WOLLF

Effect of Negative Pressure Wound Therapy vs Standard Wound Management on 12-Month Disability Among Adults With Severe Open Fracture of the Lower Limb: The WOLLF Randomized Clinical Trial.

Costa ML, Achten J, Bruce J, et al. JAMA 2018 · PMID 29896626 · doi:10.1001/jama.2018.6452

Question

After debridement of a severe open lower limb fracture, does negative pressure wound therapy improve disability compared with standard dressings?

Design

Pragmatic multicentre RCT in UK major trauma centres.

Patients

Adults with a severe (Gustilo-Anderson grade II or III) open fracture of the lower limb requiring surgical debridement.

Intervention

Negative pressure wound therapy after first debridement

Comparison

Standard wound dressing

Primary outcome

Disability Rating Index at 12 months

Key result

There was no significant difference in disability at 12 months, and no significant reduction in deep infection with negative pressure wound therapy.

Limitations

Blinding was not possible, and practice in time to definitive soft-tissue cover varied between centres.

Impact on practice

Negative pressure therapy is not superior to standard dressings as a bridge to definitive cover; the priority remains early debridement and early definitive soft-tissue coverage as per BOAST and NICE guidance.