JAMA has just published the results of the WHIST Randomized Clinical Trial, Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma. You should read the entire article which is available Open Access.
Following surgery to treat major trauma–related fractures, deep wound infection rates are high and the study was designed to determine whether incisional Negative Pressure Wound Therapy (iNPWT) would decrease the incidence of deep surgical site infection. The randomized clinical trial was conducted at 24 trauma hospitals (the United Kingdom Major Trauma Network) and included 1548 patients aged 16 years or older who underwent surgery for a lower limb fracture caused by major trauma from July 7, 2016, through April 17, 2018, with follow-up to December 11, 2018. The primary outcome measure was deep surgical site infection at 30 days. Among the 1548 adults, iNPWT (n = 785) outcomes were compared to a standard wound dressing not involving negative pressure (n = 763). There was no statistically significant difference in the rate of deep surgical site infection at 30 days between incisional negative pressure wound therapy (5.8%) and standard wound dressing (6.7%). There was also no significant difference in the rate of deep surgical site infection at 90 days (although some data were missing at this time point), and no evidence of any significant differences in patient self-reported disability, health-related quality of life, scar healing, chronic pain, or other wound healing complications.
The authors concluded that the findings do not support the use of incisional negative pressure wound therapy for surgical wounds associated with lower limb fractures from major trauma, “although the event rate at 30 days was lower than expected,” when compared to rates reported in the literature.
Dr. Fife is a world renowned wound care physician dedicated to improving patient outcomes through quality driven care. Please visit my blog at CarolineFifeMD.com and my Youtube channel at https://www.youtube.com/c/carolinefifemd/videos
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. I am sure that these types of surgeries will simply fail, if the epithelia are paved with layers of cellular debris, healing crusts or undifferentiated stem cells. And also, if the skin is covered with keratotic crusts that prevent skin respiration. Even when healing seems to be going ahead, there may be internal purulence. Cleaning up the cellular debris should be a parallel solution to stop this type of surgery that is disabling and brings morbidity.