Karlakki S, Brem M, Giannini S, Khanduja V, Stannard J, Martin R, et al.
Bone & joint research. Date of publication 2013 Dec 18;volume 2(12):276-84.
1. Bone Joint Res. 2013 Dec 18;2(12):276-84. doi: 10.1302/2046-3758.212.2000190.
Print 2013.
Negative pressure wound therapy for managementof the surgical incision in
orthopaedic surgery: A review of evidence and mechanisms for an emerging
indication.
Karlakki S(1), Brem M, Giannini S, Khanduja V, Stannard J, Martin R.
Author information:
(1)Robert Jones Agnes Hunt Orthopaedic Hospital, ArthroplastyDepartment, Oswestry
SY10 7AG, UK.
OBJECTIVES: The period of post-operative treatment before surgical wounds are
completely closed remains a key window, during which one can apply new
technologies that can minimise complications. One such technology is the use of
negative pressure wound therapy to manage and accelerate healing of the closed
incisional wound (incisional NPWT).
METHODS: We undertook a literature review of this emerging indication to identify
evidence within orthopaedic surgery and other surgical disciplines. Literature
that supports our current understanding of the mechanisms of action was also
reviewed in detail.
RESULTS: A total of 33 publications were identified, including nine clinical
study reports from orthopaedic surgery; four from cardiothoracic surgery and 12
from studies in abdominal, plastic and vascular disciplines. Most papers (26 of
33) had been published within the past three years. Thus far two randomised
controlled trials - one in orthopaedic and one in cardiothoracic surgery - show
evidence of reduced incidence of wound healing complications after between three
and five days of post-operative NPWT of two- and four-fold, respectively.
Investigations show that reduction in haematoma and seroma, accelerated wound
healing and increased clearance of oedema are significant mechanisms of action.
CONCLUSIONS: There is a rapidly emerging literature on the effect of NPWT on the
closed incision. Initiated and confirmed first with a randomised controlled trial
in orthopaedic trauma surgery, studies in abdominal, plastic and vascular surgery
with high rates of complications have been reported recently. The evidence from
single-use NPWT devices is accumulating. There are no large randomised studies
yet in reconstructive joint replacement. Cite this article: Bone Joint Res
2013;2:276-84.
DOI: 10.1302/2046-3758.212.2000190
PMCID: PMC3884878
PMID: 24352756
