Conventional Versus Instillation Negative-Pressure Wound Therapy for Severe Soft Tissue Injury in Open Pelvic Fractures: A Retrospective Review

Overview

Journal Yonsei Med J

Date 2025 Feb 2

PMID 39894042

Authors

Donghwan Choi

Won Tae Cho

Hyung Keun Song

Junsik Kwon

Byung Hee Kang

Hohyung Jung

Min Ji Kim

Kyoungwon Jung

Affiliations

Soon will be listed here.

Abstract

Purpose: We investigated the clinical features, current negative-pressure wound therapy (NPWT) management strategies, and outcomes of pelvic-perineal soft tissue infection after open pelvic fractures.

Materials And Methods: We analyzed the data of patients admitted to our trauma center with pelvic-perineal soft tissue after open pelvic fractures over a 7-year period. We investigated the injury severity score (ISS), medical costs, number of NPWTs, time required to reach definite wound coverage, complications, fracture classifications, transfusion requirements, interventions, length of stay (LOS) in hospital and intensive care unit (ICU), and prognosis.

Results: Twenty patients with open pelvic fractures were treated with NPWT, and one patient who underwent NPWT died of pelvic sepsis during ICU treatment. The median LOS in hospital and medical costs were 98 [56-164] days and 106400 [65600-171100] USD, respectively. Patients treated with instillation NPWT (iNPWT, n=10) had a shorter NPWT duration (24 [13-39] vs. 46 [42-91] days, =0.023), time to definite wound coverage (30 [21-43] vs. 49 [42-93] days, =0.026), and hospital LOS (56 [43-72] vs. 158 [101-192] days, =0.001), as well as lower medical costs (67800 [42500-102500] vs. 144200 [110400-236000] USD, =0.009) compared to those treated with conventional NPWT.

Conclusion: NPWT is a feasible method for treating pelvic soft tissue infections in patients with open pelvic fractures. iNPWT can reduce the duration of NPWT, hospital LOS, and medical costs.

References

Tsugawa K, Koyanagi N, Hashizume M, Ayukawa K, Wada H, Tomikawa M . New therapeutic strategy of open pelvic fracture associated with rectal injury in 43 patients over 60 years of age. Hepatogastroenterology. 2002; 49(47):1275-80. View

Diehm Y, Fischer S, Wirth G, Haug V, Orgill D, Momeni A . Management of Acute and Traumatic Wounds With Negative-Pressure Wound Therapy With Instillation and Dwell Time. Plast Reconstr Surg. 2020; 147(1S-1):43S-53S. DOI: 10.1097/PRS.0000000000007610. View

Dente C, Feliciano D, Rozycki G, Wyrzykowski A, Nicholas J, Salomone J . The outcome of open pelvic fractures in the modern era. Am J Surg. 2005; 190(6):830-5. DOI: 10.1016/j.amjsurg.2005.05.050. View

Frane N, Iturriaga C, Bub C, Regala P, Katsigiorgis G, Linn M . Risk factors for complications and in-hospital mortality: An analysis of 19,834 open pelvic ring fractures. J Clin Orthop Trauma. 2020; 11(6):1110-1116. PMC: 7656482. DOI: 10.1016/j.jcot.2020.08.017. View

Yang C, Goss S, Alcantara S, Schultz G, Lantis Ii J . Effect of Negative Pressure Wound Therapy With Instillation on Bioburden in Chronically Infected Wounds. Wounds. 2017; 29(8):240-246. View

Giordano V, Koch H, Gasparini S, Souza F, Labronici P, do Amaral N . Open Pelvic Fractures: Review of 30 Cases. Open Orthop J. 2017; 10:772-778. PMC: 5301299. DOI: 10.2174/1874325001610010772. View

Diehm Y, Loew J, Will P, Fischer S, Hundeshagen G, Ziegler B . Negative pressure wound therapy with instillation and dwell time (NPWTi-d) with V. A. C. VeraFlo in traumatic, surgical, and chronic wounds-A helpful tool for decontamination and to prepare successful reconstruction. Int Wound J. 2020; 17(6):1740-1749. PMC: 7948994. DOI: 10.1111/iwj.13462. View

Dong J, Zhou D . Management and outcome of open pelvic fractures: a retrospective study of 41 cases. Injury. 2011; 42(10):1003-7. DOI: 10.1016/j.injury.2011.01.032. View

Labler L, Trentz O . The use of vacuum assisted closure (VAC) in soft tissue injuries after high energy pelvic trauma. Langenbecks Arch Surg. 2006; 392(5):601-9. DOI: 10.1007/s00423-006-0090-0. View

10.

Omar M, Gathen M, Liodakis E, Suero E, Krettek C, Zeckey C . A comparative study of negative pressure wound therapy with and without instillation of saline on wound healing. J Wound Care. 2016; 25(8):475-8. DOI: 10.12968/jowc.2016.25.8.475. View

11.

Jones A, Powell J, Kellam J, McCormack R, Dust W, Wimmer P . Open pelvic fractures. A multicenter retrospective analysis. Orthop Clin North Am. 1997; 28(3):345-50. DOI: 10.1016/s0030-5898(05)70293-5. View

12.

Watkins R, Hsu J . The Road to Survival for Haemodynamically Unstable Patients With Open Pelvic Fractures. Front Surg. 2020; 7:58. PMC: 7493634. DOI: 10.3389/fsurg.2020.00058. View

13.

Goss S, Schwartz J, Facchin F, Avdagic E, Gendics C, Lantis 2nd J . Negative Pressure Wound Therapy With Instillation (NPWTi) Better Reduces Post-debridement Bioburden in Chronically Infected Lower Extremity Wounds Than NPWT Alone. J Am Coll Clin Wound Spec. 2015; 4(4):74-80. PMC: 4495738. DOI: 10.1016/j.jccw.2014.02.001. View

14.

Govaert G, Siriwardhane M, Hatzifotis M, Malisano L, Schuetz M . Prevention of pelvic sepsis in major open pelviperineal injury. Injury. 2012; 43(4):533-6. DOI: 10.1016/j.injury.2011.12.002. View

15.

Gabriel A, Camardo M, ORorke E, Gold R, Kim P . Effects of Negative-Pressure Wound Therapy With Instillation versus Standard of Care in Multiple Wound Types: Systematic Literature Review and Meta-Analysis. Plast Reconstr Surg. 2020; 147(1S-1):68S-76S. DOI: 10.1097/PRS.0000000000007614. View

16.

Ozer M, Coskun A, Ozerhan I, Ersoz N, Yildiz R, Sinan H . Use of vacuum-assisted closure (VAC™) in high-energy complicated perineal injuries: analysis of nine cases. Int Wound J. 2011; 8(6):599-607. PMC: 7950344. DOI: 10.1111/j.1742-481X.2011.00835.x. View

17.

Anchalia M, Upadhyay S, Dahiya M . Negative Pressure Wound Therapy With Instillation and Dwell Time and Standard Negative Pressure Wound Therapy in Complex Wounds: Are They Complementary or Competitive?. Wounds. 2021; 32(12):E84-E91. View

18.

Kataoka Y, Minehara H, Shimada K, Nishimaki H, Soma K, Maekawa K . Sepsis caused by peripelvic soft tissue infections in critically injured patients with multiple injuries and unstable pelvic fracture. J Trauma. 2009; 66(6):1548-54. DOI: 10.1097/TA.0b013e3181a51b0e. View

19.

Collinsworth A, Priest E, Masica A . Evaluating the Cost-Effectiveness of the ABCDE Bundle: Impact of Bundle Adherence on Inpatient and 1-Year Mortality and Costs of Care. Crit Care Med. 2020; 48(12):1752-1759. DOI: 10.1097/CCM.0000000000004609. View

20.

Jani V, Jani V, Munoz C, Govender K, Williams A, Cabrales P . Application of negative tissue interstitial pressure improves functional capillary density after hemorrhagic shock in the absence of volume resuscitation. Physiol Rep. 2021; 9(5):e14783. PMC: 7931804. DOI: 10.14814/phy2.14783. View