In the November 20, 2019 issue of JBJS, Cocjin et al. from the Philippines report results from a randomized controlled trial that compared 7-day outcomes from a commercially available NPWT system to those from an innovative, low-cost system that the authors developed locally and have been using at their institution since the mid-2000s. This home-grown system consists of an aquarium pump converted into a reusable vacuum source, along with basic hospital supplies such as surgical gauze, tubing, and plastic food wrap. The authors also compared the cost of the two systems.
For most of the measured clinical outcomes, Cocjin et al. found that their innovative NPWT system was noninferior to the commercially available system. It was actually better (but not significantly so) in terms of time of application, pain during dressing changes, and wound-contraction percentages. There were no complications with either system, and the system made from the aquarium pump and hospital supplies cost 7 times less than the commercial device ($63.75 compared to $491.38 USD). The converted aquarium-pump system can be used up to 20 times, making its per-use cost as low as $3.
Innovation is vital to advancing orthopaedics. But we must also remember that low-cost innovation is equally important for a large portion of the worldwide patient and provider population that is resource-constrained. I applaud Cocjin et al. for sharing their locally developed innovation with the wider orthopaedic community. Although further validating studies are needed, this “homemade” NPWT system has the potential to bring to a large portion of the world a cost-effective alternative to a wound-management technique that has become a mainstay in more affluent settings over the past 2 decades.
Matthew R. Schmitz, MD
JBJS Deputy Editor for Social Media