Negative pressure wound therapy (NPWT) for spinal wounds

A systematic review

Karen J. Ousey, Ross A. Atkinson, J. Bradley Williamson, Steve Lui

Research output: Contribution to journalReview article

20 Citations (Scopus)

Abstract

Background context
The management of postoperative spinal wound complication remains a challenge, with surgical site infection (SSI) incidence rates ranging from 0.4% to 20% after spinal surgery. Negative pressure wound therapy (NPWT) has been highlighted as an intervention that may stimulate healing and prevent SSI. However, the wound healing mechanism by NPWT and its effectiveness in spinal wounds still remain unclear.

Purpose
To systematically search, critically appraise, and summarize randomized controlled trials (RCTs) and non-RCTs assessing the effectiveness of NPWT in patients with a spinal wound.

Study design
Systematic review.

Methods
A systematic review based on search strategies recommended by the Cochrane Back and Wounds Review Groups was undertaken using Cochrane Library, MEDLINE, EMBASE, and CINAHL databases. Any publications between 1950 and 2011 were included. Funding to undertake the review was received from the University of Huddersfield Collaborative Venture Fund ($4,820) and KCI Medical ($4,820).

Results
Ten retrospective studies and four case studies of patients with spinal wound complication were included in this systematic review. No RCTs were found. Only one study described more than 50 patients. Generally, a pressure of -125 mm Hg was used in adults. Duration of NPWT in situ ranged from 3 to 186 days. Wound healing was assessed every 2 to 3 days and generally completed between 7 days and 16 months. Negative pressure wound therapy is contraindicated in the presence of active cerebrospinal fluid leak, metastatic or neoplastic disease in the wound or in patients with an allergy to the NPWT dressing and in those with a bleeding diathesis.

Conclusions
Published reports are limited to small retrospective and case studies, with no reports of NPWT being used as a prophylactic treatment. Larger prospective RCTs of NPWT are needed to support the current evidence that it is effective in treating spinal wound complications. In addition, future studies should investigate its use as a prophylactic treatment to prevent infection and report data relating to safety and health economics.
Original languageEnglish
Pages (from-to)1393-1405
Number of pages13
JournalSpine Journal
Volume13
Issue number10
Early online date26 Aug 2013
DOIs
Publication statusPublished - 1 Oct 2013

Fingerprint

Negative-Pressure Wound Therapy
Wounds and Injuries
Surgical Wound Infection
Randomized Controlled Trials
Wound Healing
Retrospective Studies
Disease Susceptibility
Bandages
MEDLINE
Libraries
Publications
Hypersensitivity
Economics
Databases
Hemorrhage
Safety
Pressure
Incidence

Cite this

Ousey, Karen J. ; Atkinson, Ross A. ; Williamson, J. Bradley ; Lui, Steve. / Negative pressure wound therapy (NPWT) for spinal wounds : A systematic review. In: Spine Journal. 2013 ; Vol. 13, No. 10. pp. 1393-1405.
@article{8d66cafddf8d45cbac865b731cadb0ee,
title = "Negative pressure wound therapy (NPWT) for spinal wounds: A systematic review",
abstract = "Background context The management of postoperative spinal wound complication remains a challenge, with surgical site infection (SSI) incidence rates ranging from 0.4{\%} to 20{\%} after spinal surgery. Negative pressure wound therapy (NPWT) has been highlighted as an intervention that may stimulate healing and prevent SSI. However, the wound healing mechanism by NPWT and its effectiveness in spinal wounds still remain unclear. Purpose To systematically search, critically appraise, and summarize randomized controlled trials (RCTs) and non-RCTs assessing the effectiveness of NPWT in patients with a spinal wound. Study design Systematic review. Methods A systematic review based on search strategies recommended by the Cochrane Back and Wounds Review Groups was undertaken using Cochrane Library, MEDLINE, EMBASE, and CINAHL databases. Any publications between 1950 and 2011 were included. Funding to undertake the review was received from the University of Huddersfield Collaborative Venture Fund ($4,820) and KCI Medical ($4,820). Results Ten retrospective studies and four case studies of patients with spinal wound complication were included in this systematic review. No RCTs were found. Only one study described more than 50 patients. Generally, a pressure of -125 mm Hg was used in adults. Duration of NPWT in situ ranged from 3 to 186 days. Wound healing was assessed every 2 to 3 days and generally completed between 7 days and 16 months. Negative pressure wound therapy is contraindicated in the presence of active cerebrospinal fluid leak, metastatic or neoplastic disease in the wound or in patients with an allergy to the NPWT dressing and in those with a bleeding diathesis. ConclusionsPublished reports are limited to small retrospective and case studies, with no reports of NPWT being used as a prophylactic treatment. Larger prospective RCTs of NPWT are needed to support the current evidence that it is effective in treating spinal wound complications. In addition, future studies should investigate its use as a prophylactic treatment to prevent infection and report data relating to safety and health economics.",
keywords = "Infection, Negative pressure wound therapy, Spine, Systematic review, Wound",
author = "Ousey, {Karen J.} and Atkinson, {Ross A.} and Williamson, {J. Bradley} and Steve Lui",
year = "2013",
month = "10",
day = "1",
doi = "10.1016/j.spinee.2013.06.040",
language = "English",
volume = "13",
pages = "1393--1405",
journal = "Spine Journal",
issn = "1529-9430",
publisher = "Elsevier Inc.",
number = "10",

}

Negative pressure wound therapy (NPWT) for spinal wounds : A systematic review. / Ousey, Karen J.; Atkinson, Ross A.; Williamson, J. Bradley; Lui, Steve.

In: Spine Journal, Vol. 13, No. 10, 01.10.2013, p. 1393-1405.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Negative pressure wound therapy (NPWT) for spinal wounds

T2 - A systematic review

AU - Ousey, Karen J.

AU - Atkinson, Ross A.

AU - Williamson, J. Bradley

AU - Lui, Steve

PY - 2013/10/1

Y1 - 2013/10/1

N2 - Background context The management of postoperative spinal wound complication remains a challenge, with surgical site infection (SSI) incidence rates ranging from 0.4% to 20% after spinal surgery. Negative pressure wound therapy (NPWT) has been highlighted as an intervention that may stimulate healing and prevent SSI. However, the wound healing mechanism by NPWT and its effectiveness in spinal wounds still remain unclear. Purpose To systematically search, critically appraise, and summarize randomized controlled trials (RCTs) and non-RCTs assessing the effectiveness of NPWT in patients with a spinal wound. Study design Systematic review. Methods A systematic review based on search strategies recommended by the Cochrane Back and Wounds Review Groups was undertaken using Cochrane Library, MEDLINE, EMBASE, and CINAHL databases. Any publications between 1950 and 2011 were included. Funding to undertake the review was received from the University of Huddersfield Collaborative Venture Fund ($4,820) and KCI Medical ($4,820). Results Ten retrospective studies and four case studies of patients with spinal wound complication were included in this systematic review. No RCTs were found. Only one study described more than 50 patients. Generally, a pressure of -125 mm Hg was used in adults. Duration of NPWT in situ ranged from 3 to 186 days. Wound healing was assessed every 2 to 3 days and generally completed between 7 days and 16 months. Negative pressure wound therapy is contraindicated in the presence of active cerebrospinal fluid leak, metastatic or neoplastic disease in the wound or in patients with an allergy to the NPWT dressing and in those with a bleeding diathesis. ConclusionsPublished reports are limited to small retrospective and case studies, with no reports of NPWT being used as a prophylactic treatment. Larger prospective RCTs of NPWT are needed to support the current evidence that it is effective in treating spinal wound complications. In addition, future studies should investigate its use as a prophylactic treatment to prevent infection and report data relating to safety and health economics.

AB - Background context The management of postoperative spinal wound complication remains a challenge, with surgical site infection (SSI) incidence rates ranging from 0.4% to 20% after spinal surgery. Negative pressure wound therapy (NPWT) has been highlighted as an intervention that may stimulate healing and prevent SSI. However, the wound healing mechanism by NPWT and its effectiveness in spinal wounds still remain unclear. Purpose To systematically search, critically appraise, and summarize randomized controlled trials (RCTs) and non-RCTs assessing the effectiveness of NPWT in patients with a spinal wound. Study design Systematic review. Methods A systematic review based on search strategies recommended by the Cochrane Back and Wounds Review Groups was undertaken using Cochrane Library, MEDLINE, EMBASE, and CINAHL databases. Any publications between 1950 and 2011 were included. Funding to undertake the review was received from the University of Huddersfield Collaborative Venture Fund ($4,820) and KCI Medical ($4,820). Results Ten retrospective studies and four case studies of patients with spinal wound complication were included in this systematic review. No RCTs were found. Only one study described more than 50 patients. Generally, a pressure of -125 mm Hg was used in adults. Duration of NPWT in situ ranged from 3 to 186 days. Wound healing was assessed every 2 to 3 days and generally completed between 7 days and 16 months. Negative pressure wound therapy is contraindicated in the presence of active cerebrospinal fluid leak, metastatic or neoplastic disease in the wound or in patients with an allergy to the NPWT dressing and in those with a bleeding diathesis. ConclusionsPublished reports are limited to small retrospective and case studies, with no reports of NPWT being used as a prophylactic treatment. Larger prospective RCTs of NPWT are needed to support the current evidence that it is effective in treating spinal wound complications. In addition, future studies should investigate its use as a prophylactic treatment to prevent infection and report data relating to safety and health economics.

KW - Infection

KW - Negative pressure wound therapy

KW - Spine

KW - Systematic review

KW - Wound

UR - http://www.scopus.com/inward/record.url?scp=84887992427&partnerID=8YFLogxK

U2 - 10.1016/j.spinee.2013.06.040

DO - 10.1016/j.spinee.2013.06.040

M3 - Review article

VL - 13

SP - 1393

EP - 1405

JO - Spine Journal

JF - Spine Journal

SN - 1529-9430

IS - 10

ER -