Review Examines Evidence on Negative Pressure Wound Therapy with Instillation for Infection Management in Orthopedic Trauma

In a recent review, Dr Paul Kim of the Departments of Plastic Surgery and Orthopedic Surgery, University of Texas Southwestern, Dallas, Texas, summarizes a variety of studies on negative pressure wound therapy with instillation (NPWTi) to compare outcomes with more traditional wound treatments for managing infection in orthopedic trauma cases. In orthopedic trauma soft tissue compromise in concert with the introduction of contaminants and bacteria can lead to a host of complications in addition to the need for skeletal stabilization and/or reconstruction.

“NPWTi stabilizes the soft tissue while repetitively cleansing the wound. Thus, it can be used effectively as a bridge between staged operations or in preparation for a single-staged definitive surgery,” the study’s author explains. In reviewing a large selection of existing literature on NPWTi usage, he aims to “discuss the growing body of evidence for the use of negative pressure wound therapy with instillation with a focus on infection and recommendations for its proper use.”

In this review, Dr Kim discusses evidence on NPWTi use relating to cultures, including in vitro and in vivo studies on bacterial impact; clinical observation, including wound closure and coverage rates and wound bed conversion, length of hospitalization, and number of operations; and multicenter and meta-analysis studies examining bacterial load, wound complications, number of readmissions, length of hospitalization or therapy, and number of surgeries. 

The review notes multiple studies that show decreased presence of bacteria and biofilm with use of NPWTi compared with standard NPWT or control gauze dressings across in vitro and in vivo settings, including human studies. While the author notes the possibility of antiseptic solutions used being responsible at least in part for these results, the NPWTi system served as a delivery system for regular antiseptic cleansing, and positive effects with saline-only applications have also been observed. Studies also detected a positive effect on wound conversion; reduced length of hospitalization, number of surgeries, and time to wound closure/coverage; and fewer overall wound complications with treatment via NPWTi compared with standard NPWT. Notably, economic modeling also suggested lower overall treatment costs with NPWTi therapy.

In conclusion, Dr Kim states: “NPWTi can expedite the conversion of a wound to a positive state for closure or coverage and can serve to stabilize the soft tissue between staged operations.” He reiterates the adjunct role NPWTi can play in wound care for orthopedic trauma, citing a large and growing body of supporting evidence, and noting the importance of customizing each treatment plan to a patient’s individual needs.

—Kirra Fedyszyn, Associate Digital Editor

Reference:
Kim P. Negative Pressure Wound Therapy With Instillation: An Adjunctive Therapy for Infection Management in Orthopaedic Trauma. J Orthop Trauma. 2022;36(Suppl 4):S12-S16. doi:10.1097/BOT.0000000000002428