We are pleased to read about Dr Thies’s positive experiences with negative pressure wound therapy. Usually, clinical experience is not sufficient for drawing conclusions of nationwide validity, which apply to thousands of patients in inpatient and outpatient settings. Especially outpatient NPWT entails certain risks; and that the benefits of this therapy really should be well documented. The fact that the methods of evidence based medicine are primarily applied to expensive and risky treatment methods seems to us easy to understand. Members of health insurance schemes could hardly be expected to condone a situation whereby the German Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) and the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen, IQWiG) spend a lot of time and resources evaluating interventions that hardly differ from one another in terms of their risk-benefit profile or cost.
We welcome the fact that Professor Fansa also identifies the need for further randomized studies. Wound closure by means of NPWT does not rule out the use of plastic-reconstructive methods. Perhaps a misunderstanding arose regarding this issue. In the studies starting in autumn, wound closure by reconstruction/plastic surgery is certainly an essential component within the treatment concept after appropriate conditioning of the wound areas. To avoid giving preference to one therapeutic group, photographic documentation and independent assessment of the wound should be used to ensure that the indication for plastic closure is defined dependent on local findings but independent of preceding wound treatment. The future studies will also investigate whether NPWT really reduces pain and improves quality of life.
We thank Professor Breuninger for his appreciation of the problems we identified in evaluating negative pressure wound therapy. We think this supports our methodological approach of using complete wound closure as the primary end point.
Dr. med. Frank Peinemann M.Sc.
PD Dr. med. Stefan Sauerland MPH
IQWiG Institut für Qualität u. Wirtschaftlichkeit im Gesundheitswesen, Köln
Conflict of interest statement
The authors declare that no conflict of interest exists.
|1.||Peinemann F, Sauerland S: Negative pressure wound therapy – systematic review of randomized controlled trials. Dtsch Arztebl Int 2011; 108(22): 381–9.|