Effectiveness of Negative Pressure Wound Therapy in Patients With Challenging Wounds: A Systematic Review and Meta-analysis (original) (raw)
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Effectiveness of negative pressure wound therapy is still unproven
Journal of wound care, 2011
Both experimental and epidemiological study designs, including randomized controlled trials, pseudo-randomized trials, quasi-experimental studies, before and after studies, prospective and retrospective cohort studies, case control studies, and analytical cross sectional studies were sought. Types of outcomes The primary outcome was the occurrence of post-surgical wound infection or dehiscence as measured by the following: surgical site infectionssuperficial and deep; surgical wound dehiscence; wound pain; wound seroma; wound hematoma. Search strategy Published and unpublished studies in English from 1990 to 2013 were identified by searching a variety of electronic databases. Reference lists of all papers selected for retrieval were then searched for additional studies. Methodological quality Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. Data collection Data were extracted from the included papers using a standardized data extraction tool from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. In addition to study results, the data extracted included details of the study population, setting, intervention and author's conclusion. Data synthesis Where appropriate, data were pooled using Comprehensive Meta-Analysis software. Metaanalyses were performed for three outcomes. In cases of heterogeneity between studies a narrative summary of results was undertaken. Results Eight studies were included in the review. Meta-analyses revealed a statistically significant difference in favor of the use of negative pressure wound therapy as compared to standard surgical dressings was found for surgical site infections. Conflicting results were found for wound dehiscence and seroma. Conclusions Given the small number of studies, mostly retrospective comparative cohort in design, no definitive conclusions can be reached as to the effectiveness of the use of negative pressure wound therapy in the prevention of surgical wound complications. However, there was a demonstrated association between the use of negative pressure wound therapy and reduction in surgical site infection.
Meta-analysis of negative-pressure wound therapy for closed surgical incisions
British Journal of Surgery, 2016
Background Postoperative wound complications are common following surgical procedures. Negative-pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions. Methods This was a systematic review and meta-analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions. Results Ten studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma)...
Journal of the American College of Surgeons, 2017
A new proprietary negative pressure wound device has been developed to apply negative pressure therapy to closed wounds (closed-NPWT). We postulated that closed-NPWT management of contaminated and dirty wounds would lead to faster wound healing and no significant difference in wound complications. An IRB approved, prospective randomized trial was performed. Patients were consented preoperatively, but not entered nor assigned treatment until intraoperative findings were known. Patients were randomly assigned to either open-NPWT or a wound closed with skin staples and external closed-NPWT. Primary outcome was time to complete wound healing, defined as complete epithelization of the wound. Secondary outcomes were wound complications including wound infection, seroma, and dehiscence. Statistical analysis was performed using chi-square test, Fisher exact test, t-test, and Wilcoxon Rank-Sum test with significance of p < 0.05. Twenty-five closed-NPWT and 24 open-NPWT patients were analy...
Negative pressure wound therapy - a descriptive study
Ostomy/wound management, 2011
To address a persistent lack of evidence regarding the clinical outcomes of negative pressure wound therapy (NPWT) and identify which patient groups are most likely to benefit from NPWT, a retrospective, descriptive study was conducted to describe outcomes of this treatment modality when used in clinical practice. Charts from a consecutive series of 87 patients (median age 68 years, range 16 - 92 years) who received NPWT during a period of 24 months were abstracted to a statistical software file. Patient demographics, history, and comorbidity variables as well as treatment outcomes were obtained from the computerized in- and outpatient record system. Treatment outcomes were grouped as successful (goal of care was met) or not successful (goal of care was not met). Successful treatment was noted for a total of 62 patients (71%) with a median treatment time of 17 days. The proportion of patients with a successful outcome was significantly higher in patients with infect...
Wounds: a compendium of clinical research and practice
The aim of this retrospective study was to identify risk factors related to unsuccessful treatment and complications with negative pressure wound therapy (NPWT). Methods. A consecutive series of patients treated with NPWT for wounds of various etiologies (n = 87) from 2005-2007 at a general hospital in a large city (Stockholm, Sweden) were assessed for risk for unsuccessful treatment and complications associated with NPWT. Results. Twenty-nine percent of the patients treated with NPWT had unsuccessful treatment results. The strongest risk factors associated with unsuccessful treatment were pressure ulcers (OR 4.6) or a positive culture for Staphylococci (OR 3.4). The complication rate was 21%, of which 14 patients had to terminate treatment. A positive culture for either Staphylococci or Pseudomonas was strongly associated (P = 0.001) with risk of complications during NPWT treatment. Patients with insufficient peripheral circulation in the extremities had a risk of both unsuccessful treatment and complications. Conclusion. The findings of the present study stress the importance of evaluating bacterial cultures and adequate antibiotic therapy when infection is suspected. The status of the patient's peripheral macrocirculation in the lower extremities seems to have a significant impact on the risk of unsuccessful treatment or complications. Therefore, is it of great importance to evaluate peripheral circulation status before initializing NPWT. WOUNDS 2012;24(6):168-177 From the
Efficacy of Negative Pressure Therapy (NPWT) in the Management of Wounds of Different Etiologies
Revista de Chimie, 2018
The objective was to assess the role of negative pressure wound therapy (NPWT) in the management of wounds of various etiologies, infected or not, acute or chronic. The study was conducted in a group of 37 patients (24 men and 13 women) aged 26 to 86 years with acute or chronic wounds, posttraumatic or due to chronic diseases located on the lower limbs or following oncological abdominal surgery. In all cases a Vacuum Assisted Closure (VAC) system was continuously applied using a subatmospheric pressure ranging from 90 to 120 mmHg. Beside sex, age and etiology of soft tissue defect the following parameters were studied: surgical treatment performed prior to NPWT application, frequency of dressing changes, duration of NPWT, level of subatmospheric pressure used in each case, number of hospital days, complications arising from NPWT use. The outcome was favorable in all cases without such complications as infection or bleeding, a perilesional erythema (contact dermatitis caused by the u...
The use of negative pressure wound therapy in the treatment of infected wounds. Case studies
Objective: To evaluate the results and benefits obtained from the topical use of negative pressure wound therapy (NPWT) in patients with infected wounds. Methods: This was a retrospective study of 20 patients (17 males and three females, mean age 42 years) with infected wounds treated using NPWT. The infected wounds were caused by trauma. The treatment system used was VAC. ® (Vacuum Assisted Closure, KCI, San Antonio, United States) applied to the wound in continuous mode from 100 to 125 mmHg. The parameters related to the wounds (location, number of VAC changes, the size of the defects in the soft parts, and the evolution of the state of the wound), length of hospital stay, length of intravenous antibiotic therapy, and complications related to the use of this therapy were evaluated. Results: The mean length of the hospital stay, use of NPWT, and antibacterial therapy were 41 days, 22.5 days, and 20 days respectively. The use of the VAC led to a mean reduction of 29% in the wound area (95.65-68.1 cm 2 ; p < 0.05). Only one patient did not show any improvement in the final appearance of the wound with complete eradication of the infection. No complication directly caused by NPWT was observed. Conclusion: NPWT stimulates infection-free scar tissue formation in a short time, and is a quick and comfortable alternative to conventional infected wounds treatment methods.
Negative pressure wound therapy: eleven-year experience at a tertiary care hospital
International Journal of Research in Medical Sciences, 2017
Background: Management of complicated wounds is a reconstructive challenge. A reconstructive surgeon has to be ready to face new challenges every day. Negative pressure wound therapy has revolutionized the management of complex wounds. We are presenting our experience with this wound care modality in the past 11 years.Methods: It was a prospective study conducted from January 2006 to December 2016 on patients having wounds of varied etiologies, who consented to participate in this study. Custom made low cost NPWT was used till definitive wound closure.Results: A total of 568 patients consented to participate in the study during these 11 years. No major complications were seen. Most of these were males (60.73%) in their 3rd and 4th decade. Trauma was the leading cause of wounds in 38.14%, followed by diabetic foot wounds in 21.5%. Ankle and foot was the most common site of wounds (30.92%) followed by leg (24.01%). A total of 322 small, 218 medium and 97 large size dressings were used...
Negative Pressure Wound Therapy
Archives of Surgery, 2008
To systematically examine the clinical effectiveness and safety of negative pressure wound therapy (NPWT) compared with conventional wound therapy. MEDLINE, EMBASE, CINAHL, and the Cochrane Library were searched. Manufacturers were contacted, and trial registries were screened. Randomized controlled trials (RCTs) and non-RCTs comparing NPWT and conventional therapy for acute or chronic wounds were included in this review. The main outcomes of interest were wound-healing variables. After screening 255 full-text articles, 17 studies remained. In addition, 19 unpublished trials were found, of which 5 had been prematurely terminated. Two reviewers independently extracted data and assessed methodologic quality in a standardized manner. Seven RCTs (n = 324) and 10 non-RCTs (n = 278) met the inclusion criteria. The overall methodologic quality of the trials was poor. Significant differences in favor of NPWT for time to wound closure or incidence of wound closure were shown in 2 of 5 RCTs and 2 of 4 non-RCTs. A meta-analysis of changes in wound size that included 4 RCTs and 2 non-RCTs favored NPWT (standardized mean difference: RCTs, -0.57; non-RCTs, -1.30). Although there is some indication that NPWT may improve wound healing, the body of evidence available is insufficient to clearly prove an additional clinical benefit of NPWT. The large number of prematurely terminated and unpublished trials is reason for concern.