Evidence-based recommendations for the use of Negative Pressure Wound Therapy in traumatic wounds and reconstructive surgery: Steps towards an international consensus

Abstract Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert pane...

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Bibliographic Details
Published in:	Injury 2011-02, Vol.42 (Suppl. 1), p.S1-S12
Main Authors:	Krug, E, Berg, L, Lee, C, Hudson, D, Birke-Sorensen, H, Depoorter, M, Dunn, R, Jeffery, S, Duteille, F, Bruhin, A, Caravaggi, C, Chariker, M, Dowsett, C, Ferreira, F, Martínez, J.M. Francos, Grudzien, G, Ichioka, S, Ingemansson, R, Malmsjo, M, Rome, P, Vig, S, Runkel, N, Martin, R, Smith, J
Format:	Article
Language:	eng
Subjects:	Biological and medical sciences Burns - therapy Cardiac and Cardiovascular Systems Clinical Medicine Compartment Syndromes - surgery Consensus Debridement Diseases of the osteoarticular system Evidence-Based Medicine Graft Survival Humans Injuries of the limb. Injuries of the spine Kardiologi Kirurgi Klinisk medicin Medical and Health Sciences Medical sciences Medicin och hälsovetenskap Necrosis Negative pressure wound therapy (NPWT) Negative-Pressure Wound Therapy - methods Oftalmologi Ophthalmology Orthopedics Practice Guidelines as Topic Recommendations Reconstructive closure Reconstructive Surgical Procedures Skin Transplantation - methods Surgery Surgical Flaps Systematic review Traumas. Diseases due to physical agents Traumatic wounds Wound Closure Techniques Wound Healing - physiology Wounds and Injuries - pathology Wounds and Injuries - therapy
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Summary:	Abstract Negative pressure wound therapy (NPWT) has become widely adopted over the last 15 years and over 1000 peer reviewed publications are available describing its use. Despite this, there remains uncertainty regarding several aspects of usage. In order to respond to this gap a global expert panel was convened to develop evidence-based recommendations describing the use of NPWT. In this paper the results of the study of evidence in traumatic wounds (including soft tissue defects, open fractures and burns) and reconstructive procedures (including flaps and grafts) are reported. Evidence-based recommendations were obtained by a systematic review of the literature, grading of evidence, drafting of the recommendations by a global expert panel, followed by a formal consultative consensus development program in which 422 independent healthcare professionals were able to agree or disagree with the recommendations. The criteria for agreement were set at 80% approval. Evidence and recommendations were graded according to the SIGN (Scottish Intercollegiate Guidelines Network) classification system. Twelve recommendations were developed in total; 4 for soft tissue trauma and open fracture injuries, 1 for burn injuries, 3 for flaps and 4 for skin grafts. The present evidence base is strongest for the use of NPWT on skin grafts and weakest as a primary treatment for burns. In the consultative process, 11/12 of the proposed recommendations reached the 80% agreement threshold. The development of evidence-based recommendations for NPWT with direct validation from a large group of practicing clinicians offers a broader basis for consensus than work by an expert panel alone.
ISSN:	0020-1383 1879-0267 1879-0267