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

Hyldig, Nana; Birke-Sørensen, Hanne; Kruse, Marie; Vinter, Christina Anne; Joergensen, Jan Stener; Sørensen, Jesper Roed; Mogensen, Ole; Lamont, Ronnie; Bille, Camilla

doi:10.1002/bjs.10084

Cited by 199 publications

(195 citation statements)

References 43 publications

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“…Gillespie et al 96 conducted a pilot RCT to evaluate the utility of NPWT among 70 elective hip arthroplasty patients, demonstrating only a 3% reduction in SSI incidence. In a meta-analysis of NPWT use across an array of different surgical procedures, Hyldig et al 97 reported that the use of NPWT was associated with significant reduction in wound infection and seroma formation. Among high-risk patients, Stannard et al 98 conducted an RCT of 263 randomized patients with lower extremity fractures showing SSI reduction from 19% to 9.7% using NPWT.…”

Section: Wound Vacuum Dressingmentioning

confidence: 99%

Prevention of Surgical Site Infection in Spine Surgery

et al. 2017

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BACKGROUND: Spine surgery is complicated by an incidence of 1% to 9% of surgical site infection (SSI). The most common organisms are gram-positive bacteria and are endogenous, that is are brought to the hospital by the patient. Efforts to improve safety have been focused on reducing SSI using a bundle approach. The bundle approach applies many quality improvement efforts and has been shown to reduce SSI in other surgical procedures. OBJECTIVE: To provide a narrative review of practical solutions to reduce SSI in spine surgery. METHODS: Literature review and synthesis to identify methods that can be used to prevent SSI. RESULTS: SSI prevention starts with proper patient selection and optimization of medical conditions, particularly reducing smoking and glycemic control. Screening for staphylococcus organisms and subsequent decolonization is a promising method to reduce endogenous bacterial burden. Preoperative warming of patients and timely administration of antibiotics are critical to prevent SSI. Skin preparation using chlorhexidine and alcohol solutions are recommended. Meticulous surgical technique and maintenance of sterile techniques should always be performed. Postoperatively, traditional methods of tissue oxygenation and glycemic control remain essential. Newer wound care methods such as silver impregnation dressing and wound-assisted vacuum dressing are encouraging but need further investigation. CONCLUSION: Significant reduction of SSIs is possible, but requires a systems approach involving all stakeholders. There are many simple and low-cost components that can be adjusted to reduce SSIs. Systematic efforts including understanding of pathophysiology, prevention strategies, and system-wide quality improvement programs demonstrate significant reduction of SSI.

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Section: Wound Vacuum Dressingmentioning

confidence: 99%

Prevention of Surgical Site Infection in Spine Surgery

et al. 2017

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“…The numbers needed to treat were 3 (seroma), 17 (dehiscence) and 25 (infection). Due to heterogeneity between the included studies, no general recommendations could be made yet[58]. However, this device has a potential for its use in immunosuppressed and obese patients undergoing KT.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of the negative pressure wound therapy in kidney transplant recipients

Shrestha¹

2016

WJT

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AIMTo review negative pressure wound therapy (NPWT) as an important addition to the conventional methods of wound management.METHODSA systematic review, performed by searching the PubMed, EMBASE and Cochrane Library databases, showed 11 case reports comprising a total of 22 kidney transplantation (KT) patients (range, 1 to 9), who were treated with NPWT. Application of NPWT was associated with successful healing of wounds, leg ulcer, lymphocele and urine leak from ileal conduit.RESULTSNo complications related to NPWT were reported. However, there was paucity of robust data on the effectiveness of NPWT in KT recipients; therefore, prospective studies assessing its safety and efficacy of NPWT and randomised trials comparing the effectiveness of NPWT with alternative modalities of wound management in KT recipients is recommended.CONCLUSIONNegative pressure incision management system, NPWT with instillation and endoscopic vacuum-assisted closure system are in investigational stage.

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“…[1][2][3] In 2017, Willy et al published consensus recommendations for the use of CINPWT, describing patient characteristics, incisions, and operations with a high risk of developing surgical site infections and wound complications. 5,6 Today, specific indications for use of CINPWT continue to be defined. 4 However, even before these recommendations, CINPWT was widely used in multi-morbid patients undergoing major lower non-traumatic (above-ankle) amputation, although there was no evidence of this treatment.…”

Section: Introductionmentioning

confidence: 99%

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

Stenqvist

Nielsen

Napolitano

et al. 2019

International Wound Journal

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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.

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

Cited by 199 publications

References 43 publications

Prevention of Surgical Site Infection in Spine Surgery

Prevention of Surgical Site Infection in Spine Surgery

Systematic review of the negative pressure wound therapy in kidney transplant recipients

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

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