NPWT Reduces Wound Complication Rates and Length of Stay

A new study suggests that incisional negative pressure wound therapy (iNPWT) dressings can improve predictability of outcomes following hip and knee replacement surgery.

Researchers at the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (RJAH; Oswestry, United Kingdom) conducted a randomized controlled trial of 220 patients undergoing elective primary total hip and knee arthroplasties, in order to explore the potential benefits of a portable, single use, iNPWT dressing on wound exudate, length of stay (LOS), wound complications, dressing changes, and cost-effectiveness following surgery. For the final analysis there were 102 cohort patients and 107 controls.

For the study, the researchers used the Smith & Nephew (London, United Kingdom) PICO NPWT system, indicated for chronic, acute, and traumatic wounds, subacute and dehisced wounds, partial-thickness burns, ulcers (such as diabetic or pressure), flaps and grafts, and closed surgical incisions. The system uses a one-button pump in order to provide discreet, unobtrusive treatment. The disposable device works with a revolutionary dressing technology that manages fluids, eliminating the need for bulky canisters.

The results showed an improvement in the iNPWT group compared to control in all areas. Peak post-surgical wound exudate was significantly reduced; overall LOS reduction was not significant, but there was a significant reduction in patients with extreme values of LOS in the iNPWT group. A significantly reduced number of dressing changes and a trend to a significant four-fold reduction in reported post-operative surgical wound complications (2% compared to 8.4% in controls) were observed. The study was published on August 5, 2016, in Bone & Joint Research.

“By introducing PICO as a prophylactic measure we have been able to demonstrate predictable wound healing following total hip and knee replacement procedures,” said lead author consultant orthopedic surgeon Sudheer Karlakki, MD. “Better wound management offers significant value to our hospital both in terms of reducing associated healthcare costs and by improving each patient’s outcome and experience.”

NPWT is a therapeutic technique used to promote healing in acute or chronic wounds and enhance the healing of first and second degree burns. The therapy involves controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum pump. The continued vacuum draws out fluid exudates from the wound and increases blood flow to the area. NPWT wound management has increased dramatically over the 1990s and 2000s.

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