Research progress on negative pressure wound therapy with instillation in the treatment of orthopaedic wounds

Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting

Significance: Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. Recent Advances: Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. Critical Issues: The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. Future Directions: The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.

Negative Pressure Wound Therapy for Chronic Wounds

ABSTRACT

Chronic wounds, including those caused by venous and arterial insufficiency, diabetic complications, and pressure-induced ulcers, pose significant treatment challenges. Negative pressure wound therapy has been increasingly used for managing these wounds. This treatment aims to promote wound healing, prepare the wound bed for further surgical intervention, minimize the risk of infection, and potentially shorten the time to wound healing. Considering variances in techniques applied in different regions globally, there is an emerging need to comprehensively evaluate the effectiveness of negative pressure wound therapy on chronic wounds. Unfortunately, detailed descriptions of the techniques applied to achieve negative pressure are often lacking in existing literature abstracts, posing challenges for direct comparisons. This review aims to analyze the application of negative pressure wound therapy in the treatment of chronic wounds, summarize its advantages and disadvantages, and further explore the potential value and future research direction of negative pressure wound therapy in the repair of chronic wounds.

Evolving Role of Negative Pressure Wound Therapy with Instillation and Dwell Time (NPWTi-d-) in Management of Trauma and Orthopaedic Wounds: Mechanism, Applications and Future Perspectives

Introduction

Negative Pressure Wound Therapy (NPWT) is a well-established method to promote wound healing by delivering negative pressure (a vacuum) at the wound site. Enhancement of NPWT techniques may allow an innovative way of treating trauma and orthopaedic wounds which provide unique challenges. We explore the role of negative pressure wound therapy with instillation and dwell time (NPWTi-d-) in the management of trauma and orthopaedic wounds.

Materials and Methods

A comprehensive search strategy was conducted using databases of PubMed, Web of Science, Google Scholar, and Cochrane Library with the search words of 'NPWTid' or 'NPWTi-d-' or 'NPWT with instillation' or 'Negative pressure wound treatment with instillation' to generate this narrative review. The mechanism of action of NPWTi-d-, installation solutions and current applications in the trauma and orthopaedic wounds is evaluated.

Results

NPWTi-d- provides additional mechanism to promote wound healing in a spectrum of acute and chronic orthopaedic wounds. The technique allows local delivery of hydration and elution of antibiotics to support growth of healthy granulation tissue. Various mechanism of actions contribute in drawing the wound edges together, reduce oedema, help decontamination, deliver local antibiotic and promote healing.

Conclusion

NPWTi-d- permits an enhanced, supplementary technique to encourage wound healing in challenging traumatic and orthopaedic wounds. Future applications of NPWTi-d- will depend on cost-effectiveness analysis and development of its application guidelines based on longitudinal, randomized controlled research trials.

Effectiveness of negative pressure wound therapy: Minimum five-year follow-up and review of the literature

OBJECTIVES

In this study, we aimed to assess the effectiveness of negative pressure wound therapy (NPWT) in a five-year patient cohort and to discuss the results in the light of literature data.

PATIENTS AND METHODS

Between January 2012 and December 2016, a total of 74 patients (35 males, 39 females; median age: 60 years; range, 20 to 95 years) who received NPWT were retrospectively analyzed. The patients included 49 orthopedic and traumatology, 12 vascular surgery, and 13 general surgery patients. The efficacy of wound healing, bacterial load, and the impact of comorbidities on wound healing were examined.

RESULTS

The distribution of wound types varied very widely. Certain comorbidities affected wound healing. In orthopedic traumatology patients, we observed mainly skin flora infection (57.14%), while in surgical and vascular patients, mixed flora (80%) and in many cases poly-resistant pathogens were present (methicillin-resistant Staphylococcus aureus 24%) A total of 43.3% of wounds were completely closed, while 44.6% of patients had a wound healing. Successful skin grafting was performed in 75% of wounds.

CONCLUSION

This technique may be used as widely and as early as possible. However, further large-scale, multi-center, randomized clinical trials are needed worldwide to find a place for this technique in wound care and even in primary care.