Abstract: The Efficacy of Negative Pressure Wound Therapy and Antibiotic Beads as Infection Prophylaxis in Post-Traumatic Lower Extremity Salvage

Abstract

INTRODUCTION: This study compares outcomes in trauma patients receiving negative pressure wound therapy (NPWT), antibiotic beads, or both treatments prior to soft tissue reconstruction of the lower extremity. METHODS: This is retrospective review of patients requiring soft tissue reconstruction following traumatic lower extremity open fractures in an urban Level 1 trauma center between August 2007 and March 2015. Patients with infection prior to NPWT and/or antibiotic bead application were excluded. RESULTS: In 72 trauma patients with 73 extremities having open fractures and subsequent lower limb vascularized soft tissue reconstruction, 26 received only NPWT, 24 only antibiotic beads, 2 neither treatment and 23 both treatments. There was no significant difference in time from injury to definitive soft tissue coverage, time from injury to NPWT/bead placement, or length of NPWT/beads use between groups. Infection rate was 26.9% with NPWT only, 0.0% with antibiotic beads only, 50.0% with neither treatment, and 8.7% with antibiotic beads and NPWT in combination. Patients receiving antibiotic beads alone were significantly less likely to develop an infection or complication as those receiving NPWT alone (p<0.01, p<0.01) or combined NPWT/beads (p<0.01, p<0.01). Development of infection was associated with longer periods from initiation of NPWT use to definitive soft tissue coverage (p<0.01); this finding was independent of time from injury to soft tissue coverage but correlated with number of operations. Limb salvage rate was 95.9% and 50.0% of patient could ambulate without an assistance device 3 or more months out of surgery. CONCLUSION: Antibiotic beads may be more effective than negative pressure wound therapy in preventing infections in patients awaiting soft tissue coverage of wounds. Utilizing these treatments together does not improve infection rates. Limb salvage was successful in most cases regardless of treatment.