1123 Negative pressure therapy in the prevention of surgical wound complications in breast oncoplastic surgery. A prospective randomized study

Background: Closed incision negative pressure therapy (ciNPT) may reduce the rate of wound complications and promote healing of the incisional site. We report our experience with this dressing in breast reconstruction patients with abdominal free flap donor sites. Methods: A retrospective cohort study was conducted of all patients who underwent breast reconstruction using abdominal free flaps (DIEP, MS-TRAM) at a single institution (Royal Melbourne Hospital, Victoria) between 2016 and 2021. Results: 126 female patients (mean age: 50 ± 10 years) were analysed, with 41 and 85 patients in the ciNPT (Prevena) and non-ciNPT (Comfeel) groups, respectively. There were reduced wound complications in almost all outcomes measured in the ciNPT group compared with the non-ciNPT group; however, none reached statistical significance. The ciNPT group demonstrated a lower prevalence of surgical site infections (9.8% vs. 11.8%), wound dehiscence (4.9% vs. 12.9%), wound necrosis (0% vs. 2.4%), and major complication requiring readmission (2.4% vs. 7.1%). Conclusion: The use of ciNPT for abdominal donor sites in breast reconstruction patients with risk factors for poor wound healing may reduce wound complications compared with standard adhesive dressings; however, large scale, randomised controlled trials are needed to confirm these observations. Investigation of the impact of ciNPT patients in comparison with conventional dressings, in cohorts with equivocal risk profiles, remains a focus for future research.

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Effect of Novel Anteromedial Approach on Wound Complications Following Ankle Arthroplasty

Foot & Ankle International ◽

10.1177/1071100720937247 ◽

2020 ◽

Vol 41 (10) ◽

pp. 1198-1205

Author(s):

Mansur M. Halai ◽

Ellie Pinsker ◽

Timothy R. Daniels

Keyword(s):

Surgical Approach ◽

Negative Pressure ◽

Inflammatory Arthritis ◽

Wound Complications ◽

Nurse Specialist ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Ankle Arthroplasty ◽

Factors Associated ◽

Major Complications

Background: The purpose of this study was to evaluate all wound complications following total ankle arthroplasty (TAA) before and after the implementation of a novel extensile anteromedial surgical approach. We further investigated patients and operative factors associated with wound complications. Methods: A series of 660 TAAs were collected. The median follow-up was 84 months (range, 12-204 months). Minor wound complications included discoloration, swelling, or clinical concern that merited bringing the patient back sooner for review. Major wound complications included plastic surgical consultation, debridement by the nurse specialist, negative pressure therapy, or reoperation. All major complications initially had a course of empirical oral antibiotics. Since 2011, higher-risk patients have had their TAA performed through an extensile anteromedial approach. Results: Fifty-six patients (8.5%) had wound healing issues (17 major [2.6%], 39 minor [5.9%]). All issues became evident <21 days postoperatively. Inflammatory arthritis, smoking, and coronary disease were patient factors associated with major wound complications. Four patients were treated with negative pressure therapy, 4 with debridement in the operating room, and 2 eventually converted to fusions. Fourteen patients (82%) who had major complications had an ancillary procedure to balance the TAA through a separate incision. All major wound complications had an anterior surgical approach for their TAA. Before 2011, there were 13 major wound complications. Since 2012, there have been 4 major wound complications overall, with no wound complications in the anteromedial approach cohort. Conclusion: We recommend an extensile anteromedial approach for smokers and patients with heart disease or inflammatory arthritis undergoing TAA. If a wound complication developed, a multidisciplinary team to evaluate wounds was useful. Level of Evidence: Level III, retrospective comparative series.

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Surgical wound infection prevention using topical negative pressure therapy on closed abdominal incisions – the ‘SWIPE IT’ randomized clinical trial

Journal of Hospital Infection ◽

10.1016/j.jhin.2021.01.013 ◽

2021 ◽

Vol 110 ◽

pp. 76-83

Author(s):

A.M. Di Re ◽

D. Wright ◽

J.W.T. Toh ◽

T. El-Khoury ◽

N. Pathma-nathan ◽

...

Keyword(s):

Clinical Trial ◽

Wound Infection ◽

Randomized Clinical Trial ◽

Negative Pressure ◽

Infection Prevention ◽

Surgical Wound Infection ◽

Surgical Wound ◽

Negative Pressure Therapy ◽

Pressure Therapy ◽

Topical Negative Pressure

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A simple and low- cost technique for Closed Incision Negative-Pressure Therapy

Negative Pressure Wound Therapy Journal ◽

10.18487/npwtj.v4i1.25 ◽

2017 ◽

Vol 4 (1) ◽

pp. 12

Author(s):

Dominik Andrzej Walczak ◽

Michał Wojtyniak ◽

Piotr Wojciech Trzeciak ◽

Dariusz Pawełczak ◽

Zbigniew Pasieka

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Low Cost ◽

Antibiotic Usage ◽

Preventive Strategy ◽

Site Infection ◽

Surgical Wound ◽

Negative Pressure Therapy ◽

Wound Therapy ◽

Pressure Therapy

Surgical site infection (SSI) makes patient care more expensive by prolonging antibiotic usage and hospital stay. Negative pressure wound therapy (NPWT) has been recently reported as a preventive strategy to avoid SSI. We present a simple and low-cost vacuum dressing that may improve surgical wound healing and prevent high-risk wounds from complications.

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Negative pressure therapy with the ULTRAVAC instillation in the therapy of infected laparotomies with fascitis − temporary results of a prospective randomized study

Perspectives in Surgery ◽

10.33699/pis.2019.98.4.152-158 ◽

2019 ◽

Vol 98 (4) ◽

pp. 152-158

Keyword(s):

Negative Pressure ◽

Randomized Study ◽

Prospective Randomized Study ◽

Vacuum System ◽

Control Group ◽

Pressure Therapy ◽

Financial Costs ◽

Bacterial Spectrum ◽

Hospitalization Costs ◽

Experimental Group

Introduction: Negative pressure wound therapy is a healing modality utilizing continuous or intermittently applied vacuum to the wound bed. Nowadays is available a vacuum system supported by an automated instillation with volumetric control. It`s main therapeutic benefit is the dilution of the exudate, which reduces the viscosity and secures the «delicate» necrectomy. Method: Presentation of the temporary results of a prospective randomized study comparing the effectiveness of both therapeutic techniques. Entirely 41 patients were enrolled in the study from November 2016 to September 2018. The primary goal of the project is to compare the length of therapy, the number of surgical debridements and evaluation the financial costs. Secondary targets are observed changes in biological load and bacterial spectrum. Results: The duration of the therapy was 2 days shorter in the experimental group compared to the control sample. However, the average number of applications was higher. Defects with the instillation system were characterized by a shorter cleaning phase (p=0.057). The secondary suture was reached in the experimental group at 84.2% and in the control group at 72.7%. The differences in these parameters were not statistically significant. Fascial disruption was observed in the trial group in 2 patients. The financial costs of the material used was significantly higher in patients with irrigation system (p<0.001). However, the total hospitalization costs did not differ statistically (p=0.097). There were no significant changes in the bacterial spectrum observed during therapy. There was a significant reduction in the bacterial burden during therapy in the experimental group (p= 0,035). Conclusion: Vacuum system supported by automated instillation is an effective method, accelerating cleaning phase of the wound healing. A potential risk could be the disruption of the fascia during instillation of the solution. However, the results of our work are not definitive and a larger group of patients is needed for valid conclusions.

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How Safe is the Combination of Negative Pressure Therapy and Polyhexanid Instillation in Deep Sternal Wound Complications?

10.1055/s-0040-1705323 ◽

2020 ◽

Author(s):

R. U. Kuehnel ◽

F. Schroeter ◽

G. Loladze ◽

L. Michera ◽

M. Pallmann ◽

...

Keyword(s):

Negative Pressure ◽

Wound Complications ◽

Negative Pressure Therapy ◽

Pressure Therapy

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Large abdominal hernia repair with closed incision negative pressure therapy: a case series

Journal of Wound Care ◽

10.12968/jowc.2021.30.3.192 ◽

2021 ◽

Vol 30 (3) ◽

pp. 192-196

Author(s):

Edward Wang ◽

Leigh Archer ◽

Amanda Foster ◽

Mohammed Ballal

Keyword(s):

Incisional Hernia ◽

Hernia Repair ◽

Negative Pressure ◽

Case Series ◽

Incisional Hernia Repair ◽

Abdominal Hernia ◽

Wound Complications ◽

Control Group ◽

Negative Pressure Therapy ◽

Pressure Therapy

Objective: A major challenge of large abdominal incisional hernia repair is the high rates of wound complications. Closed incision negative pressure therapy (CINPT) can offer many treatment advantages in the management of these wounds and has been shown to reduce complications for other postoperative incisions. This study assesses the wound outcomes for hernia repair patients receiving CINPT. Method: A six-year retrospective case series of patients who had undergone large abdominal incisional hernia repair wounds treated with CINPT was conducted. Outcomes for patients treated with CINPT were compared with patients who had not received CINPT acting as a control. Results: A total of 23 patients were treated with CINPT after hernia repair and compared with 12 patients in the control group. A statistically significant decreased rate of return to theatre (odds ratio: 0.12) was found in this study. Non-significant reductions in wound infection, seroma and wound dehiscence were also seen. No adverse events with CINPT therapy were reported. Conclusions: CINPT, when used after large abdominal incisional hernia repair, may help in the prevention of wound complications.

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