Closed incision negative pressure therapy: international multidisciplinary consensus recommendations

Abstract

Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words 'prevention', 'negative pressure wound therapy (NPWT)', 'active incisional management', 'incisional vacuum therapy', 'incisional NPWT', 'incisional wound VAC', 'closed incisional NPWT', 'wound infection', and 'SSIs' identified peer-reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m 2 ); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high-risk procedure or a procedure that would have highly morbid consequences if an SSI occurred.

Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study

“…Patient age (P < 0⋅0005) 2 Diabetes mellitus (P < 0⋅0005) 2 Renal insufficiency (P < 0⋅0005) 2 Overweight (P < 0⋅0005) 2 Operation time (P < 0⋅0005) 2 Malnutrition (P = 0⋅043) 1 Wound length (P = 0⋅003) 1 Perioperative blood transfusion (P = 0⋅004) 1 be specifically used as an efficient incision management measure to prevent postoperative inguinal WHCs. A similar conclusion was presented by Willy et al in the international multidisciplinary consensus recommendations, where the experts examined 100 publications and recommended the consideration of ciNPT use for patients with risk factors and high-risk procedures (42). Given the fact that the study data regarding the application of ciNPT in groin wounds after vascular surgery are based solely on the clinical examinations with the PREVENA™ Incision Management Therapy System, the question arises whether other ciNPT systems can achieve a similar positive effect on groin wounds.…”

“…A similar conclusion was presented by Willy et al . in the international multidisciplinary consensus recommendations, where the experts examined 100 publications and recommended the consideration of ciNPT use for patients with risk factors and high‐risk procedures . Given the fact that the study data regarding the application of ciNPT in groin wounds after vascular surgery are based solely on the clinical examinations with the PREVENA™ Incision Management Therapy System, the question arises whether other ciNPT systems can achieve a similar positive effect on groin wounds.…”

Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies

“…Originally developed by Argenta and Morykwas in the 1990s, 17,18 NPWT has revolutionized the treatment of complex wounds, and is currently used not only in the acute care hospital setting, but also increasingly in nursing facilities, home care settings, and internationally. 16 There is a growing body of literature reporting the use of NPWT for closed primary incisions to decrease wound complications 19–23 and specifically closed abdominal laparotomy incisions in general surgery patients, 24–27 including a retrospective case-control series from our own institution. 28 All of these reports suggest NPWT can substantially reduce wound complications and SSIs compared with standard surgical dressing (SSD).…”

The impact of surgical site occurrences and the role of closed incision negative pressure therapy

“…In December 2014, a multidisciplinary group of surgical and infectious disease experts met to discuss present clinical experience with ciNPT and recommendations for its use in different surgical incisions . Based on the literature and clinical experience, an algorithm for when surgeons might consider using ciNPT was developed.…”