Does Negative Pressure Wound Therapy Have a Role in Preventing Poststernotomy Wound Complications?

Atkins, B. Zane; Wooten, Mary Kay; Kistler, Jean; Hurley, Kista; Hughes, G. Chad; Wolfe, Walter G.

doi:10.1177/1553350609334821

Cited by 113 publications

(140 citation statements)

References 37 publications

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“…The effect of iNPWT on wound exudate might be explained by the known biomechanical mechanisms that iNPWT applies to the tissue, such as a reduction in oedema, increased blood flow14, 19 and lymph clearance21. In contrast to the study on wound exudate (S. Karlakki et al ., personal communication), the study that investigated ‘days to dry wounds’33 as a primary outcome found no effect of iNPWT.…”

Section: Discussionmentioning

confidence: 91%

“…In the latter case, the liquid is removed by evaporation through a semipermeable dressing. The mechanisms of action of this closed incision management have been supported by biomechanical studies: increased blood flow14, 19; decreased lateral and shear stress at the suture lines with decreased risk of wound dehiscence20; and increased lymph clearance with reduced formation of haematoma/seroma21 ( Fig . 1).…”

Section: Introductionmentioning

confidence: 97%

“…In recent years, the indication for NPWT has been extended to include treatment of closed surgical incisions (incisional NPWT, iNPWT). Some of the first studies were case series13, 14 and observational studies15, 16 using one of the existing NPWT devices (VAC®; KCI, San Antonio, Texas, USA) designed for open wounds17, 18. Two simplified NPWT devices became commercially available in 2010 (Prevena™; KCI) and 2011 (PICO™; Smith & Nephew, Hull, UK).…”

Section: Introductionmentioning

confidence: 99%

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Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

199

172

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BackgroundPostoperative wound complications are common following surgical procedures. Negative‐pressure wound therapy (NPWT) is well recognized for the management of open wounds and has been applied recently to closed surgical incisions. The evidence base to support this intervention is limited. The aim of this study was to assess whether NPWT reduces postoperative wound complications when applied to closed surgical incisions.MethodsThis was a systematic review and meta‐analysis of randomized clinical trials of NPWT compared with standard postoperative dressings on closed surgical incisions.ResultsTen studies met the inclusion criteria, reporting on 1311 incisions in 1089 patients. NPWT was associated with a significant reduction in wound infection (relative risk (RR) 0·54, 95 per cent c.i. 0·33 to 0·89) and seroma formation (RR 0·48, 0·27 to 0·84) compared with standard care. The reduction in wound dehiscence was not significant. The numbers needed to treat were three (seroma), 17 (dehiscence) and 25 (infection). Methodological heterogeneity across studies led to downgrading of the quality of evidence to moderate for infection and seroma, and low for dehiscence.ConclusionCompared with standard postoperative dressings, NPWT significantly reduced the rate of wound infection and seroma when applied to closed surgical wounds. Heterogeneity between the included studies means that no general recommendations can be made yet.

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Section: Discussionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Meta-analysis of negative-pressure wound therapy for closed surgical incisions

Hyldig

Birke-Sørensen

Kruse

et al. 2016

British Journal of Surgery

199

172

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“…Grauhan et al [111] showed significant reduction of SSIs in obese patients (body mass index > 30 kg/m 2 ) with median sternotomy compared with patients treated with standard wound dressings. In general, retrospective studies and randomized controlled trials provided a substantial body of evidence that the use of this prophylactic wound dressing technique may reduce the incidence of wound infections [112][113][114] . …”

mentioning

confidence: 99%

Deep sternal wound infection after cardiac surgery: Evidences and controversies

Cotogni

Barbero

Rinaldi

2015

WJCCM

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Despite many advances in prevention and perioperative care, deep sternal wound infection (DSWI) remains a pressing concern in cardiac surgery, with a still relevant incidence and with a considerable impact on in-hospital mortality and also on mid-and long-term survival. The permanent high impact of this complication is partially related to the increasing proportion of patients at highrisk for infection, as well as to the many patient and surgical risk factors involved in the pathogenesis of DSWI. The prophylactic antibiotic therapy is one of the most important tools in the prevention of DSWI. However, the choice of antibiotic, the dose, the duration, the adequate levels in serum and tissue, and the timing of antimicrobial prophylaxis are still controversial. The treatment of DSWI ranges from surgical revision with primary closure to surgical revision with open dressings or closed irrigation, from reconstruction with soft tissue flaps to negative pressure wound therapy (NPWT). However, to date, there have been no accepted recommendations regarding the best management of DSWI. Emerging evidence in the literature has validated the efficacy and safety of NPWT either as a single-line therapy, or as a "bridge" prior to final surgical closure. In conclusion, the careful control of patient and surgical risk factors -when possible, the proper antimicrobial prophylaxis, and the choice of validated techniques of treatment could contribute to keep DSWIs at a minimal rate. Core tip: Intensivists and cardiothoracic surgeons are commonly worried about surgical site infections due to increasing length of stay, costs, and mortality. In particular, deep sternal wound infection (DSWI) is a worrying complication after cardiac surgery, with a still relevant incidence. Unfortunately, DWSI appearance is related to a wide number of both patient and surgical factors. This review may be useful for guiding physicians to the knowledge of main risk factors and the choice of the appropriate management of DWSIs with the aim of reducing the rate of this potentially devastating complication in cardiac surgery patients.Cotogni P, Barbero C, Rinaldi M. Deep sternal wound infection after cardiac surgery: Evidences and controversies. World J Crit Care Med 2015; 4(4): 265-273 Available from: URL: http:// www.wjgnet.com/2220-3141/full/v4/i4/265.htm DOI: http:// dx.doi.org/10.5492/wjccm.v4.i4.265 INTRODUCTIONDeep sternal wound infection (DSWI) is one of the most complex and potentially devastating complications following median sternotomy in cardiac surgery with a significant impact on both patient prognosis and hospital budgets [1][2][3][4][5] . Despite many advances in prevention, it still remains significant and ranges between 0.5% and 6.8% [6][7][8][9][10] , with in-hospital mortality rates between 7% and 35% [2,3,7,9,[11][12][13] . Moreover, mid-and long-term survival is significantly reduced in patients that have experienced DSWI. By the end of the first year, Filsoufi et al [6] found a 15% absolute survival difference between patients ...

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“…However a more recent randomized controlled trial evaluating the impact of gentamicin-soaked collagen sponge on poststernotomy wound infection did not show a n a d v a n t a g e o f t h i s a p p r o a c h o v e r controls [116]. Based on the aforementioned successes with NPT in the treatment of documented DSWI we and others have recently evaluated the application of NPT to clean, closed incisions as a method to prevent complications in high-risk wounds [117,118]. We initially applied this form of "well wound therapy" in a cohort of 57 adult cardiac surgery patients known to be at increased risk for DSWI based on a validated risk stratification model [13].…”

Section: Can Mediastinitis Be Prevented?mentioning

confidence: 99%