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Negative pressure dressing shows healing promise

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Incisional negative pressure wound therapy can improve wound healing and reduce complications following orthopaedic surgery, according to a UK study.

Researchers tested an innovative wound care system in which a small pump applies negative pressure to a dressing for up to seven days.

“Better wound management offers significant value to our hospital”

Sudheer Karlakki

They said the single-use dressing system appeared to improve wound discharge, healing, minimise complications and improve length of stay.

They carried out a 12-month trial involving 220 patients undergoing primary hip or knee replacement at the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust in Shropshire.

The results showed a smaller range and spread of length of stay in those patients randomised to the new dressing system – one to 10 days – compared to those with a standard dressing – two to 61 days.

The use of new dressing system also resulted in a four-fold reduction in the number of patients experiencing grade 4 distribution of wound exudate within the dressing when, compared with standard wound dressing in those undergoing joint replacement.

Smith & Nephew

Negative pressure dressing shows healing promise

The PICO negative pressure wound therapy dressing used in the study

In addition, there was also a four-fold decrease – from 8% to 2% – in superficial surgical site complications.

A further benefit was shown in the significant reduction in the number of total dressing changes required per patient using the new dressing – potentially meaning greater patient comfort and less burden on nursing staff – noted the researchers.

They suggested that, while significant benefits were demonstrated for all types of patient, the use of the dressing as a prophylactic for closed surgical incision management would be “particularly beneficial” in patients categorised as high risk, for example with a body mass index over 35.

The research team acknowledged that the negative pressure wound dressing, marketed by manufacturer Smith & Nephew at £125 under name PICO, was “substantially more expensive than the traditional wound dressing”.

However, they suggested the additional cost “appears justifiable” after taking into account savings from reduced lengths of stay in hospital, fewer wound complications, fewer dressing changes and potential cost savings for wound care in the community.

“We accept that a detailed analysis of financial modelling is required and a more detailed analysis will be the subject of a future publication,” they wrote in the journal Bone & Joint Research.

“Wound complications… can have a devastating effect on a patient’s recovery”

Helen Griffiths

The researchers also highlighted that wound complications were reported in up to 10% hip and knee arthroplasties and there was a proven link between wound complications and deep prosthetic infections.

Mr Sudheer Karlakki, lead study author and consultant orthopaedic surgeon, said: “We have been able to demonstrate predictable wound healing following total hip and knee replacement procedures.

“Better wound management offers significant value to our hospital both in terms of reducing associated healthcare costs and by improving each patient’s outcome and experience,” he said.

Helen Griffiths, an outpatient nurse at the trust, added: “Wound complications do not only impact the hospital, but they can have a devastating effect on a patient’s recovery.

“There is often a financial impact for the family as more time off work is required, not just for the patient but also their carer,” she said.

“High levels of wound exudate or infections can also cause embarrassment and discomfort, often resulting in significant anxiety,” she said. “PICO can help prevent these issues through improved wound healing and increased patient confidence.”

Mr Karlakki presented the results of the randomized controlled trial at the European Bone and Joint Infection conference earlier this month.

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