NEGATIVE PRESSURE WOUND THERAPY IN WARTIME WOUNDS - CASE SERIES AND REVIEW OF THE LITERATURE

Abstract

Introduction: For a long time, the military doctrine inarguably stated that wartime wounds must be managed by debridement, lavage, saline-soaked dressing and healing by secondary intention. However, the new reality of the changed warfare and medical support doctrine (improved prehospital care, higher rate of survivors with extensive soft tissue loss, faster evacuation) forced the change of this paradigm and led to the rapid implementation of NPWT in the treatment of the complex combat wounds. Despite the large body of literature dealing with various aspects of the NPWT, there are few series reporting its use in wartime wounds. The aim of the present study is to report a part of our experience and to perform state-of-art review of the available literature. Material and methods: A total three well documented cases managed by our team are presented – two with blast trauma and one with gunshot injury. Literature search in PUBMED using the following key words –combat/warfare wound/injuires. Additionally, a manual search was performed through cross-reference. All reports concerning NPWT of combat wounds of extremities and soft tissue except for case reports were included. The following variables were analysed: mechanism of injury (blast/gunshot), number of the patients and wounds, number of dressing changes, average time to and type of closure, amputation rate, wound and flap complication rates. Results: A total of 1038 papers was found through PUBMED and additional manual search using cross-references. Of them, 17 titles were considered eligible. Two case reports and four reviews were excluded, whereas ten case series and one comparative study were included in the analysis. Conclusion: Currently, NPWT plays an important role in the treatment of the combat wounds, but no evidence based recommendations could be made at this stage. Based on the available literature, it is diffucult to conclude that NPWT diminishes the rate of wound infection and amputation rate due to the low quality of the studies and the multifactorial determination of these variables. Nevertheless, except for the well-known benefits such as evacuation of fluids, stimulation of granulation tissue and preparation for definitive closure, in combat setting NPWT offers several important advantages over the conventional dressings – the reduced need for dressing changes saves the precious and limited wartime resources such as manpower and time, provides safer evacuation with significantly improved patient’s and medical crew’s comfort.