Rationale and impact

This section briefly explains why the committee made the recommendation dated 2022 and how it might affect practice.

Temporary dressings for open fractures after wound excision but before definitive soft tissue cover

Recommendation 1.2.31

Why the committee made the recommendation

The evidence showed that use of negative pressure wound therapy (NPWT) after wound excision if immediate definitive soft tissue cover has not been performed is not more clinically effective than other dressings and is unlikely to be cost effective. However, the committee agreed that most of the evidence related to the use of NPWT as a therapy rather than as a temporary dressing (which is what it is used for in the UK) and therefore most of the long-term outcomes were not relevant to the UK context. Furthermore, the cost effectiveness of NPWT is unclear. They agreed that, on that basis, it was not appropriate to make a 'do not routinely use' recommendation.

The committee agreed that, in their experience, compared to other dressings, NPWT could:

  • reduce the number of times dressings are changed or supplemented and reduce the number of associated bedding changes, thereby saving nursing time

  • reduce the pain and discomfort of changing or supplementing dressings, thereby improving patient satisfaction.

They also noted that NPWT is useful for wounds that are heavily exuding where other dressings may need to be changed or supplemented more often.

The committee agreed that there are several types of dressing that can remain in situ until definitive soft tissue cover is performed up to 72 hours later. NPWT is not the only choice. They also agreed it was important to ensure the correct application of dressings.

The committee agreed to replace the 2016 recommendation on NPWT with a recommendation to apply a temporary dressing that avoids wound desiccation and minimises dressing changes.

They were not able to recommend specific dressings because the evidence they considered only related to NPWT, so they discussed whether to make a recommendation for research on specific temporary dressing for open fractures after wound excision but before definitive soft tissue cover. Since they could not be sure that this evidence did not already exist (because it was not searched for as part of this update) they agreed to ask stakeholders at consultation. Stakeholders did not raise any objection and so the committee proceeded to make a recommendation for research on temporary dressings.

How the recommendations might affect practice

NPWT is widely used as a temporary dressing for open fractures before definitive soft tissue cover, however other temporary dressings can be effective in providing temporary coverage and may be more cost-effective. The updated recommendation stipulates the use of a temporary dressing that prevents desiccation and minimises the number of dressing changes. This may reduce the use of NPWT.

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