Intended for healthcare professionals

Practice NIHR Signals

Negative pressure dressings are no better than standard dressings for open fractures

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.k4411 (Published 13 March 2019) Cite this as: BMJ 2019;364:k4411

Editorial

NIHR’s research signals in The BMJ

Re: Negative pressure dressings are no better than standard dressings for open fractures

Dr Goh is correct in that not all healthcare economies can provide definitive wound closure within 72 hours of injury. The lack of appropriately trained surgeons in many low to middle income countries is well-documented.

However, the NICE guideline for complex fractures (www.nice.org.uk/guidance/ng37) are based upon strong evidence that early definitive wound management reduces the risk of wound healing complications including infection:

"1.2.29 Perform fixation and definitive soft tissue cover: at the same time as debridement" or "within 72 hours of injury if definitive soft tissue cover cannot be performed at the time of debridement."

Those of us privileged to work in advanced healthcare economies should clearly aspire to this level of care.

With regard to the number of dressing changes and length of hospital stay. These are indeed important issues and are fully documented in the health economic evaluation which was an integral part of the WOLLF trial. (Negative-pressure wound therapy versus standard dressings for adults with an open lower limb fracture: the WOLLF RCT. Health Technol Assess. 2018 Dec;22(73):1-162). Disappointing as it may be, the evaluation concludes that "NPWT dressings do not provide a clinical or an economic benefit for patients with an open fracture of the lower limb".

Competing interests: Chief Investigator

14 March 2019
Matthew L Costa
Trauma Surgeon
University of Oxford
Kadoorei Centre, John Radcliffe Hospital , Oxford.