The Use of Negative Pressure Wound Therapy Associated with Decreased Infection and Increased Limb Salvage in Patients with Lower Extremity Wounds

Introduction: Negative pressure wound therapy (NPWT) has become a frequently used modality for wound management across a broad spectrum of specialties.

Purpose: Our retrospective analysis sought to find the effect of NPWT on infection rates and limb salvage on lower extremity wounds.

Methods: Various Current Procedural Terminology (CPT) codes were used to identify 256 unique patients with treated for lower extremity wounds that were cared for by a Vascular Surgery Service at a large inner city tertiary care wound program from 2016-2018. Chart review was performed on each patient to collect data on the management of their wounds. Multiple logistic regression analyses were performed with admission due to the surgical site infection (SSTI), amputations or operative intervention due to SSTI, and any future amputation as dependent variables.

Results: 43 patients were found to require subsequent admission for SSTI after having operative debridement and/or dermal matrix placement. Patients who had NPWT after their operation were found to have decreased subsequent admissions for SSTI (p<0.05). Of those patients who were admitted for SSTI, 26 required operative intervention for the management of the SSTI. Patients who had NPWT in their wound management, and developed an SSTI were less likely to require operative intervention for the management of their SSTI (p<0.01). Out of the initial 256 patients analyzed, 34 required some sort of amputation in the future in extremity with the wound managed. Patients who received NPWT were associated with decreased rate of all-cause future amputation (p<0.04).

Conclusion: The ability for NPWT to maintain a moisture balance, stimulate tissue growth, and provide adequate wound drainage may point to why we found the use of it to have decreased admissions for infections and increased limb salvage rates. Confounding variables include differences in surgeon preference, underlying initial diagnosis, wound size and duration.