Abstract
Introduction Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management. Currently, negative-pressure wound therapy (NPWT) is often used as temporary coverage for traumatic and surgical wounds, also in cases of FRI. However, controversy exists about the impact of NPWT on the outcome in FRI, specifically on infection recurrence. Therefore, this systematic review qualitatively assesses the literature on the role of NPWT in the management of FRI. Methods A literature search of the PubMed, Embase, and Web of Science database was performed. Studies that reported on infection recurrence related to FRI management combined with NPWT were eligible for inclusion. Quality assessment was done using the PRISMA statement and the Newcastle-Ottawa Quality Assessment Scale. Results After screening and quality assessment of 775 unique identified records, eight articles could be included for qualitative synthesis. All eight studies reported on infection recurrence, which ranged from 2.8% to 34.9%. Six studies described wound healing time, varying from two to seven weeks. Four studies took repeated microbial swabs during subsequent vacuum dressing changes. One study reported newly detected pathogens in 23% of the included patients, and three studies did not find new pathogens. Conclusion This review provides an assessment of current literature on the role of NPWT in the management of soft tissue defects in patients with FRI. Due to the lack of uniformity in included studies, conclusions should be drawn with caution. Currently, there is no clear scientific evidence to support the use of NPWT as definitive treatment in FRI. At this stage, we can only recommend early soft tissue coverage (within days) with a local or free flap. NPWT may be safe for a few days as temporarily soft tissue coverage until definitive soft tissue management could be performed. However, comparative studies between NPWT and early wound closure in FRI patients are needed.
Highlights
Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management
Despite the claim that negative-pressure wound therapy (NPWT) for the management of soft tissue defects can contribute to fast and safe infection control [15, 44], based on the best available evidence presented in this paper, the overall infection recurrence of FRI treated with NPWT ranges from 2.8% up to 34.9% [30,31,32,33,34,35,36,37]
Not all studies reported on how infection recurrence was diagnosed, differences in soft tissue defects were not classified in FRI, and groups were heterogeneous in regards to clinical presentation and location of FRI
Summary
Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management. Studies that reported on infection recurrence related to FRI management combined with NPWT were eligible for inclusion. This review provides an assessment of current literature on the role of NPWT in the management of soft tissue defects in patients with FRI. At this stage, we can only recommend early soft tissue coverage (within days) with a local or free flap. Fracture-related infection (FRI) [1] is a severe complication in trauma surgery It can delay bone and soft tissue healing and lead to persistent disability, with an overall reported treatment failure (e.g., amputation of the infected limb, recurrent infection) of 4-11% [2,3,4,5]. With an increasing prevalence of FRI, this indicates an upcoming challenge for healthcare systems [13]
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