Comparison of Scar Quality Between Primary Incisional Negative Pressure Wound Therapy and Conventional Surgical Dressing in Patients with Closed Forearm Fractures Treated Surgically: A Randomised Controlled Trial.

BACKGROUND

Wound healing and the quality of the scar plays a key role in deciding which dressing technique is better.

OBJECTIVE

The study aimed to determine if primary incisional negative pressure wound therapy provides better scar quality compared to conventional dressing following definitive fixation of closed forearm fractures.

METHODS

A prospective randomized control trial of patients diagnosed with acute closed forearm fractures who underwent open reduction and internal fixation from April 2022 to January 2024. Patients received either a standard sterile dressing or incisional negative pressure wound therapy (iNPWT). The primary outcome was comparing the histopathological scar quality by examining collagen composition at 12 weeks. Secondary outcomes included assessment of surgical site infection (ASEPSIS Score) and clinical scar assessment using the Patient and Observer Scar Assessment Scale. Univariate logistic regression analyses were performed.

RESULTS

34 patients were included, 47% received iNPWT (n = 16), and 53% received standard dressings (n = 18). With Masson's trichrome stain,15 participants (93.7%) in the intervention group experienced a favourable outcome with an unadjusted relative risk of 1.13 (95% CI: 0.88-1.43, p = 0.341). With Reticulin stain, 12 participants (75%) in the intervention group exhibited desirable results with an unadjusted relative risk of 0.79 (95% CI: 0.58-1.07,p = 0.13). The intervention group had a mean ASEPSIS score of 1.75 with an SD of 2.11 [95% CI-0.62 to 2.87, p = 0.14]. The calculated difference in mean Patient scar scores between the two groups was 7.31 (p = 0.003), and the observer score was 4.5 (p = 0.043).

CONCLUSIONS

Patients who underwent iNPWT showed cosmetic satisfaction of scar and favourable outcomes in histopathological assessment with Masson's trichrome stain.

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