Abstract
PurposeInfectious complications following lower extremity fracture surgery are a major concern and account for a substantial socio-economic burden to society. The aim of this pilot study was to investigate the feasibility of a new portable single-use negative pressure wound therapy device in patients undergoing major foot ankle surgery.MethodsPatients undergoing major foot ankle fracture surgery at a single level 1 trauma centre were eligible for this prospective case series. Patient characteristics were collected, as were fracture and surgical characteristics. Primary outcome was surgical site infection within 30 days as classified by the criteria from the Centers for Disease Control and Prevention. Patients in the prospective cohort were case-matched with a historical cohort from the same institution.ResultsSixty patients were included. In seven patients, the NPWT failed and treatment was ceased. Mean age was 44 years and 85% was ASA 1; 43% of the patients were actively smoking. Indications for surgery were midfoot, calcaneal, talar, and ankle fractures. In 53 patients, four (7.5%) surgical site infections occurred, two superficial (3.3%) and two (3.3%) deep infections. For 47 patients, a match was available. The incidence of surgical site infection did not statistically significantly differ between the prospective cohort and retrospective matched cohort (4.3 versus 14.9%, p = 0.29, respectively). This was also the case when looking at superficial and deep surgical site infections separately (0 versus 8.5%, p = 0.08, and 4.3 versus 6.4%, respectively).ConclusionWe have observed surgical site infections in 7.5% of the patients with the use of prophylactic negative pressure wound therapy. The incidence of surgical site infections was not statistically significantly lower compared to a matched historical cohort.
Highlights
Infectious complications following orthopaedic lower extremity surgery are a major concern
As only one prospective study on prophylactic negative pressure wound therapy in patients undergoing major lower extremity fracture surgery is available, evidence on its beneficial effect is limited and it is uncertain whether the extra expenses of the NPWT device are justified [11]
Twentyeight patients were excluded due to incision location not suitable for negative pressure wound therapy device (n = 6), active infection or open fracture (n = 5), immune deficiencies (n = 4), insufficient comprehension of Dutch language (n = 1), inability to adhere to treatment (n = 5), missed inclusion (n = 6), or declined participation (n = 1) (Fig. 1)
Summary
Infectious complications following orthopaedic (trauma) lower extremity surgery are a major concern. An incidence of almost 19% surgical site infections (SSI) following high risk lower extremity fracture surgery was observed [1]. These SSIs are a major burden to the patient and are responsible for a significant increase in (hospitalrelated) costs. As only one prospective study on prophylactic negative pressure wound therapy in patients undergoing major lower extremity fracture surgery is available, evidence on its beneficial effect is limited and it is uncertain whether the extra expenses of the NPWT device are justified [11]. It is unknown whether the good results observed with regular NPWT devices are equaled by these newly developed devices
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