A Comparative Study between Indigenous Low Cost Negative Pressure Wound Therapy with Added Local Oxygen versus Conventional Negative Pressure Wound Therapy

Abstract

Introduction: The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT.

Materials and methods: The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT.

Results: We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations.

Conclusion: Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

Keywords: NPWT; VAC; compound fracture; negative pressure wound therapy; vacuum assisted closure.

© 2020 Malaysian Orthopaedic Association (MOA). All Rights Reserved.

Figures

Fig. 1:

Randomised controlled study design and fate of all three treatment arms

Fig. 2:

Steps of application of Indigenous NPWT. (a) Sharp debridement. (b) Measurement and trimming of foam. (c) Placement of foam and Infant feeding tube. (d) Airtight sealing with a piece of IOBAN (3M). (e) Before negative pressure application. (f) Wrinkling and shrinkage after negative pressure application. (NPWT : Negative Pressure Wound Therapy. IOBAN : Iodine impregnated Antimicrobial Incise Drape by 3M).

Fig. 3:

(a,b,c,d) A patient of Morel – Lavallee Lesion at lateral aspect of thigh treated with Indigenous NPWT (3 cycles- 14 days) and healed with secondary intention.

Fig. 4:

Patient with wound over dorsal aspect of right foot and external fixator applied to span the ankle joint and immobilisation, a) after 1 cycle of indigenous NPWT+TPOT. (b) Wound after two cycles of Indigenous NPWT+TPOT. (c) Post STSG application.