Review ArticleNegative pressure wound therapy (NPWT) for spinal wounds: a systematic review
Section snippets
Description of the condition
The management of postoperative spinal wound complication remains a significant challenge. Surgical site infection (SSI) [1] and preoperative radiotherapy [2] are the overwhelming causes of morbidity in postoperative spinal wound complications. Surgical site infection rates range from 0.4% to 20% after spinal surgery [1], [3], [4], [5]. Postoperative incontinence, posterior surgical approach, and surgery for tumor resection are additional risk factors for SSI in spinal surgery [6].
Prophylactic
Types of studies
We sought all relevant RCTs or quasi-methods of participant allocation. Studies that compared NPWT versus pharmacological interventions (eg, antibiotics) and physical interventions (eg, irrigation, gauze/hydrocolloid regimen) were eligible for this review.
We also sought all other NPWT studies (case studies and retrospective studies) to evaluate the potential benefits and risks of NPWT in patients with a spinal wound.
Type of participants
This review includes any types of patient in any health care setting with a
Selection of studies
Reviewers read all titles and abstracts resulting from the search process and eliminated any studies that were not relevant for this review. Full copies of all potentially relevant studies were obtained. All reviewers acted independently to classify these as include or exclude studies. Any discrepancy about the relevance and design of the studies between the reviewers was resolved by discussion and the decision to include the studies was based on the inclusion criteria. The reviewers sought
Results
Searching the different databases for this review yielded 232 publications: 89 publications from MEDLINE, 123 publications from EMBASE, 17 publications from CINAHL, and three publications from hand-searched journals. After removing the duplicates, of which 209 did not meet the inclusion criteria, 23 publications were retrieved in full, of which nine were excluded because they were not individual studies focusing on NPWT and spinal wounds; five were literature reviews and four were not primarily
Discussion
The NPWT technique has been used with the intention of improving wound healing in patients undergoing spinal surgery. However, this review reveals no RCTs that have been undertaken to assess the clinical effectiveness of NPWT after spinal surgery. Furthermore, the majority of published reports describe the use of the technique to treat SSI, with none formally investigating its potential to stimulate wound healing and prevent infection.
Two recent prospective RCTs investigating immediate use of
Acknowledgments
The authors thank Anna Fletcher and Linda Upton (Spinal Unit, Salford Royal NHS Foundation Trust) for their support.
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FDA device/drug status: Not applicable.
Author disclosures: KJO: Grants: KCI Medical (B, Paid directly to institution), University of Huddersfield (B, Paid directly to institution). RAA: Support for travel to meetings for the study or other purposes: KCI Medical (A, Paid directly to institution); Payment for writing or reviewing the manuscript: University of Huddersfield (B, Paid directly to institution). JBW: Nothing to disclose. SL: Grants: KCI Medical (B, Paid directly to institution), University of Huddersfield (B, Paid directly to institution).
The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.
Funding to undertake the review was received from the University of Huddersfield Collaborative Venture Fund and KCI Medical. No other conflict of interest is declared.