Closed-incision negative-pressure therapy decreases complications in ventral hernia repair with concurrent panniculectomy

Diaconu, Silviu C.; McNichols, Colton H.; Ngaage, Ledibabari M.; Liang, Yuanyuan; Ikheloa, Eseigboria; Bai, Jennifer; Grant, Michael P.; Nam, Arthur J.; Rasko, Yvonne M.

doi:10.1007/s10029-018-1865-2

Cited by 21 publications

(34 citation statements)

References 27 publications

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“…The decision to utilize iVAC therapy was surgeon-dependent. iVAC therapy is thought to improve wound healing by creating a protective barrier, removing fluid and infectious materials from the incision, providing a better approximation of wound edges with decreased lateral tissue tension, and a potential increase in micro-circulation and oxygen saturation [2,[14][15][16][17][18]. Furthermore, previous studies have found iVAC use to be associated with lower rates of surgical site infections than traditional dressings in high-risk patients [2,20,23].…”

Section: Discussionmentioning

confidence: 99%

“…Another approach to complication rate reduction in groin surgery is with the use of vacuum-assisted incisional closure therapy (iVAC). The use of iVAC therapy is thought to provide benefits and decrease complication rates by acting as a barrier to the incision from external infectious sources, helping promote skin edge apposition, remove fluid and infectious materials from the incision, and increase microcirculation [2,[14][15][16][17][18]. A recent meta-analysis of iVAC therapy in patients undergoing groin vascular surgery has shown a statistically significant improvement in outcomes over traditional dressings [6].…”

Section: Introductionmentioning

confidence: 99%

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Vacuum-Assisted Incisional Closure Therapy After Groin Reconstruction With Muscle Flap

Taylor

Ngaage

Wasicek

et al. 2021

Cureus

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BackgroundGroin reconstruction with muscle flap coverage is associated with high wound complication rates. Incisional vacuum-assisted closure (iVAC) therapy may lower wound complications. We evaluated the impact of iVAC on postoperative outcomes in patients following groin reconstruction with muscle flap coverage. MethodsWe conducted a retrospective review of patients who underwent groin reconstruction with muscle flap coverage in 2012-2018. Patients were divided into those who received iVAC therapy and those who received standard sterile dressings (SSD). ResultsOf the 57 patients included, most received iVAC therapy (71%, n = 41) and the rest received SSD (28%, n = 16). The iVAC group had higher rates of diabetes, hypertension, coronary artery disease, and peripheral artery disease (p < 0.05). However, iVAC patients had comparable length of hospital stay (12 vs 8.5 days p = 0.0735), reoperations (34% vs 31%, p = 0.8415), and readmissions (32% vs 37%, p = 0.6801) with SSD patients. iVAC placement was less likely in prophylactic flaps (odds ratio 0.08, p = 0.0049). ConclusionPatients with a prophylactic flap were less likely to receive vacuum therapy, which may highlight a selection bias where surgeons pre-emptively use iVAC therapy in surgical candidates identified as high risk. The preemptive use of iVAC may minimize adverse postoperative outcomes in high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Vacuum-Assisted Incisional Closure Therapy After Groin Reconstruction With Muscle Flap

Taylor

Ngaage

Wasicek

et al. 2021

Cureus

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“…Included studies were recent, with the first included study reporting the use of pNPWT being published in 2012 42 . Thirteen publications were retrospective studies [23][24][25][26][27][28][29][30][31]37,39,42,43 , three were prospective studies 34,38,40 and five were RCT 32,33,35,36,41 . Eleven studies were observational studies with non-randomized controls [23][24][25]27,[29][30][31]37,38,40,43 , and five studies had historical controls consecutive to change of practice 26,28,34,39,42 .…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Thirteen publications were retrospective studies [23][24][25][26][27][28][29][30][31]37,39,42,43 , three were prospective studies 34,38,40 and five were RCT 32,33,35,36,41 . Eleven studies were observational studies with non-randomized controls [23][24][25]27,[29][30][31]37,38,40,43 , and five studies had historical controls consecutive to change of practice 26,28,34,39,42 . SSI was mostly defined according to the CDC criteria 23,25,28,29,31,33,35,36,[38][39][40][41] (Table S3).…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Prophylactic Negative-pressure Wound Therapy Prevents Surgical Site Infection in Abdominal Surgery: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies

Meyer¹,

Röös

Abbassi

et al. 2020

Clinical Infectious Diseases

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Background Prevention of surgical site infection (SSI) is a public health challenge. Our objective was to determine if pNPWT allows preventing SSI after laparotomy. Methods MEDLINE, Embase and Web of Science were searched on the 06.10.2019 for original studies reporting the incidences of SSI in patients undergoing open abdominal surgery with and without pNPWT. Risk difference (RD) between control and pNPWT patients and risk ratios (RR) for SSI were obtained using random effects models. Results Twenty-one studies (2’930 patients, five RCT, 16 observational studies) were retained for the analysis. Pooled RD between patients with and without pNPWT was -12% (95%CI: -17% to -8%, I2: 54%, p&0.00001) in favor of pNPWT. That risk difference was -12% (95% CI: -22 to -1%, I2 : 69%, p=0.03) when pooling only RCT (792 patients). pNPWT was protective against the incidence of SSI with a RR of 0.53 (95%CI: 0.40-0.71, I 2: 56%, p&0.0001). The effect on pNPWT was more prononced in studies with an incidence of SSI≥20% in the control arm. The preventive effect of pNPWT on SSI remained after correction for potential publication bias. However, when pooling only high-quality observational studies (642 patients) or RCT (527 patients), significance was lost. Conclusion Existing studies suggest that pNPWT on closed wounds is protective against the occurrence of SSI in abdominal surgery, but these findings need to be confirmed by more high quality evidence, preferentially in subgroups of patients with an incidence of SSI≥20% in the control arm

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“…Incisional Negative Pressure Wound Therapy (NPWT) has demonstrated improved blood flow, decreased edema, improved lymphatic clearance, and improved mechanical splinting for the incision. 46 , 47 It has been well demonstrated that the use of incisional NPWT can decrease the risk of surgical site occurrences in high-risk wounds through these mechanisms. 46 , 48 – 50 In certain cases of profound lymphedema or when the risk of dehiscence or infection is sufficiently high, the senior author will perform a “French fry, string-of-pearls technique”: this technique takes advantage of both traditional NPWT and incisional NPWT.…”

Section: Intraoperative Considerationsmentioning

confidence: 99%

Panniculectomy: Practical Pearls and Pitfalls

Janis

Jefferson

Kraft

2020

Plastic and Reconstructive Surgery - Global Open

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Summary: Panniculectomy is an increasingly common operation, given the current obesity epidemic and the increasing prevalence of bariatric surgery. At first glance, it could be considered a technically simple operation; however, this procedure can be fraught with complications, given the patient population and high demands placed on compromised abdominal tissue. Sufficient attention must be given to the nuances of patient optimization and surgical planning to maximize safe and ideal outcomes. We highlight our practical tips when performing standard or massive panniculectomy for preoperative optimization, intraoperative techniques, and postoperative management to reduce complication and maximize outcomes of this procedure from a surgeon’s and a patient’s perspective.

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Closed-incision negative-pressure therapy decreases complications in ventral hernia repair with concurrent panniculectomy

Cited by 21 publications

References 27 publications

Vacuum-Assisted Incisional Closure Therapy After Groin Reconstruction With Muscle Flap

Vacuum-Assisted Incisional Closure Therapy After Groin Reconstruction With Muscle Flap

Prophylactic Negative-pressure Wound Therapy Prevents Surgical Site Infection in Abdominal Surgery: An Updated Systematic Review and Meta-analysis of Randomized Controlled Trials and Observational Studies

Panniculectomy: Practical Pearls and Pitfalls

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