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Lygrisse KA, Teo G, Singh V, Muthusamy N, Schwarzkopf R, William L. Comparison of silver-embedded occlusive dressings and negative pressure wound therapy following total joint arthroplasty in high BMI patients: a randomized controlled trial. Arch Orthop Trauma Surg 2022; 143:2989-2995. [PMID: 35779102 DOI: 10.1007/s00402-022-04530-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 06/16/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION High body mass index (BMI) and wound drainage following total joint arthroplasty (TJA) can lead to wound healing complications and periprosthetic joint infection. Silver-embedded occlusive dressings and negative pressure wound therapy (NPWT) have been shown to reduce these complications. The purpose of this prospective trial was to compare the effect of silver-embedded dressings and NPWT on wound complications in patients with BMI ≥ 35 m/kg2 undergoing TJA. METHODS We conducted a randomized control trial of patients who had a BMI > 35 m/kg2 and were undergoing primary TJA between October 2017 and February 2020. Patients who underwent revision surgery, or those with an active infection, previous scar, history of wound healing complications, post-traumatic degenerative joint disease with hardware, or inflammatory arthritis were excluded. Patients were randomized to receive either a silver-embedded occlusive dressing (control) or NPWT. Frequency distributions, means, and standard deviations were used to describe patient demographics, postoperative complications, 90-day readmissions, and reoperations. T-test and chi-squared tests were used to test for significant differences between continuous and categorical variables, respectively. RESULTS Two hundred-thirty patients with 3-month follow-up were included. One-hundred-fifteen patients received the control and 115 patients received NPWT. There were six patients (5.2%) in the control group with wound complications (drainage: n = 5, non-healing wound: n = 1) and two patients (1.7%) in the NPWT with complications (drainage: n = 2). There were no 90-day readmissions in the control group versus two (1.8%) 90-day readmissions in the NPWT group. Finally, three patients (2.6%) in the control group underwent reoperations (irrigation and debridement [I&D], I&D with modular implant exchange, and implant revision), while none in the NPWT group had undergone reoperation. The two groups showed insignificant differences in wound complications (p = 0.28), 90-day readmissions (p = 0.50), and reoperations (p = 0.25). CONCLUSION Patients with BMI ≥ 35 m/kg2 undergoing TJA have no statistical difference in early wound complications, readmissions, or reoperations when treated with either silver-embedded dressings or NPWT.
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Affiliation(s)
- Katherine A Lygrisse
- Department of Orthopedic Surgery, Huntington Hospital, Zucker School of Medicine Hofstra/Northwell, 270 Park Ave, Huntington, NY, 11743, USA
| | - Greg Teo
- Department of Orthopedic Surgery, Hospital for Special Surgeries, 541 East 71st St, 7th Fl, New York, NY, 10021, USA
| | - Vivek Singh
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Nishanth Muthusamy
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA.
- Department of Orthopedic Surgery, Division of Adult Reconstructive Surgery, NYU Langone Health, 301, East 17th Street, New York, NY, 10003, USA.
| | - Ran Schwarzkopf
- Department of Orthopedic Surgery, NYU Langone Health, 301 East 17th Street, 15th Fl Suite 1518, New York, NY, 10003, USA
| | - Long William
- Department of Orthopedic Surgery, Hospital for Special Surgeries, 541 East 71st St, 7th Fl, New York, NY, 10021, USA
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Elhage KG, Awad ME, Irfan FB, Lumbley J, Mostafa G, Saleh KJ. Closed-incision negative pressure therapy at -125 mmHg significantly reduces surgical site complications following total hip and knee arthroplasties: A stratified meta-analysis of randomized controlled trials. Health Sci Rep 2022; 5:e425. [PMID: 35229037 PMCID: PMC8865069 DOI: 10.1002/hsr2.425] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/29/2021] [Accepted: 09/30/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Closed-incision negative pressure wound therapy (ciNPT) has shown promising effects for managing infected wounds. This meta-analysis explores the current state of knowledge on ciNPT in orthopedics and addresses whether ciNPT at -125 mmHg or -80 mmHg or conventional dressing reduces the incidence of surgical site complications in hip and knee arthroplasty. METHODS This meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines and Cochrane Handbook. Prospective randomized controlled trials (RCTs) with ciNPT use compared to conventional dressings following hip and knee surgeries were considered for inclusion. Non-stratified and stratified meta-analyses of six RCTs were conducted to test for confounding and biases. A P value less than .05 was considered statistically significant. RESULTS The included six RCTs have 611 patients. Total hip and knee arthroplasties were performed for 51.7% and 48.2% of the included population, respectively. Of 611 patients, conventional dressings were applied in 315 patients and 296 patients received ciNPT. Two ciNPT systems have been used across the six RCTs; PREVENA Incision Management System (-125 mmHg) (63.1%) and PICO dressing (-80 mmHg) (36.8%). The non-stratified analysis showed that the ciNPT system had a statistically significant, lower risk of persistent wound drainage as compared to conventional dressing following total hip and knee arthroplasties (OR = 0.28; P = .002). There was no difference between ciNPT and conventional dressings in terms of wound hematoma, blistering, seroma, and dehiscence. The stratified meta-analysis indicated that patients undergoing treatment with high-pressure ciNPT (120 mmHg) displayed significantly fewer overall complications and persistent wound drainage (P = .00001 and P = .002, respectively) when compared to low-pressure ciNPT (80 mmHg) and conventional dressings. In addition, ciNPT is associated with shorter hospital stays. (P = .005). CONCLUSION When compared to conventional wound dressing and -80 mmHg ciNPT, the use of -125 mmHg ciNPT is recommended in patients undergoing total joint arthroplasty.
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Affiliation(s)
- Kareem G. Elhage
- FAJR ScientificNorthvilleMichigan48167USA
- Wayne State University, School of MedicineDetroitMichiganUSA
| | - Mohamed E. Awad
- FAJR ScientificNorthvilleMichigan48167USA
- NorthStar Anesthesia‐Detroit Medical centerDetroitMichiganUSA
- Michigan State University, College of Osteopathic MedicineDetroitMichiganUSA
| | - Furqan B. Irfan
- Michigan State University, College of Osteopathic MedicineDetroitMichiganUSA
| | - Joshua Lumbley
- NorthStar Anesthesia‐Detroit Medical centerDetroitMichiganUSA
| | - Gamal Mostafa
- Wayne State University, School of MedicineDetroitMichiganUSA
- Surgical Outcomes Research Institute, John D. Dingell VA Medical CenterDetroitMichiganUSA
| | - Khaled J. Saleh
- FAJR ScientificNorthvilleMichigan48167USA
- Michigan State University, College of Osteopathic MedicineDetroitMichiganUSA
- Surgical Outcomes Research Institute, John D. Dingell VA Medical CenterDetroitMichiganUSA
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Silverman RP, Apostolides J, Chatterjee A, Dardano AN, Fearmonti RM, Gabriel A, Grant RT, Johnson ON, Koneru S, Kuang AA, Moreira AA, Sigalove SR. The use of closed incision negative pressure therapy for incision and surrounding soft tissue management: Expert panel consensus recommendations. Int Wound J 2021; 19:643-655. [PMID: 34382335 PMCID: PMC8874075 DOI: 10.1111/iwj.13662] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/04/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
As the use of closed incision negative pressure therapy (ciNPT) becomes more widespread, dressing designs have evolved to address implementation challenges and meet surgeon demand. While traditional application of ciNPT was limited to the immediate suture line, a novel dressing that covers the incision and additional surrounding tissues has become available. To expand upon previous ciNPT recommendations and provide guidance on this new dressing, an expert panel of plastic surgeons convened to review the current literature, identify challenges to the implementation and sustainability of ciNPT, and use a modified Delphi technique to form a consensus on the appropriate use of ciNPT with full‐coverage dressings. After three rounds of collecting expert opinion via the Delphi method, consensus was reached if 80% of the panel agreed upon a statement. This manuscript establishes 10 consensus statements regarding when ciNPT with full‐coverage foam dressings should be considered or recommended in the presence of patient or incision risk factors, effective therapeutic settings and duration, precautions for use, and tools and techniques to support application. The panel also discussed areas of interest for future study of ciNPT with full‐coverage dressings. High‐quality, controlled studies are needed to expand the understanding of the benefits of ciNPT over the incision and surrounding tissues.
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Affiliation(s)
- Ronald P Silverman
- Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, USA.,3M Company, St. Paul, Minnesota, USA
| | - John Apostolides
- Defy Plastic & Reconstructive Surgery, San Diego, California, USA
| | | | - Anthony N Dardano
- Department of Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, Florida, USA
| | | | | | - Robert T Grant
- Division of Plastic and Reconstructive Surgery, New York-Presbyterian Hospital-Columbia and Weill Cornell, New York, New York, USA
| | | | - Suresh Koneru
- Advanced Concepts in Plastic Surgery, San Antonio, Texas, USA
| | | | - Andrea A Moreira
- Department of Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA
| | - Steven R Sigalove
- Scottsdale Center for Plastic Surgery, Paradise Valley, Arizona, USA
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Yaghmour KM, Hossain FS, Konan S. Clinical and Health-Care Cost Analysis of Negative Pressure Dressing in Primary and RevisionTotal Knee Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2020; Publish Ahead of Print:541-548. [PMID: 33369987 DOI: 10.2106/jbjs.20.01254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) has been used because of its perceived advantages in reducing surgical site infections, wound complications, and the need for further surgery. The purpose of this study was to assess the infection rates, wound complications, length of stay, and financial burden associated with NPWT use in primary and revision total knee arthroplasty (TKA). METHODS We performed a PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) systematic review of the existing literature on using NPWT in primary and revision TKA. PubMed, Embase, Science Direct, and the Cochrane Library were utilized. The risk of bias was evaluated using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool, and the quality of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria. RESULTS Twelve articles that evaluated 1,403 primary TKAs and 279 revision TKAs were reviewed. NPWT significantly reduced complication rates in revision TKA. However, there was no significant difference in infection rates between NPWT and regular dressings in primary or revision TKA. NPWT use in primary TKA significantly increased the risk of blistering, although no increase in reoperations was noted. The analysis showed a possible reduction in length of stay associated with NPWT use for both primary and revision TKA, with overall health-care cost savings. CONCLUSIONS Based on a meta-analysis of the existing literature, we do not recommend the routine use of NPWT. However, in high-risk revision TKA and selected primary TKA cases, NPWT reduced wound complications and may have health-care cost savings. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Khaled M Yaghmour
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | - Sujith Konan
- Department of Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, United Kingdom
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