Evaluation of closed incision management with negative pressure wound therapy (CIM): Hematoma/seroma and involvement of the lymphatic system

Abstract

The objective of this porcine study was to evaluate the effect of closed incision management with negative pressure wound therapy (CIM) on hematoma/seroma formation, fluid removal into the CIM canister, and involvement of the lymphatic system. In each swine (n = 8), two sets of ventral contralateral subcutaneous dead spaces with overlying sutured incisions were created. Stable isotope-labeled nanospheres were introduced into each subcutaneous dead space. Each contralateral incision was assigned to CIM (continuous -125 mmHg negative pressure) and control (semipermeable film dressing), respectively. Following 4 days of therapy, hematoma/seroma was weighed, total fluid volume in canisters was measured, five pre-identified lymph nodes were harvested, and five key organs were biopsied. There was 25 ± 8 g (standard error [SE]) (63%) less hematoma/seroma in CIM sites compared to control sites (p = 0.002), without any fluid collection in the CIM canister. In lymph nodes, there were ∼60 μg (∼50%) more 30- and 50-nm nanospheres from CIM sites than from control sites (p = 0.04 and 0.05, respectively). There was significantly greater nanosphere incidence from CIM sites than from control sites in lungs, liver, and spleen (p < 0.05); no nanospheres were detected in kidney biopsies. Thus, in this porcine model, application of CIM significantly decreased hematoma/seroma levels without fluid collection in the canister, which may be explained by increased lymph clearance.

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

“…However, with a mean reduction of 1·97 ml (day 5) and 1·44 ml (day 10), the clinical relevance is questionable. A larger effect was found in an animal study21 focusing on the effect of iNPWT treatment on lymph clearance. The authors found that 4 days of treatment reduced the quantity of haematoma/seroma by a mean(s.e.m.)…”

“…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.…”

“…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).…”

Preliminary Outcome of Treatment of Postoperative Primarily Closed Sternotomy Wounds Treated Using Negative Pressure Wound Therapy

“…It provides wound integrity, eliminating free spaces in the subcutaneous tissue between the layers of deep and superficial sutures, reducing the risk of hematoma formation (8). Kilpadi et Cunningham in an animal model evaluated significantly reduced incidence of hematoma formation in wounds treated using negative pressure therapy as compared to the control group, without collection of fluid in the container connected to the system, which can be explained by more extensive elimination from necrotic wound areas through the lymphatic system (9). Systems for the treatment of primarily closed wounds are composed of a tight dressing applied on the wound, overlapping on the skin around the wound, connected via a tube with a small pump generating negative pressure.…”

23rd Annual Meeting of the Wound Healing Society; SAWC Spring/WHS Joint Meeting; Silver (25th) Anniversary of the Wound Healing Society

“…Average evolution of wounds was 3.68 years, with an initial area of 31.76 cm 2 . .At the end of the treatment average wound size was 3.43 cm 2 . A global improvement in wound closure of 96.81% was observed after 49 days period.…”