/JAAOS-D-18-00193.
- 14. Tait MA, Bracey JW, Roulette P, Lewis DR. Infection Rates in Open Hand Fractures: Can Surgical Treatment Be Delayed? J Surg Orthop Adv. 2024;33(4):222-224.
- 15. Reátiga Aguilar J, Gonzalez Edery E, Guzmán Badrán J, et al. Open tibial plateau fractures: Infection rate and functional outcomes. Injury. 2023;54 Suppl 6:110720. doi: 10.1016/j.injury.2023.04.007.
- 16. Gardezi M, Roque D, Barber D, et al. Wound Irrigation in Orthopedic Open Fractures: A Review. Surg Infect (Larchmt). 2021;22(3):245-252. doi: 10.1089/sur.2020.075.
- 17. Dwivedi AK. How to write statistical analysis section in medical research. J Investig Med. 2022;70(8):1759-1770. doi: 10.1136/jim-2022-002479.
- 18. Kim Y, Kong CG, Park HY, Lee KS, Sur YJ. Clinical and radiographic outcomes of negative pressure wound therapy combined with polymethylmethacrylate sealant for wound management of Gustilo type III open tibia fractures. Acta Orthop Traumatol Turc. 2023;57(6):366-371. doi: 10.5152/j.aott.2023.22104.
- 19. Qian H, Lei T, Hu Y. Negative pressure wound therapy versus gauze dressings in managing open fracture wound of lower limbs: A meta-analysis of randomized controlled trials. Foot Ankle Surg. 2022;28(7):1120-1128. doi: 10.1016/j.fas.2022.03.012.
- 20. De Pellegrin L, Feltri P, Filardo G, et al. Effects of negative pressure wound therapy with instillation and dwell time (NPWTi-d) versus NPWT or standard of care in orthoplastic surgery: A systematic review and meta-analysis. Int Wound J. 2023;20(6):2402-2413. doi: 10.1111/iwj.14072.
- 21. Cortez A, Urva M, Subramanian A, et al. Delays in Debridement of Open Femoral and Tibial Fractures Increase Risk of Infection. J Bone Joint Surg Am. 2023;105(20):1622-1629. doi: 10.2106/JBJS.23.00074.
- 22. von Rüden C, Wunder J, Schirdewahn C, Augat P, Hackl S. Initial treatment of severe soft-tissue injuries in closed and open fractures to prevent fracture-related infection. Injury. 2024;55 Suppl 6:111935. doi: 10.1016/j.injury.2024.111935.
- 23. Loh B, Lim JA, Seah M, Khan W. Perioperative management of open fractures in the lower limb. J Perioper Pract. 2022;32(5):100-107. doi: 10.1177/17504589211012150.
- 24. Winstanley RJH, Hadfield JN, Walker R, et al; Open-Fracture Patient Evaluation Nationwide (OPEN) collaborators. The Open-Fracture Patient Evaluation Nationwide (OPEN) study: the management of open fracture care in the UK. Bone Joint J. 2022;104-B(9):1073-1080. doi: 10.1302/0301-620X.104B9.BJJ-2022-0202.R1.
- 25. Jia B, Xue R, Li J, Guo J, Liu J. Novel insights into vancomycin-loaded calcium sulfate and negative pressure wound therapy in preventing infections in open fractures. J Orthop Surg Res. 2024;19(1):517. doi: 10.1186/s13018-024-04931-5.
Toplam 25 adet kaynakça vardır.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Original Article |
| Yazarlar | |
| Erken Görünüm Tarihi | 19 Ağustos 2025 |
| Yayımlanma Tarihi | |
| Gönderilme Tarihi | 19 Nisan 2025 |
| Kabul Tarihi | 17 Ağustos 2025 |
| Yayımlandığı Sayı | Yıl 2025 EARLY ONLINE |
e-ISSN: 2149-3189
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2025