Does closed incision negative wound pressure therapy in non‐traumatic major lower‐extremity amputations improve survival rates?

Abstract

Closed incision negative pressure wound therapy (CINPWT) has been shown to be clinically effective compared with the traditional gauze dressing, reducing surgical site infections and wound complications. We evaluated the effect of CINPWT compared with gauze dressing on the need for revision surgery and survival after non‐traumatic major lower amputation. We included 309 patients undergoing 403 major lower amputations in a retrospective study from January 1, 2010 to November 23, 2017. A total of 139 patients received CINPWT, and 170 patients received stump bandage. There was no statistically significant difference between the two groups regarding the need for revision surgery (P = .45). Fourteen stump bandage patients and 15 CINPWT patients died in hospital (P = .57). One year after amputation, 55 CINPWT patients and 66 stump bandage patients had died (P = .82). Survival probabilities adjusted for age and gender 2 years after amputation were .52 (.43‐.61) and .49 (.42‐.58), respectively, and 3 years after amputation were .36 (.25‐.50) and .39 (.32‐.47), respectively. We also found no significant difference in the need for revision surgery in survival probabilities up till 3 years after amputation between patients treated with CINPWT and patients treated with gauze bandage postoperatively.

Incisional negative pressure wound therapy to reduce surgical-site infections in major limb amputations: a meta-analysis

“…These papers were scanned, and any duplicates or topic-unrelated articles were excluded. After analyzing the eligibility criteria, three of the seven studies could be included in our quantitative analysis (2,11,12). There were three retrospective casecontrol studies containing a total of 457 patients.…”

“…Lower extremity amputation bears a high risk for postsurgical wound infections (1). Multi-morbid patients with diabetes-induced peripheral arterial disease represent the main subjects of major lower limb amputations (2). A combination of impaired blood supply and hyperglycemic states further increases the risk of surgical-site infections (3,4).…”

Closed-incision negative-pressure wound management in surgery—literature review and recommendations

“…The authors concluded that ciNPWT may be used to reduce wound healing deficits in patients following periprosthetic lower limb fractures (level IV) [13]. In another retrospective case-control study, 309 patients undergoing 403 major lower limb amputations for non-traumatic indications were analysed with a specific focus on the potential effect of ciNPWT on postoperative survival rates [14]. Most common indications for lower limb amputation were diabetes and chronic wounds.…”

“…Furthermore, there was no significant difference between the two groups with regards to rate of revision surgery (12.2% vs. 15.9%; ciNPWT vs. control; p = 0.740). The authors concluded that ciNPWT does not improve survival probability in patients undergoing major lower limb amputation for non-traumatic indications (level IV) [14]. Zayan et al [15] published results of a retrospective case series including 4 patients with upper limb amputation and 21 patients with lower limb amputation.…”

Clinical Applications and Benefits of Using Closed-incision Negative Pressure Therapy with Novel Dressing: A Review Article

“…Wound healing is strictly regulated by cytokines and growth factors released at the wound site [8]. Regeneration is uncommon, although there are hopes of forming a similar structure with the parent tissue [9]. Healing results in functionality and structurally satisfactory but not identical results [10].…”