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- Talk
- 15/09/2021
- Canada
The Use of Negative Pressure Wound Therapy in Patients with Open Fractures
Description
In this presentation, Yousif Atwan discusses a subset of research from the FLOW Investigators regarding the utilization of negative pressure wound therapy (NPWT) in patients with severe open fractures. Atwan begins by outlining the high complication rates associated with open fractures, specifically highlighting the prevalence of infection, which can affect up to 27% of lower extremity cases, leading to significant health care costs and decreased quality of life.
The presentation explains that after standard management, wounds are typically covered to minimize contamination, and NPWT is identified as a promising dressing option, known for its ability to reduce bacterial load and promote healing. Atwan references initial clinical trials that provide mixed results, prompting further research to compare outcomes of NPWT to standard dressings.
The methodology involves analyzing data from the FLOW database, focusing on patients with Gustilo type 2 and 3 injuries, excluding those with pre-existing infections. The study employs a propensity score method to match treatment groups while balancing various factors that could impact outcomes. The primary outcome measure is the rate of re-operation due to infection within 12 months.
Results reveal that patients treated with NPWT had higher re-operation rates due to infection (18.8% vs. 6.3% in standard dressing). Sensitivity analyses confirm that even after excluding the most severe cases and comprehensive infection scenarios, the odds of requiring re-operation remained significantly higher for those in the NPWT group.
While assessing the health-related quality of life outcomes, NPWT patients showed decreased physical component scores post-treatment, though their mental component scores improved. However, these changes were not clinically meaningful.
Atwan concludes by emphasizing the findings suggest NPWT may not offer the advantages previously anticipated for severe open fractures, and in some cases, may be linked to an increased risk of infection. The need for additional research is underscored, and gratitude is extended to the FLOW Investigators and affiliates for their contributions.