Early clinical outcomes of patients wound, using negative pressure wound therapy in wound dressing of patient with open fractures of the tibia and fibula gustilo anderson grade iiib at Muhimbili Orthopedic Institute (MOI)

Abstract

Background: Open fractures are often high-energy injuries and are frequently associated with life-threatening injuries, skin degloving, soft tissue crushing, and contamination. Open Tibia fractures causes great suffering to patients and are an enormous economic burden especially in developing countries. Negative Pressure Wound Therapy (NPWT) has shown a promising treatment method when managing these wounds. The four primary effects of NPWT are; wound contraction, stabilization of the wound environment, decreased edema and removal of wound exudates, and micro deformation. These effects allow NPWT to speed wound healing; increase blood flow around wounds; improve wound bed preparation for subsequent closure or coverage, and change wound biochemistry, bacterial burden, and systemic response. Objective: The study aimed at determining the early outcomes; granulation tissue formation, wound site infection, re-debridement and grafting proportion, when using negative pressure wound therapy (NPWT) in the management of wounds in patients with Gustilo-Anderson IIIB fracture of the tibia treated at MOI from June 2017 to March 2018 Methodology: One arm cohort study was conducted at Muhimbili Orthopedics and Trauma Institute (MOI) from June 2017 to March 2018. Twenty four patients meeting the inclusion criteria were enrolled into the study consecutively as they presented to the hospital, data was collected using a structured questionnaire and Bates-Jansen wound assessment tool was used in the assessment of wound on each dressing change, Results: A total of 24 patients were enrolled during the study period, 18 (75%) were males and 6 (25%) were females, male: female was 3:1, the mean age was 36.67 standard deviation 15.216 years, the majority of patients (54.2%) were in the age group between 21-40 years, the mean time from injury to intravenous antibiotics prophylaxis was 6.54 standard deviation 1.719 hours, the mean time from injury to surgical debridement was 9.79 standard deviation 1.587 hours. The mean duration of using NPWT was 4.9 standard deviation 1.6 days, and the mean number of dressing change was 2.88 standard deviation 0.338. The duration for formation of healthy granulation tissues covering more than 90% of the wound bed was found to be 4.92 standard deviation 1.586 days, the infection rate was found to be 16.7 %. The proportion of patients who underwent graft procedure to cover the soft tissue defect was 16.7%, the mean wound area reduction was 10.42 cm2 (63.46%) p-value <0.001, re-debridement was found to be 20.8% of these, 16.64% was due to infection and 4.16% was due to secondary necrosis. The early infection rate was 16.7% , time from injury to antibiotics of more than 6 hours was associated with development of infection p-value = 0.018, while time from injury to surgical debridement was not associated with development of infection p-value = 0.288. Conclusion and recommendations: Road traffic accidents (RTA) are in rise, due to poor infrastructures, increase in motorcycles as means of transportation, these contributes to a raise in high energy injuries which pos treatment challenges due to complex soft tissue disruption, the affected age group is between 21-40 years, this group is the working force for the economic growth of our country. New modality of wound dressing using NPWT shows promising early treatment outcomes and lowers the complication rates. There was statistical association between development of early infection and delay in prophylactic antibiotic. There is need of affirmative action’s to advocate early intravenous antibiotics prophylaxis to patients with open fracture to lower the infection burden. This can be achieved by regular training first health care responders who provide the basic life support to trauma victims. A larger multicentre case control study is needed in order to establish the effectiveness of using NPWT in wound management of open fractures compared to wet dressing in Tanzania.