Closed-Incision Negative-Pressure Therapy in Obese Patients Undergoing Cesarean Delivery: A Randomized Controlled Trial

Gunatilake, Ravindu; Swamy, Geeta K.; Brancazio, Leo R.; Smrtka, Michael P.; Thompson, Jennifer L.; Gilner, Jennifer; Gray, Beverly; Heine, R. Phillips

doi:10.1055/s-0037-1603956

Cited by 51 publications

(74 citation statements)

References 17 publications

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“…The reduction in overall complications and hospital stay are directly related to each other and both have been reported before. 13,15,17,18,27 Our results vary from some earlier reports 14,15,20 where a reduction in the number of complications requiring surgery was reported. Our study did not find this during the initial stay in hospital, but we found a reduction in open wounds at 3 months after surgery, which indirectly resulted in a reduction for the need of later surgical revisions.…”

Section: Discussioncontrasting

confidence: 99%

“…Negative pressure treatment resulted in several positive outcomes, such as decrease in overall complications, significantly reduced length of stay in hospital, and decrease in the number of open recurrent wounds at 3 months after discharge from hospital, which are all important outcome measures. The reduction in overall complications and hospital stay are directly related to each other and both have been reported before . Our results vary from some earlier reports where a reduction in the number of complications requiring surgery was reported.…”

Section: Discussionsupporting

confidence: 70%

“…31 Incisional negative pressure therapy for closed wounds has shown to be beneficial in several surgical subgroups. [12][13][14][15][17][18][19][20][22][23][24][25][26][27] It has not, however, been reported before in the treatment after pressure ulcer reconstructions. The current study aimed to see whether there was a difference in rates of acute and late wound-healing complications or other outcome measures when the postoperative dressing was switched from a regular wound dressing to an incisional negative pressure wound dressing in this very specific group of challenging patients.…”

Section: Discussionmentioning

confidence: 99%

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Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction

Papp

2018

International Wound Journal

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Complications after pressure ulcer reconstruction are common. A complication rate of 21% to 58% and a 27% wound recurrence has been reported. The aim of this study was to decrease postoperative wound‐healing complications with incisional negative pressure wound therapy (iNPWT) postoperatively. This was a prospective non‐randomised trial with a historic control. Surgically treated pressure ulcer patients receiving iNPWT were included in the prospective part of the study (Treatment group) and compared with the historic patient cohort of all consecutive surgically treated pressure ulcer patients during a 2‐year period preceding the initiation of iNPWT (Control). There were 24 patients in the Control and 37 in the Treatment groups. The demographics between groups were similar. There was a 74% reduction in in‐hospital complications in the Treatment group (10.8% vs 41.7%, P = 0.0051), 27% reduction in the length of stay (24.8 vs 33.8 days, P = 0.0103), and a 78% reduction in the number of open wounds at 3 months (5.4 vs 25%, P = −0.0481). Recurrent wounds and history of previous surgery were risk factors for complications. Incisional negative pressure wound therapy shortens hospital stay, number of postoperative complications, and the number of recurrent open wounds at 3 months after reconstructive pressure ulcer surgery, resulting in significant cost savings.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

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Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction

Papp

2018

International Wound Journal

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“…The successful application of ciNPT on clean, closed wounds has been reported in a broad spectrum of patients and operative interventions resulting in positive clinical results in a majority of the RCTs identified in the literature search ( Table 2) [11][12][13][14][15][16][17][18][19]. Similarly, rates of SSIs, surgical site complications, readmissions, and/or reoperations were reduced in patients receiving ciNPT compared to historical control populations [20][21][22][23][24][25].…”

Section: Literature Searchmentioning

confidence: 95%

Closed Incision Negative Pressure Therapy: Review of the Literature

Fernández¹,

Matthews²,

Alvarez³

et al. 2019

Cureus

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Surgical site infection and other common surgical site complications (dehiscence, hematoma, and seroma formation) can lead to serious and often life-threatening complications. Gauze, adhesive dressings, and skin adhesives have traditionally been utilized for incision management. However, the application of negative pressure wound therapy over clean, closed surgical incisions (closed incision negative pressure therapy, ciNPT), has become a recent option for incision management. A brief review of ciNPT clinical evidence and health economic evidence are presented. A brief literature review was performed using available publication databases (PubMed, Ovid®, Embase®, and QUOSA™) for articles in English reporting on the use of ciNPT between October 1, 2016, to March 31, 2019. The successful application of ciNPT over clean, closed wounds has been reported in a broad spectrum of patients and operative interventions, resulting in favorable clinical results. Four of the five studies that examined health economics following the use of ciNPT reported a potential reduction in the cost of care. The authors' own experience and published results suggest that patients at high risk for developing a surgical site complication may benefit from the use of ciNPT during the immediate postoperative period. Additional studies are needed across various surgical disciplines to further assess the safety, and cost-effectiveness of ciNPT use in patient populations.

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“…A total of 35 articles discussed prophylactic VSD (pVSD) for abdominal incisions with primary suture, of which 6 were RCTs 32 , 33 , 34 , 35 , 36 , 37 and 29 were observational studies. 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 …”

Section: Recommendationsmentioning

confidence: 99%

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

Sun

et al. 2019

Chinese Journal of Traumatology

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Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2–4. Weak recommendations were made regarding questions 1 and 5–11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

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Closed-Incision Negative-Pressure Therapy in Obese Patients Undergoing Cesarean Delivery: A Randomized Controlled Trial

Cited by 51 publications

References 17 publications

Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction

Incisional negative pressure therapy reduces complications and costs in pressure ulcer reconstruction

Closed Incision Negative Pressure Therapy: Review of the Literature

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

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