Impact of negative pressure wound therapy on open diaphyseal tibial fractures: A prospective randomized trial

IntroductionOpen tibial fractures are associated with a high incidence of mainly osteomyelitis. Negative pressure wound therapy (NPWT) is a novel form of treatment that uses subatmospheric pressure to effect early wound healing.Objectives and study designTo determine the effect of NPWT on incidence of deep infections/osteomyelitis after open tibial fractures using a prospective randomized study design.Materials and methodsNinety-three open tibial fractures were randomized into two groups receiving NPWT and the second group undergoing periodic irrigation, cleaning and debridement respectively. The wounds were closed or covered on shrinkage in size and sufficient granulation. Evidence of infection was sought during the course of treatment and follow up. Also serial cultures were sent every time the wound was cleaned.Results and conclusionsPatients in the control group developed a total of 11 infections (22%) as opposed to only 2 (4.6%) in the NPWT group (p < 0.05). The relative risk was 5.5 (95% confidence interval) suggesting patients who received NPWT were 5.5 times less likely to develop infection. Twenty patients developed positive growth when samples were sent for culture with 3 (6.9%) in the NPWT group and 17 (34%) in the control group (p < 0.05). Only 5 patients (25%) went on the develop osteomyelitis, all being a part of the control group. Thus negative pressure wound therapy is indeed beneficial for preventing the incidence of both acute infections and osteomyelitis in open fractures. However a significant difference was not seen in the time required for the wound to be ready for delayed primary closure or coverage.     

Negative-pressure wound therapy for deep sternal wound infections reduces the rate of surgical interventions for early re-infections

OBJECTIVES To evaluate the outcome of treatment for deep sternal wound infection (DSWI) in a nationwide patient cohort, before and after the introduction of negative-pressure wound therapy (NPWT). METHODS This was a population-based cohort of all patients treated for DSWI in Iceland out of 2446 open heart operations performed between 2000 and 2010. Length of hospital stay, survival and reoperations were compared in (i) 23 patients treated with open and/or closed irrigation before August 2005 (conventional treatment, CvT group) and in (ii) 20 patients treated after this time with NPWT as a first-line therapy (NPWT group). RESULTS The DSWI rate was 1.8% and did not change during the study period. Demographics were similar for both groups, except for peripheral arterial disease which was less common in the NPWT group. Coagulase-negative staphylococci were also more common (as the only pathogen identified) in the NPWT group (70% vs 30%, P?=?0.01). The median length of hospital stay was 43?days in both groups and the sternum could be closed with delayed primary closure in all except 2 patients, one in each group. Eight patients in the CvT group required surgical revision for re-infections, including debridement and rewiring, when compared with 1 patient in the NPWT group (P?=?0.02). Furthermore, 6 patients in the CvT group developed late chronic infections of the sternum requiring surgical revision, compared with one in the NPWT group (P?=?0.10). The 30-day mortality was not significantly different between groups (4% vs 0%, P?>?0.1) and the same was true for 1-year mortality (17% vs 0%, P?=?0.11). CONCLUSIONS NPWT significantly reduces the risk of early re-infections in patients with DSWI. There was a lower rate of late chronic sternal infections and lower mortality in the NPWT group, but the difference was not statistically significant. We conclude that NPWT should be considered as a first-line treatment for most DSWIs.     

C‐reactive protein and leucocyte counts drop faster using the HeartShield® device in patients with DSWI

Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier disc (HeartShield?) has been suggested to offer protection against this lethal complication by preventing the heart from being drawn up by the negative pressure and damaged by the sharp sternum bone edges. Seven patients treated with conventional NPWT and seven patients treated with NPWT with a protective barrier disc (HeartShield) were compared with regard to bacterial clearance and infection parameters including C‐reactive protein levels and leucocyte counts. C‐reactive protein levels and leucocyte counts dropped faster and bacterial clearance occurred earlier in the HeartShield® group compared with the conventional NPWT group. Negative biopsy cultures were shown after 3·1 ± 0·4 NPWT dressing changes in the HeartShield group, and after 5·4 ± 0·6 NPWT dressing changes in the conventional NPWT group (P < 0·001). All patients were followed up with clinical check‐up after 3 months. None of the patients in the HeartShield group had any signs of reinfection such as deep sternal wound infection (DSWI) or sternal fistulas, whereas in the conventional NPWT group, two patients had signs of sternal fistulas that demanded hospitalisation. HeartShield hinders the right ventricle to come into contact with the sharp sternal edges during NPWT and thereby protects from heart damage. This study shows that using HeartShield is beneficial in treating patients with DSWI. Improved wound healing by HeartShield may be a result of the efficient drainage of wound effluents from the thoracic cavity.     

Effects of platelet‐rich plasma on the healing of sternal wounds: A meta‐analysis

Sternal wound infection (SWI) is a devastating complication after cardiac surgery. Platelet‐rich plasma (PRP) may have a positive impact on sternal wound healing. A systematic review with meta‐analyses was performed to evaluate the clinical effectiveness of topical application of autologous PRP for preventing SWI and promoting sternal wound healing compared to placebo or standard treatment without PRP. Relevant studies published in English or Chinese were retrieved from the Cochrane Central Register of Controlled Trials (The Cochrane Library), PubMed, Ovid EMBASE, Web of Science, Springer Link, and the WHO International Clinical Trials Registry Platform (ICTRP) using the search terms “platelet‐rich plasma” and “sternal wound” or “thoracic incision.” References identified through the electronic search were screened, the data were extracted, and the methodological quality of the included studies was assessed. The meta‐analysis was performed for the following outcomes: incidence of SWI, incidence of deep sternal wound infection (DSWI), postoperative blood loss (PBL), and other risk factors. In the systematic review, totally 10 comparable studies were identified, involving 7879 patients. The meta‐analysis for the subgroup of retrospective cohort studies (RSCs) showed that the incidence of SWI and DSWI in patients treated with PRP was significantly lower than that in patients without PRP treatment. However, for the subgroup of randomized controlled trials (RCTs), there was no significant difference in the incidence of SWI or DSWI after intervention between the PRP and control groups. There was no significant difference in PBL in both RCTs and RSCs subgroups. Neither adverse reactions nor in‐situ recurrences were reported. According to the results, PRP could be considered as a candidate treatment to prevent SWI and DSWI. However, the quality of the evidence is too weak, and high‐quality RCTs are needed to assess its efficacy on preventing SWI and DSWI.     

Platelet‐rich plasma inside the sternotomy wound reduces the incidence of sternal wound infections

Despite the large choice of wide‐spectrum antibiotic therapy, deep sternal wound infection (DSWI) following cardiac surgery is a life‐threatening complication worldwide. This study evaluated that the use of platelet‐rich plasma (PRP) applied inside the sternotomy wound would reduce the effect of sternal wound infections, both superficial and deep. Between January 2007 and January 2012, 1093 consecutive patients underwent cardiac surgery through median sternotomy. Patients were divided into two groups. Group B, the study group, included those who received the PRP applied inside the sternotomy wound before closure. Group A, the control group, included patients who received a median sternotomy but without the application of PRP. Antibiotic prophylaxis remained unchanged across the study and between the two groups. Occurrence of DSWI was significantly higher in group A than in group B [10 of 671 (1·5%) versus 1 of 422 (0·20%), P = 0·043]. Also, superficial sternal wound infections (SSWIs) were significantly higher in group A than in group B [19 of 671 (2·8%) versus 2 of 422 (0·5%), P = 0·006]. The use of PRP can significantly reduce the occurrence of DSWI and SSWI in cardiac surgery.     

Negative-pressure wound therapy following cardiac surgery: bleeding complications and 30-day mortality in 176 patients with deep sternal wound infection

Negative-pressure wound therapy (NPWT) has been used for the treatment of deep sternal wound infection (DSWI) with promising results. However, questions have been raised regarding the potential risk of right ventricle (RV) rupture during treatment. In the present study, we evaluate our clinical experience of NPWT focusing on RV rupture and major bleeding complications and its potentially negative impact on 30-day mortality during an 11-year period. Serious bleeding complications during NPWT were reviewed for 176 patients treated for DSWI between January 1999 and April 2010. The 30-day mortality following DSWI was 1.1% (2/176). Four patients (2.3%) suffered bleeding from the RV rupture during NPWT of the sternal wound (two spontaneous and two debridement related). Furthermore, two patients had debridement-related bleedings from the venous bypass grafts during wound dressing change. The very low 30-day mortality (1.1%) following DSWI supports the use of NPWT. Overall, even if major bleeding complications may occur, the risk of RV rupture seems to be outweighed by the benefit of superior infection control. However, surgical experience is recommended when debriding sternal wounds and we recommend the use of a wound dressing, such as paraffin gauze, in order to protect the RV from direct contact with the polyurethane foam.     

Negative‐pressure wound therapy for III/IV pressure injuries: A meta‐analysis

This meta‐analysis was conducted to identify the potential benefits and the efficacy of negative‐pressure wound therapy (NPWT) for III/IV pressure injuries (PIs) compared with standard wound care (SWC). Sixteen RCTs with 629 patients were included in our analysis. The methodological quality was assessed by the Cochrane Collaboration Tool. The outcomes included complete ulcer healing rate, wound healing time, pain score, the frequency of dressing change, hospitalization cost, the condition of the exudate, and the wound improvement. The percentage of healing rate was 61.45% for the NPWT group and 36.90% for SWC (95% CI: 1.32‐1.70). There were significant differences in wound healing time (WMD = ?16.47 days, 95% [CI (?22.36, ? 10.59) days, P ≤ .001]). The pain score and hospitalization cost in NPWT was lower compared with SWC group (WMD = ?2.39, 95% CI [?3.47, ?1.30], P ≤ .001); (SMD = ?2.55, 95% CI [?4.07, ?1.03], P < .01). The frequency of dressing change in both NPWT groups was greatly reduced (SMD = ?3.61, 95% [CI (?4.57, ? 2.66) times, P ≤ .001]). Our meta‐analysis indicated that NPWT was associated with greater improvements in improving PIs and shorting healing time for III/IV PIs. However, this conclusion needs to be confirmed by high‐quality multicenter RCTs.     

Clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds: A meta-analysis of randomised controlled trials

Negative pressure wound therapy (NPWT) with or without instillation has been extensively applied for patients with multiple wound types. Whether NPWT with instillation is superior to NPWT alone is not known. This study aims to compare the efficacy between negative pressure wound therapy with instillation (NPWTi) and standard negative pressure wound therapy for wounds. The authors searched for randomised controlled trials (RCTs) in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials investigating clinical outcomes of negative pressure wound therapy with instillation vs standard negative pressure wound therapy for wounds. The registration number (protocol) on PROSPERO is CRD42022287178. Eight RCTs involved 564 patients met the inclusion criteria and were included finally. NPWTi showed a significant fewer surgeries and dressing changes (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05), and smaller wound area after treatment (RR and 95% CI, −9.31 [−17.54, −1.08], P < 0.05) compared with NPWT. No significant difference was observed on healing rate, time to heal, length of stay, dehiscence, reinfection, reoperation and readmission between NPWTi and NPWT. The addition of instillation to NPWT could improve clinical outcomes regarding the number of surgeries and dressing changes, and wound area after treatment in patients with multiple wound types. However, because of the heterogeneity these conclusions still need to be further validated by more well-designed RCTs with large sample sizes.     

Randomized controlled trial comparing the combination of a polymeric membrane dressing plus negative pressure wound therapy against negative pressure wound therapy alone: The WICVAC study

Negative pressure wound therapy (NPWT) is the treatment of choice for chronic wounds; yet, it is associated with considerable workload. Prompted by its nonadhesive and wound‐healing properties, this study investigated the effect of an additional polymeric membrane interface dressing (PMD; PolyMem WIC) in NPWT. From October 2011 to April 2013, 60 consecutive patients with chronic leg wounds or surgical site infections after revascularization of lower extremities were randomly allocated to either treatment with conventional NPWT (control arm) or NPWT with an additional PMD (intervention arm). The primary outcome was wound healing achieved within 30 days, the secondary endpoints included: number of days between dressing changes, wound‐related pain, cost efficiency, and occurrence of adverse events ( ClinTrials.gov Identifier: NCT02399722). Forty‐seven patients completed follow‐up. No difference in wound healing was observed (p > 0.05) between both study arms. The additional PMD allowed significantly longer wearing times (days) between dressing changes (intervention: 8.8 ± 0.5, control: 4.8 ± 0.2; p < 0.001). Pain was slightly higher in patients randomized to NPWT alone (VAS score: 4.8 ± 2.9) compared to NPWT + PMD (VAS score: 3.0 ± 2.9, p = 0.063). No wound infections were observed. Costs were reduced by 34% per patient in the intervention arm. These results suggest that the combination of NPWT and an additional interface PMD is a safe and economic method for the treatment of chronic wounds, which requires significantly fewer dressing changes for a comparable wound healing.     

Cyclic negative pressure wound therapy: an alternative mode to intermittent system

The purpose of this study was to develop and test a novel mode of negative pressure wound therapy (NPWT) that minimises pain while preserving the efficacy in wound healing. A porcine model was used in this study. Wounds were generated in animals and treated with either simple dressing or various treatment modes of NPWT. The wound volume, perfusion level and vasculature status were analysed and compared among different groups. Clinical application was performed to evaluate the level of pain occurring when negative pressure is applied. Among the NPWT groups, the Cyclic‐50 group showed most decrement in wound volume, even though statistical relevance was not found (P = 0·302). The perfusion level was significantly increased in the Cyclic‐50 group compared with the Intermittent group (P < 0·001) and the Cyclic‐100 group (P = 0·004). Evaluation of blood vessel formation revealed that the Cyclic‐50 group showed the highest number of vasculature with statistical significance (P < 0·001). In clinical application, the cyclic group showed significant decrease in pain compared with the intermittent group (P = 0·001). The cyclic NPWT mode decreased patient discomfort while maintaining superior wound healing effects as the intermittent mode.     

A systematic review of the effectiveness of negative pressure wound therapy in the management of diabetes foot ulcers

Foot ulcers are a common complication in patients with diabetes. Negative pressure wound therapy (NPWT) is a wound care therapy that is being increasingly used in the management of foot ulcers. This article presents a systematic review examining the effectiveness of this therapy. The review question is how effective is NPWT in achieving wound healing in diabetes foot ulcers? The primary outcome for this study was the number of patients achieving complete wound healing (secondary outcomes, other markers of wound healing, adverse events and patient satisfaction). A systematic literature review and tabulative synthesis of randomised controlled trials (RCTs). The review identified four RCTs of weak to moderate quality. Only one study examining NPWT in postamputation wound healing reported data on the primary outcome. These data show a 20% improvement in wound healing [odds ratios = 2·0%, confidence interval (CI) ?1·0 to 4·0] and number needed to treat = 6 (CI 4–64). No serious treatment‐related complications were reported by any of the studies. One study suggested a reduction in the risk of secondary amputation (absolute risk reduction = 7·9%, CI 0·5–15·43). Studies also reported an increase in granulation and wound‐healing rates in patients treated with NPWT therapy. No data on patient satisfaction or experience were reported. While all the studies included in the review indicated that the NPWT therapy is more effective than conventional dressings, the quality of the studies were weak and the nature of the inquiries in terms of outcome and patient selection divergent. There is a strong need for larger trials to assess NPWT therapy in diabetes care with different groups of patients and in relation to different clinical objectives and parameters.     

Effects of negative pressure wound therapy on wound infection and healing in patients with open fracture wounds: A meta-analysis

A meta-analysis was conducted to comprehensively evaluate the impact of negative pressure wound therapy (NPWT) on wound infection and healing in patients with open fracture wounds. Computer searches were performed in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the application of NPWT in open fracture wounds, with the search period covering the databases inception to September 2023. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Overall, 17 RCTs involving 1814 patients with open fracture wounds were included. The analysis revealed that compared with other treatment methods, NPWT significantly shortened the wound healing time (standardized mean difference [SMD] = −2.86, 95% confidence intervals [CI]: −3.51 to −2.20, p < 0.001) and fracture healing time (SMD = −3.14, 95% CI: −4.49 to −1.79, p < 0.001) in patients with open fracture wounds. It also significantly reduced the incidence of wound infection (odds ratio [OR] = 0.36, 95% CI: 0.23–0.56, p < 0.001) and complications (OR = 0.29, 95% CI: 0.20–0.40, p < 0.001). This study indicates that in the treatment of open fracture wounds, NPWT, compared with conventional treatment methods, can accelerate the healing of wounds and fractures, effectively control infections and reduce the occurrence of complications, demonstrating high safety.     

A prospective,randomized, controlled clinical trial on the efficacy of a single‐use negative pressure wound therapy system,compared to traditional negative pressure wound therapy in the treatment of chronic ulcers of the lower extremities

Multicenter, phase‐4, randomized, comparative‐efficacy study in patients with VLUs or DFUs comparing for noninferiority the percentage change in target ulcer dimensions (area, depth, and volume) a single‐use negative pressure wound therapy (s‐NPWT) system versus traditional NPWT (t‐NPWT) over a 12‐week treatment period or up to confirmed healing. Baseline values were taken at the randomization visit. Randomized by wound type and size, 164 patients with non‐infected DFUs and VLUs were included. The ITT population was composed of 161 patients (101 with VLUs, 60 with DFUs) and 115 patients completed follow‐up (64 in the s‐NPWT group and 51 in the t‐NPWT group) (PP population). The average age for all patients was 61.5 years, 36.6% were women, and treatment groups were statistically similar at baseline. Primary endpoint analyses on wound area reduction demonstrated statistically significant reduction in favor of s‐NPWT (p = 0.003) for the PP population and for the ITT population (p < 0.001). Changes in wound depth (p = 0.018) and volume (p = 0.013) were also better with s‐NPWT. Faster wound closure was observed with s‐NPWT (Cox Proportional Hazards ratio (0.493 (0.273, 0.891); p = 0.019) in the ITT population. Wound closure occurred in 45% of patients in the s‐NPWT group vs. 22.2% of patients in the t‐NPWT group (p = 0.002). Median estimate of the time to wound closure was 77 days for s‐NPWT. No estimate could be provided for t‐NPWT due to the low number of patients achieving wound closure. Device‐related AEs were more frequent in the t‐NPWT group (41 AEs from 29 patients) than in the s‐NPWT group (16 AEs from 12 patients). The s‐NPWT system met noninferiority and achieved statistical superiority vs. t‐NPWT in terms of wound progression toward healing over the treatment period. When NPWT is being considered for the management of challenging VLUs and DFUs, s‐NPWT should be considered a first choice over other types of NPWT.     

富血小板血浆治疗下肢缺血性难愈创面的临床观察

背景与目的 下肢缺血性难愈创面在经过积极腔内介入或开放手术重建肢体血运后,仍然存在住院周期长、治疗难度大、费用较高等,且创面愈合效果不佳。富血小板血浆（PRP）具有制备简单、来源丰富、相对安全无副作用等优势,可直接作用于创面并增强创面愈合进程,已广泛应用于难愈创面修复领域,但对于下肢缺血性难愈创面少有报道。本研究探讨PRP在下肢缺血性难愈合创面治疗中的临床疗效及安全性,以期为此类难愈性创面的临床治疗提供参考和借鉴。方法 在2021年1月—2022年12月北京医院血管外科、河南中医药大学第一附属医院周围血管科收治的下肢缺血性难愈创面患者中,选取患肢踝肱指数（ABI）>0.5~<0.9、创面床分期为红期（肉芽组织期）、创面面积>1~<20 cm²、无死腔或引流不畅的难愈性创面;抽取患者自体静脉血50 mL,采用密度梯度离心法二次离心,制备PRP及PRP凝胶。在戒烟、降脂、抗凝、抗血小板、改善循环、降压、降糖全身治疗基础上,创面清创后局部给予PRP创基直接注射和创面外用PRP凝胶联合治疗,隔7 d换药1次。观察14 d后创面面积（依据创面面积判定疗效）、肉芽评分、渗出量评分、创面深度评分,以及炎性指标［白细胞（WBC）、C-反应蛋白（CRP）水平、红细胞沉降率（ESR）水平］、疼痛评分与不良反应发生情况。结果 经PRP治疗14 d后,患者创面面积较治疗前明显缩小［（10.16±4.07）cm² vs.（5.11±3.38）cm²,P=0.000］,其中创面面积痊愈8例（12.7%）、显效25例（39.7%）、有效24例（38.1%）、无效6例（9.5%）,总有效率90.5%;创面局部深度、肉芽组织及渗出量量化评分均较治疗前明显改善（均P<0.05）。治疗后均未应用抗生素治疗,炎性指标WBC、CRP、ESR水平较前降低,患者自我疼痛评分较前减低（均P<0.05）;治疗过程中均未见明显不良反应。结论 PRP创基直接注射和创面局部外用凝胶的联合方法,可促进肉芽生长、上皮爬行,加快创面愈合过程,抑制创面炎症反应,降低患者疼痛感,用于治疗下肢缺血性难愈创面安全有效。     

Randomized clinical study to compare negative pressure wound therapy with simultaneous saline irrigation and traditional negative pressure wound therapy for complex foot infections

The aim of this study was to compare the efficacy of different negative pressure wound therapy (NPWT) devices and NPWT with and without simultaneous irrigation in patients admitted to hospital with moderate and severe foot infections. Ninety patients were randomized in a 12‐week prospective, randomized noninferiority trial to compare wound healing in patients with moderate and severe infected foot wounds treated with NPWT after surgery. Inclusion criteria included ABI > 0.5 or toe pressures >30 PVR/mmHg, >18 years of age and exclusion included active Charcot arthropathy, collagen vascular disease, HIV, and hypercoagulable state. We compared two different traditional devices, NPWT‐K (KCI, VAC Ulta) and NPWT‐C (Cardinal, PRO), and NPWT‐I with saline irrigation (Cardinal, PRO). All patients had therapy delivered at 125 mmHg continuous pressure. In patients who received simultaneous saline irrigation (NPWT‐I), the administration rate was 15 ml per hour. The primary outcome was the proportion of healed wounds in 12 weeks. Secondary outcomes included surgical wound closure, number of surgeries, length of stay, and time to wound healing. Continuous data was presented as mean ± standard deviation. Analysis of variance was used to compare continuous variables and chi‐square to compare dichotomous variables with an alpha of 0.05. There were no differences in outcomes among NPWT‐I, NPWT‐C, and NPWT‐K groups in proportion of healed wounds (63.3%, 50.0%, 46.7% p = 0.39), surgical wound closure (83.3%, 80.0%, 63.3%, p = 0.15), number of surgeries (2.0 ± 0.49, 2.4 ± 0.77, 2.4 ± 0.68, p = 0.06), length of stay (16.3 ± 15.7, 14.7 ± 7.4, 15.3 ± 10.5 days, p = 0.87), time to wound healing (46.2 ± 22.8, 40.9 ± 18.8, 45.9 ± 28.3 days, p = 0.78). We did not identify any significant differences in clinical outcomes or adverse events between patients treated with different NPWT devices or NPWT with and without irrigation.     

Impact of negative pressure wound treatment on incidence of surgical site infection in varied orthopedic surgeries: A systematic review and meta-analysis

Negative pressure wound therapy (NPWT) is a popular treatment to heal infected wounds. This meta-analysis aimed to determine if NPWT was more effective than conventional wound dressings for surgical site infections (SSI) in varied orthopaedic surgeries. Literature was retrieved from seven electronic databases (Medline, Web of Science, PubMed, Embase, Google Scholar, Cochrane Library, and CNKI). Randomised control trials (RCT) and retrospective cohort studies (RS) involving arthroplasty, fracture, and spinal surgery were extracted. SSI was our primary outcome, while total complications and length of hospital stay were secondary outcomes. We carried out the risk of bias assessment and meta-analysis using the Cochrane Risk of Bias 2.0 tool and Stata 17.0. Among the 798 studies retrieved, 18 of them met our inclusion criteria. We identified 13 RCTs and 5 RSs. The results of meta-analysis showed that the incidence of SSI in the NPWT group was significantly lower relative to the control group (OR = 0.60, 95% CI 0.47 to 0.77, P < 0.001). Subgroup analyses revealed that the incidences of SSI involving arthroplasty, fracture, and spinal surgery in the NPWT group accounted for 46%, 69%, and 37% relative to the control group, respectively. The incidence of SSI in RS (OR = 0.27, 95% CI 0.13 to 0.56) was significantly lower than that in RCT (OR = 0.69, 95% CI 0.54 to 0.90) (P = 0.02). Moreover, patients in the NPWT group had a lower total complication rate (OR = 0.51, 95% CI 0.34 to 0.76) and shorter hospital stays (SMD = −0.42, 95% CI −0.83 to −0.02), although high heterogeneity existed. NPWT may be an efficient alternative to help prevent the incidence of SSI and total complications as well as achieved shorten hospital stay in varied orthopaedic surgeries. The rational use of NPWT should be based on the presence of patients' clinical conditions and relevant risk factors.     

Evaluation of wound healing effects of micronized acellular dermal matrix in combination with negative pressure wound therapy: In vivo study

Acellular dermal matrix (ADM) grafts can provide coverage for full-thickness skin defects and substitute for dermal defects. We tested the effectiveness of micronized ADM (mADM) as a dressing material, combined with negative pressure wound therapy (NPWT), for managing superficial wounds. We compared the wound healing effect of mADM in combination with NPWT with those of gelatin and mADM applied with a foam dressing. These therapeutic materials were applied to 36 cm² excisional wounds in a porcine full-thickness skin defect model. Wound healing kinetics and new tissue formation were assessed 10 days after the initial treatment by measuring the wound area. Collagen deposition and neovascularization were histologically evaluated. Compared with the other two groups, mADM plus NPWT combination group had a significantly larger wound area at the baseline (P = .0040), but the smallest on the 7th day (P = .0093). In addition, collagen formation and neovascularization were more histologically promoted than in the other two groups. mADM showed better results than the gelatin group but less collagen and revascularization than the combination group, and there was no significant difference in wound area. Our results show that the combination of mADM and NPWT has a synergistic wound healing effect.     

Poly‐N‐acetyl glucosamine nanofibers for negative‐pressure wound therapies

The wound healing promoting effect of negative wound pressure therapies (NPWT) takes place at the wound interface. The use of bioactive substances at this site represents a major research area for the development of future NPWT therapies. To assess wound healing kinetics in pressure ulcers treated by NPWT with or without the use of a thin interface membrane consisting of poly‐N‐acetyl glucosamine nanofibers (sNAG) a prospective randomized clinical trial was performed. The safety of the combination of NPWT and sNAG was also assessed in patients treated with antiplatelet drugs. In the performed study, the combination of NPWT and sNAG in 10 patients compared to NPWT alone in 10 patients promoted wound healing due to an improved contraction of the wound margins (p = 0.05) without a change in wound epithelization. In 6 patients treated with antiplatelet drugs no increased wound bleeding was observed in patients treated by NPWT and sNAG. In conclusion, the application of thin membranes of sNAG nanofibers at the wound interface using NPWT was safe and augmented the action of NPWT leading to improved wound healing due to a stimulation of wound contraction.     

Deep Sternal Wound Infection and Mortality in Cardiac Surgery: A Meta-analysis

BackgroundDeep sternal wound infection (DSWI) is a rare but severe complication after cardiac surgical procedures and has been associated with increased early morbidity and mortality. Studies reporting long-term outcomes in patients with DSWI have shown contradictory results. We performed a study-level meta-analysis evaluating the impact of DSWI on short- and long-term clinical outcomes.MethodsA systematic literature search was conducted to identify studies comparing short- and long-term outcomes of patients submitted to cardiac surgical procedures who developed DSWI and patients who did not. The primary outcome was overall mortality. Secondary outcomes were in-hospital mortality, follow-up mortality, major adverse cardiovascular events, myocardial infarction, and repeat revascularization. Postoperative outcomes were also investigated.ResultsTwenty-four studies totaling 407 829 patients were included. Overall, 6437 (1.6%) patients developed DSWI. Mean follow-up was 3.5 years. DSWI was associated with higher overall mortality (incidence rate ratio [IRR], 1.99; 95% CI, 1.66-2.38; P < .001), in-hospital mortality (odds ratio, 3.30; 95% CI, 1.88-5.81; P < .001), follow-up mortality (IRR, 2.02; 95% CI, 1.39-2.94; P = .001), and major adverse cardiovascular events (IRR, 2.04; 95% CI, 1.60-2.59; P < .001). No differences in myocardial infarction and repeat revascularization were found, but limited studies reported those outcomes. DSWI was associated with longer postoperative hospitalization, stroke, myocardial infarction, and respiratory and renal failure. Sensitivity analyses on isolated coronary artery bypass grafting studies and by adjustment method were consistent with the main analysis.ConclusionsCompared with patients who did not develop DSWI, patients with DSWI after cardiac surgical procedures had increased risk of death as well as short- and long-term adverse clinical outcomes.     

A systemic review and a meta-analysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings

We performed a meta-analysis to evaluate the influences of closed incisions in orthopaedic trauma surgery (OTS) by negative pressure wound treatment (NPWT) compared with conventional dressings. A systematic literature search up to March 2022 was done and 14 studies included 3935 subjects with OTS at the start of the study; 2023 of them used NPWT and 1912 were conventional dressings. They were reporting relationships between the influences of closed incisions in OTS by NPWT compared with conventional dressings. We calculated the odds ratio (OR) with 95% confidence intervals (CIs) to assess the influences of closed incisions in OTS by NPWT compared with conventional dressings using the dichotomous methods with a random or fixed-effect model. NPWT had significantly lower deep surgical site infections (SSIs) (OR, 0.65; 95% CI, 0.48-0.87, P = .004), superficial SSIs (OR, 0.34; 95% CI, 0.19-0.61, P < .001), and wound dehiscence (OR, 0.41; 95% CI, 0.21-0.80, P = .009) compared with conventional dressings in subjects with closed incisions in OTS. NPWT showed a beneficial effect on deep SSIs, superficial SSIs, and wound dehiscence compared with conventional dressings in subjects with closed incisions in OTS. Further studies are required to validate these findings.