Negative pressure wound therapy for surgical wounds healing by primary closure

Norman, Gill; Goh, En Lin; Dumville, Jo C; Shi, Chunhu; Liu, Zhenmi; Chiverton, Laura; Stankiewicz, Monica; Reid, Adam J.

doi:10.1002/14651858.cd009261.pub5

Cited by 85 publications

(125 citation statements)

References 179 publications

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“…This may further explain our overall positive graft take rates in the first week. The removal of excess exudate through NPWT reduces the risk of hematoma formation and prevents the complications of graft shear or lift‐off 37‐39 ; this is consistent with our graft take results.…”

Section: Discussionsupporting

confidence: 89%

“…Our infection rate outcomes indicated a significant risk reduction, which is consistent with findings from several past reviews 17,39,43‐47 . It is suggested that NPWT decreases the infection rate due to the following reasons: For wound care management, the NPWT systems lower dressing frequency, the wound site would be exposed less 17,48,49 .…”

Section: Discussionsupporting

confidence: 89%

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Negative pressure wound therapy for burn patients: A meta‐analysis and systematic review

Lin

Kao

Chen

et al. 2020

International Wound Journal

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Negative pressure wound therapy (NPWT), which has been applied in various medical specialties to accelerate wound healing, has been the object of a few investigations. We explored the effectiveness of NPWT and the possibility of its inclusion in burn management guidelines. Randomised controlled trials comparing NPWT with non‐NPWT treatments for burn wounds were extracted from PubMed. For the risk of bias analysis, all included studies were evaluated according to the Cochrane risk of bias tool and the approaches outlined in the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) Handbook. Outcomes such as graft take rate in the first week, infection rate, and overall complication rate were analysed. Six studies that included a total of 701 patients met our inclusion criteria. Qualitative analysis revealed that the NPWT group had a significantly better overall graft rate in the first week (P = 0.001) and a significantly lower infection rate (P = 0.04). No significant difference in the overall complication rate was found. Our results indicate that NPWT is a safe method for stimulating healing and lowering the infection rate of burn wounds. NPWT can be part of general burn management, and its incorporation into burn treatment guidelines is recommended.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 89%

Negative pressure wound therapy for burn patients: A meta‐analysis and systematic review

Lin

Kao

Chen

et al. 2020

International Wound Journal

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“…If they did not have any sign of sternum stabilization, they also were treated in the same way. Those with mediastinitis were applied with vacuum-assisted closure (VAC) in addition to anti biotherapy, according to the wound microgram culture result [Norman 2020]. Necrotic tissue was debrided, and the sternum was rewired after the infection was healed, and the sternum was covered with major pectus muscle [Elassal 2020].…”

Section: Methodsmentioning

confidence: 99%

Sternum Dehiscence: A Preventable Complication of Median Sternotomy

Ata

Beyaz

2020

HSF

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Background: The incidence of sternal dehiscence following cardiothoracic surgery via sternotomy is rare. It causes serious patient dissatisfaction and leads to higher hospital costs. For years, each clinic has made efforts to reduce this complication. Here, we aimed to summarize our techniques to prevent dehiscence. Material: This retrospective study included two groups operated via median sternotomy from March 2009 to May 2019. The first group included 1,105 consecutive patients who only received sternum wire for sternum closure from March 2009 to October 2013. The second group included 1,559 consecutive patients operated from January 2014 to May 2019; preventive closure techniques were performed for predefined high-risk patients in this group. These closure techniques included polyglyconate (Maxon) or simple longitudinal reinforced sutures, sternal cable or sternoband, sternal plate, and Robiscek technique. Results: All patients in Group 1, and 63.8% (995/1559) patients in Group 2 received sternal wire only (P < .001). In Group 2, we applied preventive closure techniques to 564 (36.2%) patients. There was no sternal dehiscence in Group 2, whereas 29 (2.6%) patients postoperatively suffered sternal dehiscence in Group 1; this was statistically significant (P = .001, OR:85.5, 95%CI:5.22-1400.4). The overall incidence of mediastinitis was 0.94%. The incidence significantly was lower in Group 2 (P = .004, OR:3.6, 95%CI:1.52-8.82). Sternum-related mortality in Group 2 also was lower (0.54% versus 0.06%, P = .048, OR:8.5, 95% CI: 1.02-70.75). Conclusion: Sternal dehiscence can be avoided by careful perioperative risk assessment and enhanced closure techniques. The same special consideration may significantly reduce mediastinitis and sternal-related mortality.

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“…However, the scope of this guideline is limited by the inherent bias of basing this decision on mainly nonrandomized studies [11–13]. A Cochrane meta‐analysis published in 2020 included 44 RCTs of different types of surgery and found ‘moderate‐certainty evidence' that SUNPDs reduce the incidence of SSI [14]. However, a meta‐analysis limited to laparotomies (elective and emergency) found no significant difference in the rate of SSI between negative‐pressure wound therapy and standard dressings [15].…”

Section: Introductionmentioning

confidence: 99%

An international pragmatic randomized controlled trial to compare a single‐use negative‐pressure dressing versus the surgeon’s preference of dressing to reduce the incidence of surgical site infection following emergency laparotomy: the SUNRRISE trial protocol

Wilkin¹,

Clouston²,

Coe³

et al. 2021

Colorectal Disease

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Aim: Surgical site infection (SSI) is a common complication following emergency laparotomy, occurring in around 25% of patients in UK practice. The adoption of single-use negative-pressure dressings (SUNPDs) has been proposed as a prophylactic method of reducing the rate of SSI. The primary aim of the randomized controlled trial (RCT) described herein is to determine if a SUNPD reduces SSI at 30 days after an emergency laparotomy. Method:The Single Use Negative pRessure dressing for Reduction In Surgical site infection following Emergency laparotomy (SUNRRISE) study is an international, multicentre, pragmatic, phase III RCT with internal feasibility phase. As stated, the primary aim is to determine if a SUNPD reduces SSI at 30 days postoperatively. Patients will be randomized in a 1:1 ratio to receive either a SUNPD or a dressing of the surgeon's preference. Outcome assessors will be blinded to treatment allocation. The primary outcome measure is SSI within 30 days of surgery as defined by the US Centers for Disease Control criteria. A total of 840 patients will be required to detect a relative reduction of 40% in SSI rates (from 25% to 15%) with 90% power accounting for a 20% attrition rate. Discussion: SUNRRISE is an international, multicentre RCT evaluating the prophylactic use of SUNPD in primary closed emergency laparotomy wounds for the reduction of SSI.Our hypothesis is that a SUNPD is superior to the surgeon's preference of dressing in reducing SSIs at 30 days. The findings may influence dressing choice following emergency abdominal surgery in the future. Primary outcome(s)Surgical site infection at 30 days postprocedure Key secondary outcomes Length of hospital stay, wound complications, readmission rate, quality of life, cost effectiveness, patient acceptability

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Negative pressure wound therapy for surgical wounds healing by primary closure

Cited by 85 publications

References 179 publications

Negative pressure wound therapy for burn patients: A meta‐analysis and systematic review

Negative pressure wound therapy for burn patients: A meta‐analysis and systematic review

Sternum Dehiscence: A Preventable Complication of Median Sternotomy

An international pragmatic randomized controlled trial to compare a single‐use negative‐pressure dressing versus the surgeon’s preference of dressing to reduce the incidence of surgical site infection following emergency laparotomy: the SUNRRISE trial protocol

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