Negative Pressure Wound Therapy for Closed Surgical Wounds in Musculoskeletal Oncology Patients - A Case-Control Trial

Following excision of musculoskeletal tumours, patients are at high risk of wound issues such as infection, dehiscence and delayed healing. This is due to a multitude of factors including the invasive nature of the disease, extensive soft tissue dissection, disruption to blood and lymphatic drainage, residual cavity and adjuvant therapies. The use of negative pressure wound therapy (NPWT) has a growing body of evidence on its beneficial effect of wound healing such as promoting cell differentiation, minimising oedema and thermoregulation. Traditionally, these dressings have been used for open or dehisced wounds; however recent research has investigated its role in closed wounds.Aim:To evaluate the effect of NPWT in patients with closed wounds, either primarily or with flap coverage, in our high risk group. Consecutive patients who had a NPWT dressing applied were selected, and a control group was established by a blinded researcher with matching for tissue diagnosis, surgical site, gender and age. The primary outcome measured was documented for wound complications, with secondary data collected on radiotherapy and wound drainage.Results:Patients were well matched between the intervention (n=9) and control (n=9) groups for gender, age and tissue diagnosis. Both groups had 1 patient who underwent preoperative radiotherapy. A total of 3 wound infections occurred in the control group and none in the NPWT group. Overall there was a trend towards lower drain output and statistically significantly reduced infection rate in the NPWT group.Conclusion:In this short series, despite the NPWT patients having more additional risk factors for wound issues, they resulted in fewer infections. The sample size is not sufficient to have statistically significant reduction. Further evaluation on the value of NPWT in this patient group should be prospectively evaluated.

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2186 Towards Zero SSIs: Incisional Negative Pressure Wound Therapy in High Risk Gynecologic Surgery Patients May Reduce Infections but not Overall Wound Complications

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2019.09.295 ◽

2019 ◽

Vol 26 (7) ◽

pp. S166

Author(s):

KE Nixon ◽

SK Warring ◽

SS Paknikar ◽

AL Weaver ◽

ME Mc Gree ◽

...

Keyword(s):

High Risk ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Gynecologic Surgery ◽

Wound Complications ◽

Wound Therapy

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The Utility of Disposable Negative Pressure Wound Therapy (PICO) in Wound Healing of Latissimus Dorsi Musculocutaneous Flap Donor Sites

Journal of Wound Management and Research ◽

10.22467/jwmr.2019.00983 ◽

2020 ◽

Vol 16 (1) ◽

pp. 21-25

Author(s):

Jeoung Hyun Nam ◽

Eun Soo Park ◽

Seok Hwan Kim

Keyword(s):

Wound Healing ◽

Negative Pressure ◽

Latissimus Dorsi ◽

Negative Pressure Wound Therapy ◽

Musculocutaneous Flap ◽

Wound Complications ◽

Control Group ◽

Dressing Method ◽

Wound Therapy ◽

Latissimus Dorsi Musculocutaneous Flap

Background: Among treatments aiming to solve surgical wound complications, negative pressure wound therapy (NPWT) is considered an innovative method. NPWT can promote wound healing, protect the wound from infection and reduce the tension on suture sites. At the same time, the large machine required in the therapy led to some inconvenience. The PICO system has recently been developed as a simple pocket-sized NPWT device. By comparing the time required for healing of the wound, incidence of wound complications, duration of hospital stays, and dressing costs, we attempted to confirm the utility of PICO for managing latissimus dorsi musculocutaneous flap donor sites.Methods: PICO was used on nine donor sites of patients who had undergone breast reconstruction using latissimus dorsi musculocutaneous flaps. PICO was applied immediately after operation and removed on the 9th day. In the control group, daily conventional dressings were administered commensurate with the condition of the wounds. We defined the wound healing time to the point when no more dressing was needed. For the costs of dressing, only costs incurred on the donor sites were included.Results: Wound healing was proven to be faster in the PICO group (P=0.035) versus the control group, and no complications were observed in the PICO group. Also, the cost of PICO was lower compared to the costs incurred by the conventional dressing method (P<0.001).Conclusion: We suggest that PICO can reduce wound complications on areas where anatomical movement could lead to tension, while also reducing dressing costs.

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Negative pressure wound therapy (NPWT) on closed incisions to prevent surgical site infection in high-risk patients in hepatopancreatobiliary surgery: study protocol for a randomized controlled trial—the NP-SSI trial

Trials ◽

10.1186/s13063-020-04831-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Frank W. Brennfleck ◽

Lena Linsenmeier ◽

Henrik H.G. Junger ◽

Katharina M. Schmidt ◽

Jens M. Werner ◽

...

Keyword(s):

Surgical Site Infection ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Wound Complications ◽

Control Group ◽

Complication Rates ◽

Site Infection ◽

Wound Therapy ◽

Randomized Controlled ◽

Incisional Ssis

Abstract Background Incisional surgical site infections (iSSI) in hepatopancreatobiliary (HPB) surgery usually lead to prolonged hospital stays, consume valuable resources, and impact on patients’ outcome. Prophylactic closed incision negative pressure wound therapy (ciNPWT) to decrease wound complications has become available. Owing to an increasing number of studies, evidence for superiority in many indication areas has accumulated; however, in general surgery, there are a few data and those have shown contradictory results. Methods In this monocentric, prospective, randomized, controlled, two-armed study, the influence of ciNPWT on incisional surgical site infection rates after HPB operations will be investigated. A total of 222 patients will be randomized 1:1 to an interventional group (7-day treatment with ciNPWT) or a control group (treated with gauze dressing). The primary parameter to evaluate efficacy is the rate of incisional SSIs within 30 days after surgery. Additionally, several clinically relevant secondary outcomes will be assessed. Discussion A reduction in the rate of incisional SSIs would not only lead to a significant cost reduction and shorter postoperative length of stay, but may also improve postoperative quality of life for patients. While earlier publications have shown advantages for ciNPWT, recent studies did not confirm a positive effect regarding iSSI rate. Even if iSSI rate is not reduced, findings obtained from the secondary endpoints may be of clinical relevance, such as reduction of wound complication rates. Trial registration This trial has been registered in the German Clinical Trials Register, DRKS 00015136. Registered on 19 February 2019 and has been approved by the local ethics committee of the University of Regensburg: 18-1225-101.

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Expanded negative pressure wound therapy in healing diabetic foot ulcers: a prospective randomised study

Journal of Wound Care ◽

10.12968/jowc.2021.30.2.121 ◽

2021 ◽

Vol 30 (2) ◽

pp. 121-129

Author(s):

Ferdinando Campitiello ◽

Manfredi Mancone ◽

Angela Della Corte ◽

Raffaella Guerniero ◽

Silvestro Canonico

Keyword(s):

Negative Pressure ◽

Diabetic Foot ◽

Negative Pressure Wound Therapy ◽

Healing Time ◽

Primary Objective ◽

Foot Ulcers ◽

Wound Complications ◽

Control Group ◽

Diabetic Foot Ulcers ◽

Wound Therapy

Objective: This study aims to evaluate the benefits of treating diabetic foot ulcers (DFU) through a revised procedure using the mechanisms underlying negative pressure wound therapy (NPWT) in such a way as to achieve reduced and more evenly distributed lateral tension lines across the wound. Method: Patients with type 2 diabetes were assessed for elegibility. Included patients were divided randomly into two groups: the NPWT control group and the NPWT+ group. Patients in the NPWT control group were treated in the traditional manner: wounds were covered with foams shaped to fit the wound precisely. In the NPWT+ group, foams were shaped to fit the wound precisely, and an additional foam was then wrapped around the foot. Results: Some 85 patients were assessed for eligibility; 59 were randomised into two groups: 29 patients in the NPWT+ group and 30 patients in the NPWT group. The primary objective was median healing time (NPWT+ 19 days, interquartile ratio (IQR) 7.5; NPWT 33 days, IQR 16; p<0.00001), and complete wound healing at three weeks (NPWT+ 55.20% NPWT 26.70% p=0.02). Secondary endpoints included number of major amputations (none in either group) and number of infections (NPWT+ 3.44% of patients, NPWT 6.66% of patients; p=0.57). Conclusion: Our initial findings show that this treatment significantly reduced wound closure times and accelerated healing in DFUs. It also demonstrated promising improvements in healing rates, with no significant increase in wound complications.

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Use of incisional vacuum-assisted closure in the prevention of postoperative infection in high-risk patients who underwent spine surgery: a proof-of-concept study

Journal of Neurosurgery Spine ◽

10.3171/2019.2.spine18947 ◽

2019 ◽

Vol 31 (3) ◽

pp. 430-439 ◽

Cited By ~ 1

Author(s):

Bailey A. Dyck ◽

Christopher S. Bailey ◽

Chris Steyn ◽

Julia Petrakis ◽

Jennifer C. Urquhart ◽

...

Keyword(s):

High Risk ◽

Diagnostic Criteria ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Wound Dressings ◽

Control Group ◽

Proof Of Concept ◽

Risk Of Infection ◽

Vacuum Assisted Closure ◽

Wound Therapy

OBJECTIVEThis proof-of-concept study was conducted to determine whether negative-pressure wound therapy, through the use of incisional vacuum-assisted closure (VAC), is associated with a reduction in surgical site infections (SSIs) when compared to standard wound dressings in patients undergoing open posterior spinal fusion who have a high risk of infection.METHODSA total of 64 patients were examined; 21 patients received incisional VAC application (VAC group) versus 43 diagnosis-matched patients who received standard wound dressings (control group). Patients in the VAC group were prospectively enrolled in a consecutive series between March 2013 and March 2014 if they met the following diagnostic criteria for high risk of infection: posterior open surgery across the cervicothoracic junction; thoracic kyphosis due to metastatic disease; high-energy trauma; or multilevel revision reconstructive surgery. Patients in the VAC group also met one or more comorbidity criteria, including body mass index ≥ 35 or < 18.5, diabetes, previous radiation at surgical site, chemotherapy, steroid use, bedridden state, large traumatic soft-tissue disruption, or immunocompromised state. Consecutive patients in the control group were retrospectively selected from the previous year by the same high-risk infection diagnostic criteria as the VAC group. All surgeries were conducted by the same surgeon at a single site. The primary outcome was SSI. All patients had 1 year of follow-up after their surgery. Baseline demographics, intraoperative parameters, and postoperative wound infection rates were compared between groups.RESULTSPatient demographics including underlying comorbidities were similar, with the exception that VAC-treated patients were malnourished (p = 0.020). VAC-treated patients underwent longer surgeries (p < 0.001) and required more postoperative ICU admissions (p = 0.039). The median length of hospital stay was not different between groups. In total, 9 control patients (21%) developed an SSI, versus 2 VAC-treated patients (10%).CONCLUSIONSPatients in this cohort were selected to have an increased risk of infection; accordingly, the rate of SSI was high. However, negative-pressure wound therapy through VAC application to the postoperative incision resulted in a 50% reduction in SSI. No adverse effects were noted secondary to VAC application. The preliminary data confirm the authors’ proof of concept and strongly support the need for a prospective randomized trial.

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The effects and use of negative pressure wound therapy – a set of case reports

Perspectives in Surgery ◽

10.33699/pis.2020.99.4.183-188 ◽

2020 ◽

Vol 99 (4) ◽

pp. 183-188

Keyword(s):

Wound Healing ◽

High Risk ◽

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Chronic Wounds ◽

Wide Spectrum ◽

Case Reports ◽

Modern Medicine ◽

Wound Therapy ◽

Basic Set

Modern medicine offers a wide spectrum of wound healing resources for acute or chronic wounds. Negative pressure wound therapy (NPWT) is a very effective method, allowing complicated defects and wounds to heal. The basic set is usually provided with various special accessories to facilitate the use and support safe application of NPWT to high-risk tissue. Selected case reports are presented herein to document the special use and combinations of materials in negative pressure wound therapy.

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Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02221-w ◽

2021 ◽

Author(s):

Johanna C. Wagner ◽

Anja Wetz ◽

Armin Wiegering ◽

Johan F. Lock ◽

Stefan Löb ◽

...

Keyword(s):

Negative Pressure ◽

Wound Closure ◽

Negative Pressure Wound Therapy ◽

Wound Complications ◽

Skin Closure ◽

Wound Treatment ◽

Open Wound ◽

Wound Therapy ◽

Significant Difference ◽

Open Wound Treatment

Abstract Purpose Traditionally, previous wound infection was considered a contraindication to secondary skin closure; however, several case reports describe successful secondary wound closure of wounds “preconditioned” with negative pressure wound therapy (NPWT). Although this has been increasingly applied in daily practice, a systematic analysis of its feasibility has not been published thus far. The aim of this study was to evaluate secondary skin closure in previously infected abdominal wounds following treatment with NPWT. Methods Single-center retrospective analysis of patients with infected abdominal wounds treated with NPWT followed by either secondary skin closure referenced to a group receiving open wound therapy. Endpoints were wound closure rate, wound complications (such as recurrent infection or hernia), and perioperative data (such as duration of NPWT or hospitalization parameters). Results One hundred ninety-eight patients during 2013–2016 received a secondary skin closure after NPWT and were analyzed and referenced to 67 patients in the same period with open wound treatment after NPWT. No significant difference in BMI, chronic immunosuppressive medication, or tobacco use was found between both groups. The mean duration of hospital stay was 30 days with a comparable duration in both patient groups (29 versus 33 days, p = 0.35). Interestingly, only 7.7% of patients after secondary skin closure developed recurrent surgical site infection and in over 80% of patients were discharged with closed wounds requiring only minimal outpatient wound care. Conclusion Surgical skin closure following NPWT of infected abdominal wounds is a good and safe alternative to open wound treatment. It prevents lengthy outpatient wound therapy and is expected to result in a higher quality of life for patients and reduce health care costs.

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