Correspondence (letter to the editor): Objective Is Questionable

I can only underline the authors’ conclusion—namely, that further studies are needed. I am a plastic surgeon working in reconstructive surgery, treating large defects after infections, trauma, and tumors on a daily basis, but I have doubts about the ultimate objective. It is not negative pressure wound therapy (NPWT) that needs to be evaluated as this procedure has an undisputed position in conditioning wounds right up to wound closure by a plastic surgeon, especially large wounds and those with a primary infection. Until the wound is closed, NPWT does not only increase patients’ quality of life because of less frequently needed painful changes of dressings (intervals of up to seven days are entirely feasible), but it improves the wound after debridement so that we can close the wound more quickly and more safely. This does not relate to skin transplants only but also to coverage with pediculed and free microvascular flaps. Aspects of infection and vascularization of the wound (or limb) always need to be clarified before any procedure can take place. Admittedly, such an end point depends on clearly more (subjective) variables, but the fact that an end point is difficult to measure should not serve as a deterrent to defining an objective correctly. It would be regrettable for our patients if new studies again evaluated the wrong end point. In this context, reconstructive (plastic) surgeons should be included from the initial study design.