Blister formation with negative pressure dressings after total knee arthroplasty

Abstract

Background Negative pressure wound dressings have revolutionized the treatment of open wounds by stimulating the formation of granulation tissue and hastening wound closure. We hypothesized that negative pressure therapy in the immediate postoperative period after total knee arthroplasty (TKA) in high-risk patients would also hasten the time to a dry wound. Methods This prospective, randomized trial compared the number of days to a dry wound after TKA with application of a negative pressure dressing compared with sterile gauze dressing in 51 patients undergoing 60 TKA surgeries (9 bilateral). Patients undergoing primary TKA who were obese (BMI≥30) and received enoxaparin were randomized to receive either a negative pressure dressing or sterile gauze for 48 hours postoperatively. The days to a dry wound, total weight of drainage, number of gauze dressings used, duration of hospital stay and infection rate were recorded. Results Twenty-four knees received negative pressure therapy and 36 knees had sterile gauze placed. There was no significant difference in the primary endpoint of days to a dry wound (4.3 days with negative pressure and 4.1 days with sterile gauze). There were two postoperative infections, one in each arm of the study. The study was stopped prematurely when 15 of 24 knees (63%) treated with the negative pressure wound dressing developed skin blisters. Conclusions Negative pressure wound therapy did not appear to hasten wound closure and was associated with blisters. There does not appear to be a benefit to the routine use of negative pressure wound dressings in the immediate postoperative TKA period.