The use of negative pressure wound therapy in traumatology and orthopedics. part 2. particular cases of application of the method: validity, effectiveness, tips

The purpose of the study is to analyze the literature data on the use of negative pressure wound therapy in clinical practice, in particular in traumatology and orthopedics, to study the effectiveness  of the technique in a specific clinical situation, to assess its feasibility, as well as to summarize  the clinical experience of authors. 
Despite the universality of the method, in each specific clinical situation there are some subtleties in the use of negative pressure therapy systems. On the other hand, despite the seemingly indisputable absolute positive effect of negative pressure therapy, in some clinical situations its effectiveness is comparable to classical treatment methods, and due to some features, its use in such clinical cases becomes not economically justified. Negative pressure therapy is widely used both in the treatment of damage to integumentary tissues, wounds requiring skin-plastic treatment methods, and as part of the complex treatment of deep periprosthetic joint infection, chronic osteomyelitis, and open fractures of the extremities. Currently, negative pressure therapy is often used in surgical practice in the area of a postoperative wound in order to prevent infectious complications in individuals at risk. The use of negative pressure therapy has also found its place in the therapy measures of decubitation of various localizations.

1. Stannard J. P., Volgas D. A., Stewart R., McGwin G. Jr., Alonso J. E. Negative pressure wound therapy after severe open fractures: a prospective randomized study. J Orthop Trauma. 2009 Sep;23(8):552–7.

2. Iheozor-Ejiofor Z., Newton K., Dumville J. C., Costa M. L., Norman G., Bruce J. Negative pressure wound therapy for open traumatic wounds. Cochrane Database Syst Rev. 2018 Jul 3;7(7):CD012522.

3. Bhattacharyya T., Mehta P., Smith M., Pomahac B. Routine use of wound vacuum-assisted closure does not allow coverage delay for open tibia fractures. Plast Reconstr Surg. 2008 Apr;121(4):1263–1266.

4. Costa M. L., Achten J., Bruce J., Tutton E, Petrou S., Lamb S. E., Parsons N. R.; UK WOLLF Collaboration. Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb: The WOLLF Randomized Clinical Trial. JAMA. 2018 Jun 12;319(22):2280–2288.

5. Sergeev K. N., ZHaglin A. V. Ispol’zovanie sistemy lecheniya ran otricatel’nym davleniem u pacientovs oslozhnennoj kostnoj travmoj // Rany i ranevye infekcii. – 2014. T. 1, № 2. – S. 44–50.

6. Sweere V., Sliepen J., Haidari S., Depypere M., Mertens M., IJpma F., Metsemakers W. J., Govaert G. Use of negative pressure wound therapy in patients with fracture-related infection more than doubles the risk of recurrence. Injury. 2022 Dec;53(12):3938–3944.

7. Riechelmann F., Kaiser P., Arora R. Primäres Weichteilmanagement bei offenen Frakturen [Primary soft tissue management in open fracture]. Oper Orthop Traumatol. 2018 Oct;30(5):294–308.

8. Rupp M., Popp D., Alt V. Prevention of infection in open fractures: Where are the pendulums now? Injury. 2020 May;51 Suppl 2:S57–S63.

9. Arti H., Khorami M., Ebrahimi-Nejad V. Comparison of negative pressure wound therapy (NPWT) &conventional wound dressings in the open fracture wounds. Pak J Med Sci. 2016 Jan-Feb;32(1):65–9.

10. Nair A. V., Nazar P., Sekhar R., Ramachandran P., Moorthy S. Morel-Lavallée lesion: A closed degloving injury that requires real attention. Indian J Radiol Imaging. 2014 Jul;24(3):288–90.

11. Loktionov P. V. Opyt lecheniya ran nizhnih konechnostej s obshirnoj travmaticheskoj otslojkoj kozhi i podkozhnoj kletchatki / P. V. Loktionov, Yu. V. Gudz’ // Mediko-biologicheskie i social‘no-psihologicheskie problemy bezopasnosti v chrezvychajnyh situaciyah. – 2015. – № 1. – S. 22–28.

12. Kahveci R.; Turkish Wound Working Group. Negative Pressure Wound Therapy for Complex Surgical Wounds in 59 Patients Across Secondary and Tertiary Care Centers in Turkey. Eplasty. 2022 Nov 22;22:e60.

13. Sitnik, A. A. Vosstanovlenie myagkih tkanej priotkrytyh perelomah goleni / A. A. Sitnik, P. A. Volotovskij, A. V. Beleckij // Medicinskie novosti. – 2016. – № 11. – S. 37–41.

14. Bogdanov, S. B. Sovershenstvovanie sposobov hirurgicheskogo lecheniya v kombustiologii s primene- niem vakuumnoj terapii / S. B. Bogdanov, D. N. Marchenko, V. Yu. Ivashchuk // Plasticheskaya hirurgiya i esteticheskaya medicina. – 2022. – № 2. – S. 57–62.

15. Yin Y., Zhang R., Li S., Guo J., Hou Z., Zhang Y. Negative-pressure therapy versus conventional therapy on split-thickness skin graft: A systematic review and meta-analysis. Int J Surg. 2018 Feb;50:43–48.

16. Yin Y., Zhang R., Li S., Guo J., Hou Z., Zhang Y. Negative-pressure therapy versus conventional therapy on split-thickness skin graft: A systematic review and meta-analysis. Int J Surg. 2018 Feb;50:43–48.

17. Ward C., Ciraulo D., Coulter M., Desjardins S., Liaw L., Peterson S. Does treatment of split-thickness skin grafts with negative-pressure wound therapy improve tissue markers of wound healing in a porcine experimental model? J Trauma Acute Care Surg. 2012 Aug;73(2):447–51.

18. Does the application of incisional negative pressure therapy to high-risk wounds prevent surgical site complications? A systematic review / M. J. Ingargiola, L. N. Daniali, E. S. Lee et al. // Eplasty. – 2013. – Vol. 20. №13. – e 49.

19. Howell R. D., Hadley S., Strauss E., Pelham F. R. Blister formation with negative pressure dressings after total knee arthroplasty. Curr Orthop Pract. 2011; 22(2):176–9.

20. Chau W. W., Lo K. C., Lau L. C., Ong M. T., Ho K. K. Single use Negative Pressure Wound Therapy (NPWT) system in the management of knee arthroplasty. BMC Musculoskelet Disord. 2023 May 5; 24(1):351.).

21. Kunze K. N., Hamid K. S., Lee S., Halvorson J.J., Earhart J. S., Bohl D. D. Negative-Pressure Wound Therapy in Foot and Ankle Surgery. Foot Ankle Int. 2020 Mar;41(3):364–372.

22. Zhang D., He L. A systemic review and a metaanalysis on the influences of closed incisions in orthopaedic trauma surgery by negative pressure wound treatment compared with conventional dressings. Int Wound J. 2023 Jan;20(1):46–54.

23. Gao J., Wang Y., Song J., Li Z., Ren J., Wang P. Negative pressure wound therapy for surgical site infections: A systematic review and meta-analysis. J Adv Nurs. 2021 Oct;77(10):3980–3990.

24. Pervyj opyt ispol‘zovaniya vakuumnoj terapii v profilaktike nagnoeniya ushityh ran myagkih tkanej / V. V. Fedyushkin, S. N. Pyatakov, A. G. Baryshev [i dr.] // Rany i ranevye infekcii. ZHurnal imeni prof. B. M. Kostyuchyonka. – 2022. – T. 9, № 4. – S. 6–15.

25. Anagnostakos K., Mosser P. Bacteria identification on NPWT foams: clinical relevance or contamination? J Wound Care. 2012 Jul;21(7):333–4, –9.

26. Han H.S., Kang S.B. Relations between longterm glycemic control and postoperative wound and infectious complications after total knee arthroplasty in type 2 diabetics. Clin Orthop Surg. 2013 Jun;5(2): 118–23.

27. Carroll K., Dowsey M., Choong P., Peel T. Risk factors for superficial wound complications in hip and knee arthroplasty. Clin Microbiol Infect. 2014 Feb;20(2): 130–5.

28. Wang B., Cheng W., Liu F., Guo Z., Ji Z., Sun K., Yao M.. Efficacy and safety of vancomycin-loaded calcium sulfate versus conventional surgical debridement for pediatric acute osteomyelitis: a retrospective study. BMC Musculoskelet Disord. 2022 Dec 23;23(1):1124.

29. Li Q., Song S. F., Zhang W., Wu G. Z., Liu L. Z. [Clinical study on negative pressure closed drainage combined with vancomycin loaded calcium sulfate and autogenous bone in the treatment of chronic osteo- myelitis]. Zhongguo Gu Shang. 2017 Nov 25;30(11): 1059–1062.

30. Kirr R., Wiberg J., Hertlein H. Klinische Erfahrungen und Ergebnisse über die Anwendung der V. A. C.-Instill bei infizierten Hüft- und Kniegelen-ksprothesen [Clinical experience and results of using the V. A. C. instill therapy in infected hip- and knee prosthetics]. Zentralbl Chir. 2006 Apr;131 Suppl 1: S79–82.

31. Lehner B., Bernd L. Anwendung der V. A. C.-Instill-Therapie bei periprothetischen Hüft- und Kniegelenksinfekten [V. A. C.-instill therapy in periprosthetic infection of hip and knee arthroplasty]. Zentralbl Chir. 2006 Apr;131 Suppl 1:S160–4.

32. Tsvetkov V. O., Ivkov A. V., Mikaelyan L. S., Kolovanova O. V. A promising contribution to negative pressure wound therapy in treatment of prosthetic joint infection. Discussion based on case report. Ann Med Surg (Lond). 2022 Feb 7;75:103339.

33. Fröschen F. S., Walter S. G., Randau T. M., Gravius N., Gravius S, Hischebeth GTR. The use of negative pressure wound therapy increases failure rate in debridement and implant retention for acute prosthetic joint infection. Technol Health Care. 2020;28(6): 721–731.

34. Izakovicova P., Borens O., Trampuz A. Peripro- sthetic joint infection: current concepts and outlook. EFORT Open Rev. 2019 Jul 29;4(7):482–494.

35. Şahin E., Rizalar S., Özker E. Effectiveness of negative-pressure wound therapy compared to wet-dry dressing in pressure injuries. J Tissue Viability. 2022 Feb;31(1):164–172.