Negative pressure wound therapy for surgical wounds healing by primary closure

Abstract

Background Indications for the use of negative pressure wound therapy (NPWT) are broad and include prophylaxis for surgical site infections (SSIs). Existing evidence for the effectiveness of NPWT on postoperative wounds healing by primary closure remains uncertain. Objectives To assess the effects of NPWT for preventing SSI in wounds healing through primary closure, and to assess the cost‐effectiveness of NPWT in wounds healing through primary closure. Search methods In January 2021, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In‐Process & Other Non‐Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries and references of included studies, systematic reviews and health technology reports. There were no restrictions on language, publication date or study setting. Selection criteria We included trials if they allocated participants to treatment randomly and compared NPWT with any other type of wound dressing, or compared one type of NPWT with another. Data collection and analysis At least two review authors independently assessed trials using predetermined inclusion criteria. We carried out data extraction, assessment using the Cochrane risk of bias tool, and quality assessment according to Grading of Recommendations, Assessment, Development and Evaluations methodology. Our primary outcomes were SSI, mortality, and wound dehiscence. Main results In this fourth update, we added 18 new randomised controlled trials (RCTs) and one new economic study, resulting in a total of 62 RCTs (13,340 included participants) and six economic studies. Studies evaluated NPWT in a wide range of surgeries, including orthopaedic, obstetric, vascular and general procedures. All studies compared NPWT with standard dressings. Most studies had unclear or high risk of bias for at least one key domain. Primary outcomes Eleven studies (6384 participants) which reported mortality were pooled. There is low‐certainty evidence showing there may be a reduced risk of death after surgery for people treated with NPWT (0.84%) compared with standard dressings (1.17%) but there is uncertainty around this as confidence intervals include risk of benefits and harm; risk ratio (RR) 0.78 (95% CI 0.47 to 1.30; I 2 = 0%). Fifty‐four studies reported SSI; 44 studies (11,403 participants) were pooled. There is moderate‐certainty evidence that NPWT probably results in fewer SSIs (8.7% of participants) than treatment with standard dressings (11.75%) after surgery; RR 0.73 (95% CI 0.63 to 0.85; I 2 = 29%). Thirty studies reported wound dehiscence; 23 studies (8724 participants) were pooled. There is moderate‐certainty evidence that there is probably little or no differe...

Surgical Site Infection Prevention

“…Authors of a metaanalysis of 23 RCTs involving 2547 patients undergoing various surgical procedures (eg, abdominal, cesarean delivery, orthopedic, vascular) concluded that use of incisional negative pressure wound therapy for primary wound closure was associated with lower rates of surgical site infection than use of standard dressings: 9.7% (124 of 1279) vs 15% (191 of 1268; RR, 0.67 [95% CI, 0.53-0.85]; P < .001); however, the effect varied by procedure type. 69 The authors indi-cated that they did not find evidence for substantial differences between the different types of surgery. Similarly, authors of a recent meta-analysis of 28 RCTs concluded that incisional negative pressure wound therapy was associated with lower rates of surgical site infection than standard dressing: 8.8% (194 of 2193) vs 14% (315 of 2205; RR, 0.61 [95% CI, 0.49-0.76]; P < .001).…”

Patients’ Experiences Using Closed Incision Negative Pressure Wound Therapy Dressing After Infra-Inguinal Vascular Surgery

“…Research on patients’ experiences of iNPWT for the treatment of closed wounds is scarce and there is a high demand for qualitative studies supplementing the quantitative RCTs ( 7 ).…”

Rapidly spreading deep dissecting hematoma occurring 1 month after a minor trauma: A case report

“…3 , 4 , 9 Negative wound pressure therapy (NWPT) is recommended by some authors when skin grafting is being considered, 9 and the majority of articles on DDH mention the use of NWPT, 3 , 10 – 12 despite the low level of evidence supporting its value. 13 , 14 Post-operative wound management was limited to local care and dressings in only two reported DDH cases. 6 , 15 In our case, rapid healing deemed skin grafting unwarranted, so NWPT was not proposed.…”