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Annals of Surgery Journal Club
Interactive resource for surgery residents and surgeons to discuss and critically evaluate articles published in Annals of Surgery selected by a monthly guest expert who will review an article each month, offer questions and respond to reader's comments.
Saturday, March 02, 2013
March Journal Club
Moderator: Dr. Adrian Barbul
 
Article: Negative Pressure Wound Therapy for At-Risk Surgical Closures in Patients With Multiple Comorbidities: A Prospective Randomized Controlled Study. Masden, Derek; Goldstein, Jesse; Endara, Mathew; Xu, Kyle; Steinberg, John; Attinger, Christopher. Annals of Surgery. 255(6):1043-1047, June 2012.
 
Summary: This is a randomized study of the effect of negative pressure wound therapy (NPWT) on the healing of wounds of the lower extremity and abdomen closed primarily or by delayed primary means. The study included high risk patients with many co-morbidities such as low serum albumin (~2.3g/Dl), diabetes (>70%), hypertension, peripheral vascular disease and renal failure. In the OR, the patient was assigned to a treatment arm using block randomization. Controls received a silver-impregnated dressing. Treatment was for three days. A total of 81 patients completed the study and were analyzed.

All wounds were evaluated after three days and in subsequent clinic visits by providers blinded to the randomization. All groups were well matched in terms of operations and risk factors. No differences were found in rates of infection (6.8% for NPWT vs 13.5% for controls) or time to diagnosis of infection, dehiscence (36.4% vs 29.7%) or time to dehiscence. The authors conclude that the use of NPWT in high risk wounds, primarily of the lower extremities, does not offer any advantage over standard dressings. 

The use of NPWT in many surgical situations has undergone explosive growth. Its use, however, is often driven by ease of use, advantage as an adjunct in wound care, and suggestions of enhanced wound healing.  The authors are to be commended for rigorously studying the effectiveness of NPWT in the population described.  The authors themselves were surprised by the findings, having felt that surely NPWT would be advantageous. Such studies conducted with similar open mindedness are needed to fully understand the role of NPWT in modern wound care.

 

Questions:

1. Is the widespread use of NPWT well supported by a large number of randomized, blinded, well-designed studies in different surgical situations?

2. Does the current study demonstrate any bias?  Are you ready to apply its findings into your own practice?

3. Do you believe that NWPT improves wound healing? How do you use it in your current practice?

 

Please feel free to comment on any or all of the questions above. We look forward to hearing from you, the Annals readers.

 

 

 

 

 

 

 

About the Author

Dr. John Mullen
Dr. John Mullen is Program Director of the General Surgery Residency at the Massachusetts General Hospital, Visiting Surgeon in the Division of Surgical Oncology, and Assistant Professor of Surgery at Harvard Medical School. He completed his residency training in general surgery at the MGH in 2003, just prior to the implementation of the resident duty hour restrictions. Dr. Mullen’s clinical focus is the surgical treatment of gastric cancer and soft tissue sarcoma, and his research interests are in surgical education and clinical and translational cancer research.

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