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Injury. 2019 Apr 22. pii: S0020-1383(19)30249-9. doi: 10.1016/j.injury.2019.04.018. [Epub ahead of print]

Negative pressure wound therapy vs. conventional management in open tibia fractures: Systematic review and meta-analysis.

Author information

1
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: junojuno49@gmail.com.
2
Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: eoak22@empal.com.

Abstract

BACKGROUND:

Severe open tibia fractures are disastrous injuries associated with a high incidence of complications. Negative pressure wound therapy (NPWT) is a novel treatment for open tibia fractures; however, its efficacy remains unclear. This is a systematic review and meta-analysis performed to evaluate the effect of NPWT on decreasing the infection rate, amputation rate, nonunion rate, and flap-related complications in open tibia fractures.

METHODS:

The MEDLINE, EMBASE, and Cochrane Library databases were systematically searched. Complications were evaluated in terms of the rates of infection, amputation, nonunion, and flap-related complications.

RESULTS:

Twelve studies were included. In the meta-analysis, NPWT showed significantly lower soft-tissue infection rate (odds ratio [OR] 0.48, 95% confidence interval [CI] 0.34-0.68, P < 0.0001), nonunion rate (OR 0.61, 95% CI 0.39-0.95, P = 0.03), flap necrosis rate (OR 0.37, 95% CI 0.21-0.63, P = 0.0003), and flap revision rate (OR 0.44, 95% CI 0.22-0.89, P = 0.02) than conventional wound management. However, no significant difference was found in osteomyelitis rate (OR 0.54, 95% CI 0.09-3.28, P = 0.50) and amputation rate (OR 0.89, 95% CI 0.36-2.22, P = 0.80) between the 2 groups.

CONCLUSION:

Lower rates of soft-tissue infection, nonunion, flap necrosis, and flap revision were observed in the NPWT group than in the conventional dressing group. However, additional high-quality studies are warranted to verify the efficacy of NPWT in the treatment of severe open tibia fractures. We could not make a definitive conclusion about the comparative efficacy of the 2 methods in terms of complications because of insufficient data.

KEYWORDS:

Conventional wound management; Meta-analysis; Negative pressure wound therapy; Open tibia fractures; Systematic review

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