Outcome of negative pressure therapy in treatment of infected wounds of lower limb a retrospective study

Introduction: Infected wounds irrespective of their location are such a burden to the patient and the healthcare which is beyond any description we can make. Presence of infection is a complex problem especially in extremities, which leads to spectrum of complications such as soft tissue loss, exposure of sensitive structures like tendons, nerves, bones etc and even amputation. Infections have always been a matter of worry for the surgeons and especially orthopedicians. Wound healing process can be at times complicated by infections resulting in prolonged hospitalization and even death. Negative pressure therapy was described in 1993 by Fleishmann et al, and was then introduced in clinical setting in 1997 by Argenta and Morykwas. It is currently a preferred method of wound management especially in infected wounds, diabetic foot ulcers etc due to its ability to reduce healing time, promotes wound healing, wound bed preparation for skin grafting, reduction of bacterial load and early development of granulation tissue by angiogenic stimulation etc. Objective: The aim of this study is to evaluate the outcome and benefits of negative pressure therapy (NPWT) in patients with infected wounds of lower limbs. Methods: After taking proper clearance from the hospital’s ethical committee data records of 30 patients (mean age 49 yrs (18-80 yrs), 25 Males and 5 Females) treated at Govt. Medical College for infected wounds of lower limbs using negative pressure therapy during the time period of 1 year (1st September 2017 to 31st August 2018) were taken for analysis. This is a retrospective study and after analyzing the hospital records a final inference was made regarding final outcome and presented in suitable tabular and descriptive form. The negative pressure therapy (NPWT) was applied to the infected wound after proper Wound wash and debridement, in continuous mode for 5 days with a negative pressure between 50 to 200 mmHg. Results: As per our analysis the mean hospital stay was 30 days (20-40 days), mean intravenous antibiotic therapy was 10 days (5-15 days) and mean use of negative pressure therapy was 12.5 days (5- 20days). Use of negative pressure resulted in gross reduction in wound size and infection. Only 4 patients required a 2nd revised NPWT, 1 patient required 4 NPWT dressings but all the patients showed a positive outcome with respect to wound healing, complete eradication of infection. Conclusion: This analysis revealed that although the cost benefit ratio of using Negative pressure therapy for infected wound remains a debatable topic, still it has proven its worth by treating all the wounds and infections associated with them without causing the pain and discomfort to the patient which the patients with regular daily dressings experience.