High-tech treatment of open leg wounds no better than using regular dressings, study suggests

A new study on open leg fractures has suggested there is no difference to patient recovery when high-tech negative pressure wound therapy devices are used, compared to standard dressings.

A randomised clinical trial across 24 hospitals was conducted by the University of Warwick Clinical Trials Unit and the University of Oxford. Their results were published in the Journal of the American Medical Association (JAMA), earlier this month.

The study was conducted on people with open leg fractures, where the bone has pierced the skin. The exposed bone is exposed to contamination and infection rates in severe open leg fractures can be up to 27%.  As well as affecting the recovery of the patient, infections can also increase healthcare costs due to longer hospital stays or extra treatments.

Negative-pressure wound therapy (NPWT) is a new type of dressing used after surgery, where a vacuum created using a suction pump removes blood and fluid that may collect in a wound. The vacuum can also encourage the formation of healing tissue but NPWT dressings, as well as the vacuum machines are a lot more expensive than traditional wound dressings.

Researchers compared the level of disability, rate of infection and quality of life in 460 patients with severe open fractures of the lower leg. Patients were given a questionnaire to assess their level of disability after one year after they sustained their injury.

The study found no evidence that negative pressure wound devices reduced the patients’ disability after a year. The research team also found there was no evidence of a difference in the rate of deep infections, wound healing or patient quality of life.

Lead author, Matt Costa, professor of Orthopaedic Trauma Surgery, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS) 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. Just as importantly, the study also shows that UK patients and clinicians can work together to deliver high-quality evidence, even in the most difficult context of major trauma.”

Co-author, professorial Fellow at Warwick Medical School, Professor Julie Bruce, 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. However it was conducted 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.”