Efficacy and safety of negative pressure wound therapy for Szilagyi grade III peripheral vascular graft infection.

A best evidence topic in vascular surgery was written according to a structured protocol. The question addressed was whether it is safe and effective to use negative pressure wound therapy (NPWT) for Szilagyi grade III (i.e. the arterial implant proper involved in the infection) peripheral vascular graft infection. Altogether, 69 papers were found using the reported search. From the search results, reference lists of potentially eligible studies and related citations in PubMed, seven papers represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. In the only randomized, controlled trial that compared NPWT (n = 10) and alginate dressing change (n = 10), the NPWT group demonstrated shorter time to full skin epithelialization (median 57 vs 104 days; P = 0.026). In the other six case series, the recruited case number ranged from 12 to 72. The mode of NPWT varied among the included studies, with the majority using a continuous negative pressure of 125 mmHg. One study combined NPWT and sartorius myoplasty, another used sartorius myoplasty in selected cases and others did not. The mean duration of using NPWT ranged from 14.2 to 43 days. The mean duration to achieve complete wound healing ranged from 24 (the study with sartorius myoplasty) to 51 days. The NPWT treatment failure rate ranged from 0 (the study with sartorius myoplasty) to 25%. The major complication of NPWT was bleeding and the incidence rate was reported to be <10%. We conclude that the amount of evidence for recommending NPWT alone as the first-line treatment for Szilagyi grade III peripheral vascular graft infection is small with only one small-sized randomized controlled trial demonstrating that NPWT alone is superior to alginate dressing change in shortening the time to complete wound healing by 2 months. Limited evidence (case series with >1 year of follow-up) showed that NPWT with a continuous negative pressure of 125 mmHg, or combined NPWT and sartorius myoplasty, may shorten the time to complete wound healing by 2 months, have a >70% success rate, and have a <10% NPWT-related complication rate.