Conventional wound management versus a closed suction irrigation method for infected laparotomy wound – A comparative study

Zhen, Zuo Jun; Lai, Eric C. H.; Lee, Qing Han; Chen, Huan Wei; Lau, Wan Yee; Wang, Feng Jie

doi:10.1016/j.ijsu.2011.02.012

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…After application of inclusion and exclusion criteria, 20 full-text articles were assessed for eligibility. Of these, 9 studies were subsequently excluded; reasons for exclusion are outlined in eTable 1 in the Supplement. Two articles (NEPTUNE [Negative Pressure Wound Therapy Use to Decrease Surgical Nosocomial Events in Colorectal Resections] and PONIY [Postoperative Negative-Pressure Incision Therapy Following Open Colorectal Surgery] trials) were published protocols of RCTs that were currently recruiting patients and were therefore also excluded.…”

Section: Resultsmentioning

confidence: 99%

Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

et al. 2018

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IMPORTANCE Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. OBJECTIVE To evaluate the association of prophylactic NPWT with SSI rates in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. DATA SOURCES The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched without language restrictions for relevant articles from inception until December 2017. The latest search was performed on December 31, 2017. The bibliographies of retrieved studies were further screened for potential additional studies. STUDY SELECTION Randomized clinical trials and nonrandomized studies were included. Unpublished reports were excluded, as were studies that examined NPWT (or standard nonpressure) dressings only without a comparator group. Studies that evaluated the use of NPWT in open abdominal incisions were also excluded. Disagreement was resolved by discussion, and if the question remained unsettled, the opinion of the senior author was sought. A total of 198 citations were identified, and 189 were excluded. DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted according to PRISMA guidelines. Data were independently extracted by 2 authors. A random-effects model was used for statistical analysis. MAIN OUTCOMES AND MEASURES The primary outcome measure was SSI, and secondary outcomes included seroma and wound dehiscence rates. These outcomes were chosen before data collection. RESULTS Nine unique studies (3 randomized trials and 2 prospective and 4 retrospective studies) capturing 1266 unique patients were included. Of these, 1187 patients with 1189 incisions were included in the final analysis (52.3% male among 7 studies reporting data on sex; mean [SD] age, 52 [15] years among 8 studies reporting data on age). Significant clinical and methodologic heterogeneity existed among studies. On random-effects analysis, NPWT was associated with a significantly lower rate of SSI compared with standard dressings (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52; P < .001). However, no difference in rates of seroma (pooled OR, 0.38; 95% CI, 0.12-1.23; P = .11) or wound dehiscence (pooled OR, 2.03; 95% CI, 0.61-6.78; P = .25) was found. On sensitivity analysis, focusing solely on colorectal procedures, NPWT significantly reduced SSI rates (pooled OR, 0.16; 95% CI, 0.07-0.36; P < .001). CONCLUSIONS AND RELEVANCE Application of NPWT on closed laparotomy wounds in general and colorectal surgery is associated with reduced SSI rates but similar rates of seroma and wound dehiscence compared with conventional nonpressure dressings.

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Section: Resultsmentioning

confidence: 99%

Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

et al. 2018

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“…By comparison, in the setting of infected laparotomy wounds, NPWT has been found to decrease the time to healing. Zhen et al [38], in a study of 130 patients found that NPWT significantly decreased the mean time to healing (8.1 vs 18.5 days). As such, we would expect NPWT to shorten the time to healing in our patients.…”

Section: Discussionmentioning

confidence: 99%

Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

2019

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BackgroundAbdominal wall surgical site complications following renal transplantation can be challenging to manage. A sub-group of these recipients will require operative management or advanced wound care such as negative pressure wound therapy (NPWT). The aim of this study was to determine if there were any preoperative, intraoperative and postoperative characteristics in our recipients’ cohort which were associated with the requirement for such interventions.MethodsA retrospective review of medical records was performed for all recipients who sustained abdominal wall complications following renal transplantation at our centre from 2006 to 2016.ResultsA total of 64/828 recipients (7.7%) had abdominal wall complications. The mean weight for these patients was 84.9 kg (±16.6 kg) and the mean body mass index was 30.2 (±5.1). Forty-five recipients (70%) had a superficial wound dehiscence while nine (14%) had a complete fascial dehiscence. Operative intervention was required in 13/64 patients (20%) and was more likely to be required in the presence of a fascial dehiscence (9/9, 100%) or a wound collection (10/31, 32%) (p < 0.001, p = 0.021). NPWT was used in 17/64 patients (27%) and was more commonly required in patients with diabetes mellitus (10/24, 42%), a complete fascial dehiscence (5/9, 56%) or evidence of infection (16/44, 36%) (p = 0.039, p = 0.034, p = 0.008).ConclusionsThe requirement for either operative management or the use of NPWT in the management of abdominal wall complications following renal transplantation in our experience was more common in recipients with diabetes mellitus, and in the setting of either complete fascial dehiscence, abdominal wall wound collections and/ or infection.

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“…Zhen et al in his study posted that the duration of hospital stay was 9 days in patients with drain and 20 days in patients without drain. 12 Similarly, study conducted by Kagita et al found that overall mean duration stay in patients with drain to be 5 to 15 days and 5 to 20 days in patients without subcutaneous drain placement. 13…”

Section: Discussionmentioning

confidence: 90%

Role of closed subcutaneous drain in prevention of surgical site infection in perforation peritonitis

et al. 2023

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Background: Surgery for perforation peritonitis is associated with the highest rates of infective complications, especially surgical site infection. SSI occurs due to failure of obliteration of dead space during abdominal wound closure resulting in formation of hematoma and seroma collection in the surgical wound viz. abdominal wound in cases of perforation peritonitis. This acts as a good culture medium for bacterial organisms to grow and cause wound infection. The bacterial pathogens can be either from intra-abdominal sepsis or nosocomial in origin. Closed suction drains can be used effectively to eliminate dead space in the wound and evacuates the seroma or hematoma collection, thereby reducing chances of SSI and also helps in early detection of SSI by inspecting the nature of drain output. Aim was to evaluate the role of closed suction drains in prevention of SSI in cases of perforation peritonitis. Methods: Comparative study of 60 cases of perforation peritonitis divided into two equal groups (Group A patient with closed suction drain in subcutaneous space vs. Group B patient without closed suction drain). Outcomes of SSI were compared. Results: The incidence of SSI in Group A was 33% whereas in Group B was 70%. 40% cases in SSI in Group A whereas 76% cases of SSI in Group B developed wound dehiscence. Most cases of SSI was diagnosed on POD 2 for Group A and on POD 4 for Group B. Conclusions: The study supports use of closed suction drain in perforation peritonitis for prevention, early detection and appropriate management of SSI.

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Conventional wound management versus a closed suction irrigation method for infected laparotomy wound – A comparative study

Cited by 6 publications

References 7 publications

Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

Role of closed subcutaneous drain in prevention of surgical site infection in perforation peritonitis

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