High tech wound treatment for severe open fractures is "no better than regular dressings" - new study

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High tech treatment of open leg wounds is no better than using regular dressings, a new research study suggests.

The study, “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” published in Journal of the American Medical Association (available on CKN), found that patient recovery was the same whether a sophisticated Negative Pressure Wound Therapy (NPWT) device was used or just a standard dressing.

The research by the universities of Warwick and Oxford in the UK looked at 460 patients with an “open” fracture of the leg, where the bone had broken through the skin. Over a year, researchers compared the level of disability, rate of infection and quality of life in patients treated with NPWT against those treated with standard dressings.

The researchers noted that with severe open leg fractures that infection rates could be up to 27%, which both affected patient recovery and increased healthcare costs due to longer hospital stays.

NPWT devices work by creating a vacuum using a suction pump that removes blood and fluid that may collect in a wound. The vacuum may also encourage the formation of granulation (healing) tissue. However, the research team found no evidence that the high-tech NPWT devices reduced the patients’ disability at 12 months, compared to standard treatment.

Lead author Professor Matt Costa, from Oxford University, said “our study did not find any benefit of using negative pressure devices in the treatment of these very serious injuries. Our research has implications for both patients and healthcare systems with regard to the management of severe open fractures.”

Study co-author Professor Julie Bruce, from Warwick Medical School, said “before this study there was only one small randomised clinical trial comparing standard wound dressings with the devices which suggested negative-pressure wound therapy improved patient outcomes.” But she noted that the previous research was only carried out at one trauma centre and only included 59 patients.

“Despite the lack of strong evidence, clinical guidelines around the world recommended the use of these devices for open fracture wounds. These guidelines will need updating,” she said.

Because the type of dressing was clearly visible it was not possible to do a blind study of participants and surgeons. However, the surgical and healthcare team were not involved in any outcome assessments, the study authors said.

The primary method of measurement was a questionnaire given to the patients to rate their level of disability one year after they sustained their injury. Wound photographs were also taken at six weeks and reviewed by independent clinicians. The questionnaire results were 45.5 (negative pressure) versus 42.4 (standard dressings) points out of a possible 100 where zero represents normal function and 100 complete disability.