Risk of infection with delayed wound coverage by using negative-pressure wound therapy in Gustilo Grade IIIB/IIIC open tibial fracture: An evidence-based review

摘要

Dear Sir,Patients with high-grade open tibial fractures are often associated with severe bone and soft-tissue injury.Contamination of the bone and devitalisation of the surrounding soft tissue further increase the risk of infection. In 1986 Godina reported postoperative infection rates were 1.5% in early reconstruction group (ie. performing flap coverage within 72 h of injury) and 17.5% in delayed reconstruction group (ie. performing flap coverage between 72 h and 3 months after injury).1 However, the definition of early reconstruction remains ambiguous, Godina's results were reported before the popularisation of negative-pressure wound therapy (NPWT), or vacuum-assisted closure in the management of open tibial fracture, and experience with lower extremity free-flap reconstruction has increased since his pioneer report.2 NPWT has been proved to be safe and provides a good primary dressing over severe bone and soft-tissue defects.3 Whether the use of NPWT may allow delay wound coverage for severe open tibial fracture for more than 7 days remained undetermined.