WHIST

Effect of Incisional Negative Pressure Wound Therapy vs Standard Wound Dressing on Deep Surgical Site Infection After Surgery for Lower Limb Fractures Associated With Major Trauma: The WHIST Randomized Clinical Trial.

Costa ML, Achten J, Knight R, et al. JAMA 2020 · PMID 32044942 · doi:10.1001/jama.2020.0059

Question

Does incisional negative pressure wound therapy over closed surgical wounds reduce deep infection after fixation of lower limb fractures from major trauma?

Design

Pragmatic multicentre RCT in trauma hospitals across the UK Major Trauma Network.

Patients

Adults aged 16 or over having surgery for lower limb fractures sustained in major trauma.

Intervention

Incisional negative pressure wound therapy

Comparison

Standard wound dressing

Primary outcome

Deep surgical site infection at 30 days

Key result

There was no significant difference in deep surgical site infection at 30 days between incisional negative pressure therapy and standard dressings.

Limitations

Blinding was not possible, and the intervention was applied across a broad range of fracture types and surgical approaches.

Impact on practice

Does not support routine use of incisional negative pressure dressings after lower limb fracture surgery, with savings in cost and resource.