Effect of negative pressure wound therapy with and without instillation and dwell time in type IIIA/IIIB fractures using the Bates-Jensen wound assessment tool

What is it about?

Background Gustilo-Anderson type 3A/3B fractures present significant challenges in orthopedic trauma management due to extensive soft tissue damage and high infection risk. While negative pressure wound therapy (NPWT) has shown efficacy, the addition of instillation and dwell time (NPWTi-d) may offer enhanced benefits for complex wound management in these fractures. Aim This study aimed to compare wound healing outcomes between NPWT and NPWTi-d in patients with Gustilo-Anderson type 3A/3B fractures using the Bates-Jensen Wound Assessment Tool (BWAT). Methods This retrospective cross-sectional study analysed records of 60 patients with Gustilo-Anderson type 3A/3B fractures treated between November 2023 and October 2024 at R L Jalappa Hospital, India. Patients were equally divided into NPWT (n=30) and NPWTi-d (n=30) groups. Primary outcomes included BWAT scores, while secondary outcomes encompassed complication rates and hospitalisation duration. Patients on immunosuppressive therapy or with diabetes mellitus were excluded. Statistical analysis included independent t-tests, chi-square tests, and multivariate regression analysis. Results NPWTi-d demonstrated superior outcomes with significantly fewer post-intervention complications (10.0% versus 30.0%, p=0.028), shorter hospitalisation (15.80±2.09 versus 18.00±5.46 days, p=0.042), and better BWAT score improvement (19.37±2.86 versus 18.50±4.49, p=0.039). Notably, NPWTi-d showed particularly significant benefits in more severe type 3B fractures (p=0.022). Multivariate analysis identified NPWTi-d as an independent predictor of better wound outcomes (β=-1.85, 95% CI: -3.62 to -0.08, p=0.040) and shorter hospital stay (β=-2.24 days, 95% CI: -4.31 to -0.17, p=0.034). Conclusion NPWTi-d demonstrated superior efficacy compared to standard NPWT in managing Gustilo-Anderson type 3A/3B fractures, with particular benefits in more severe type 3B injuries, suggesting it as a preferred treatment modality for complex open fractures. Implications for clinical practice The significant improvements in wound healing metrics and reduced hospitalisation with NPWTi-d indicate potential benefits for both patient outcomes and healthcare resource utilisation in trauma care, especially for severe open fractures requiring specialised wound management.

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