Despite the many scientific technological advances, such as the advent of antibiotics, highlevel preclinical and intensive medicine, SSI continues to be a problem that haunts orthopaedic and trauma surgeons. There is a need for a comprehensive knowledge regarding risk factors (RF) and possible preventive measures to control SSI. Commercially available ciNPT may offer surgeons an additional option to manage clean, closed surgical incisions.
Methods
Medline literature search and analysis (EndNote / PubMed) 1968-2017 (as of march 1st 2017). Used keywords were (filter „title“): "surgical site infection" OR "postoperative infection". Trauma and orthopaedic associated risk factors were selected. Additionally, a literature search was performed using key words ‘prevention’, ‘negative pressure wound therapy (NPWT)’, ‘active incisional management’, ‘incisional vacuum therapy’, ‘incisional NPWT’, ‘incisional wound VAC’, ‘closed incisional NPWT’ published from 2000 to 2015.
Results
Identification of 858 relevant articles from the 50 years 1968-2017. Pooled SSI rate is 0,3% (hand surgery) and 19% (III° open fractures). For open fractures, there is no clear tendency towards lower infection rates during the past five decades. Identification of 115 RFs is possible from three subject areas (patientdependent, organizational and procedural, trauma and operation dependent). The five most important RF are
body mass index over 35 (kg/m2), increased duration of surgery, diabetes mellitus, increased blood glucose levels in the perioperative period even in the case of non-diabetics and errors in the perioperative antibiotic prophylaxis. The ciNPT search found >100 publications that fulfilled the search criteria. Based on higher evidence, high-risk incisions (sternotomy and incisions in extremities after high-energy open trauma) are principally recommended for ciNPT use. In 'lower'-risk incisions, the addition of patient-related or operationrelated risk factors justifies the application of ciNPT.
Discussion/Conclusion
Inconsistent definition of "infection", interaction of the RF and the different followup duration limit the meaningfulness of the study. In the future considerable efforts must be made in order to achieve a noticeable reduction in the rate of infection, especially in the case of high risk patients. One successful option is ciNPT.
