Abstract
Introduction:The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT.Materials and Methods:The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT.Results:We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations.Conclusion:Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.
Highlights
The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics
Negative Pressure Wound Therapy (NPWT) which is more commonly known as vacuum assisted closure (VAC) helps to combat this situations as it decreases the frequency of dressing change and days of hospitalisation
In case of previously infected wounds, sterile cultures were obtained in 72% (21/29) of patients using indigenous NPWT, 79% (15/19) of patients using conventional NPWT and 85% (6/7) of patients using indigenous NPWT with Topical Pressurised Oxygen Therapy (TPOT) group after completion of therapy
Summary
The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Conclusion: Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It decreases the dependency on plastic surgeons for management of such wounds. The different effects of NPWT as described by various studies are reduction in wound size[2,3,4], stimulation of granulation tissue[2], removal of small tissue debris, decreased protease content, and removal of exudate It reduces the interstitial edema[2,3,5] thereby increasing microcirculation, local blood flow and oxygenation[5]. NPWT which is more commonly known as vacuum assisted closure (VAC) helps to combat this situations as it decreases the frequency of dressing change and days of hospitalisation
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