LIMITED RECOMMENDATION There is one moderate quality prospective randomized trial (Stannard 2012) on this topic that demonstrated reduced deep surgical site infection using NPWT. A second earlier study by the same group also reported reduced drainage using this technique.
Benefits & Harms
There are no reported harms.
Outcome Importance
If the rate of infection can be decreased with negative pressure wound therapy, then patients’ outcomes will be improved and there is potential for health care cost savings
Cost Effectiveness/Resource Utilization
Although the overall cost-benefit analysis is currently unknown, utilization of negative pressure wound therapy invariably adds cost to the standard treatment, however, surgical site infections are associated with worse patient outcomes, and both high healthcare and associated societal costs.
Acceptability
Negative pressure wound therapy is used for many applications, so this practice is likely to be acceptable to many clinicians if it does not delay discharge or is not too expensive to implement.
Feasibility
While certainly feasible in this clinical scenario, the inability to demonstrate any benefit has failed to justify the increased costs associated. Although NPWT for post-operative wound care following ORIF for high risk closed fractures after major extremity trauma is an attractive option in selected cases, implementation will likely continue to be influenced by cost considerations.
Future Research
There is only one high quality study available, and a larger multicenter trial on this topic would provide more compelling data.