Thank you for your kind letter regarding our article. We feel that you have made some very valid points about us making a number of small changes to the ‘conventional’ NPTW dressings for treatment of infected metalwork.
We acknowledged in our paper that one of the disadvantages of our technique was an increased inpatient stay. We agree that changing the dressings in theatre under general anaesthesia allows serial debridements of the wound and helps prevent secondary contamination. We cannot confirm whether or not the polyvinyl foam actually decreased bacterial load as we did not carry out microbiological testing of the foam at every dressing change.
However, we feel that the primary difference in our technique is that of skin closure over the NPWT dressing, which we believe confers a number of significant advantages. This creates a biological seal, which helps prevent leakage and therefore secondary contamination of the metalwork as well as facilitating better functioning of the NPWT equipment. It also prevents retraction of the wound edges, which makes final wound closure easier, once the NPWT dressing is removed, and therefore reduces the chance of further wound healing complications.
We hope that this letter clarifies the main messages of our paper. If there is anything else you would like to discuss, please do not hesitate to contact us.