Negative Pressure Wound Therapy for Closed Surgical Wounds in Musculoskeletal Oncology Patients - A Case-Control Trial

Abstract

Following excision of musculoskeletal tumours, patients are at high risk of wound issues such as infection, dehiscence and delayed healing. This is due to a multitude of factors including the invasive nature of the disease, extensive soft tissue dissection, disruption to blood and lymphatic drainage, residual cavity and adjuvant therapies. The use of negative pressure wound therapy (NPWT) has a growing body of evidence on its beneficial effect of wound healing such as promoting cell differentiation, minimising oedema and thermoregulation. Traditionally, these dressings have been used for open or dehisced wounds; however recent research has investigated its role in closed wounds.Aim:To evaluate the effect of NPWT in patients with closed wounds, either primarily or with flap coverage, in our high risk group. Consecutive patients who had a NPWT dressing applied were selected, and a control group was established by a blinded researcher with matching for tissue diagnosis, surgical site, gender and age. The primary outcome measured was documented for wound complications, with secondary data collected on radiotherapy and wound drainage.Results:Patients were well matched between the intervention (n=9) and control (n=9) groups for gender, age and tissue diagnosis. Both groups had 1 patient who underwent preoperative radiotherapy. A total of 3 wound infections occurred in the control group and none in the NPWT group. Overall there was a trend towards lower drain output and statistically significantly reduced infection rate in the NPWT group.Conclusion:In this short series, despite the NPWT patients having more additional risk factors for wound issues, they resulted in fewer infections. The sample size is not sufficient to have statistically significant reduction. Further evaluation on the value of NPWT in this patient group should be prospectively evaluated.

Closed incision negative pressure wound therapy versus conventional dressings following soft-tissue sarcoma excision: a prospective, randomized controlled trial

“… 14 Sarcoma patients generally fulfil all of these categories, but there are comparatively few studies on the use of NPWT in this group of patients. While an earlier retrospective case-matched study at our institution indicated a lower SSI rate in patients treated with closed incision NPWT than conventional dressings, 15 we highlighted the need for prospective evidence.…”

SUNstudy Study Protocol: Sarcoma Usual versus Negative Pressure Study Protocol

“…A case-control trial performed at our unit demonstrated zero SSI's after negative dressing application in a cohort of 9 patients who underwent sarcoma excision [8]. We propose a clinically significant improvement in SSI rate to be 15%, thereby aiming for an overall SSI rate of 5%.…”

“…Within the high-risk group of patients undergoing resection of a soft tissue sarcoma there is little evidence of the beneficial use of negative pressure dressings. A recent case-controlled study performed at our unit, however, demonstrates encouraging results with zero surgical site complications in patients who underwent sarcoma resection followed by primary wound closure and application of a negative pressure dressing [8].…”

“…Peat et al report wound complication rates of 16% [4], however Baldini et al suggest rates as high as 56%, especially seen in those who have undergone neo-adjuvant radiotherapy or with margins close to the skin surface [5]. In the last 15 years there is an emerging body of evidence suggesting a reduction in wound complications with the primary application of a negative pressure dressing [6,7,8,[9][10][11]. However, the negative pressure dressings typically have an increased cost and added complexity in usage compared to conventional dressings, meaning that their routine use remains elusive.…”

Closed-Incision Negative-Pressure Wound Therapy after Resection of Soft-Tissue Tumors Reduces Wound Complications: Results of a Randomized Trial

“…25 Only two retrospective case control studies to our knowledge have examined the impact of closed-incision negative-pressure wound therapy after soft-tissue sarcoma resection, observing lower wound complications. 26,27…”