Negative Pressure Wound Therapy vs Conventional Wound Treatment in Subcutaneous Abdominal Wound Healing Impairment

Abstract

IMPORTANCE Negative pressure wound therapy (NPWT) is an established treatment option, but there is no evidence of benefit for subcutaneous abdominal wound healing impairment (SAWHI). OBJECTIVE To evaluate the effectiveness and safety of NPWT for SAWHI after surgery in clinical practice. DESIGN, SETTING, AND PARTICIPANTSThe multicenter, multinational, observer-blinded, randomized clinical SAWHI study enrolled patients between August 2, 2011, and January 31, 2018. The last follow-up date was June 11, 2018. The trial included 34 abdominal surgical departments of hospitals in Germany, Belgium, and the Netherlands, and 539 consecutive, compliant adult patients with SAWHI after surgery without fascia dehiscence were randomly assigned to the treatment arms in a 1:1 ratio stratified by study site and wound size using a centralized web-based tool. A total of 507 study participants (NPWT, 256; CWT, 251) were assessed for the primary end point in the modified intention-to-treat (ITT) population.INTERVENTIONS Negative pressure wound therapy and conventional wound treatment (CWT). MAIN OUTCOMES AND MEASURESThe primary outcome was time until wound closure (delayed primary closure or by secondary intention) within 42 days. Safety analysis comprised the adverse events (AEs). Secondary outcomes included wound closure rate, quality of life (SF-36), pain, and patient satisfaction. RESULTSOf the 507 study participants included in the modified ITT population, 287 were men (56.6%) (NPWT, 155 [60.5%] and CWT, 132 [52.6%]) and 220 were women (43.4%) (NPWT, 101 [39.5%] and CWT 119 [47.4%]). The median (IQR) age of the participants was 66 (18) years in the NPWT arm and 66 (20) years in the CWT arm. Mean time to wound closure was significantly shorter in the NPWT arm (36.1 days) than in the CWT arm (39.1 days) (difference, 3.0 days; 95% CI 1.6-4.4; P < .001). Wound closure rate within 42 days was significantly higher with NPWT (35.9%) than with CWT (21.5%) (difference, 14.4%; 95% CI, 6.6%-22.2%; P < .001). In the therapy-compliant population, excluding study participants with unauthorized treatment changes (NPWT, 22; CWT, 50), the risk for wound-related AEs was higher in the NPWT arm (risk ratio, 1.51; 95% CI, 0.99-2.35).CONCLUSIONS AND RELEVANCE Negative pressure wound therapy is an effective treatment option for SAWHI after surgery; however, it causes more wound-related AEs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01528033 JAMA Surg. 2020;155(6):469-478.

The technique for less infectious and earlier healing of stoma closure wound: negative pressure wound therapy with instillation and dwelling followed by primary closure

“…A study on the use of NPWT in the prevention of SSI and shortening of wound healing period after stoma closure was not able to show the efficacy of NPWT compared to that of purse-string sutures in significantly reducing the wound healing time [ 5 ]. Additionally, local infection may occur as an adverse event with NPWT [ 5 , 14 ].…”

Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer

“…It can make wounds heal quickly, especially for those with large soft tissue defects. 16 , 17 A study by Kaneko reported that incisional continuous negative pressure wound therapy could reduce the incidence of SSI following APR. 18 Recently, the use of prophylactic negative-pressure wound therapy for prevention of wound-related complications showed encouraging results in terms of reduction of SSI after APR.…”

Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

“…The use of negative pressure therapy for wounds healing by secondary intention has increased in spite of the lack of evidence of its advantage [14]. Just recently, one randomized control trial has been published comparing negative pressure therapy to conventional wound therapy [15]. The results showed that negative pressure therapy reduces the time until complete wound closure and increases the number of wounds closed after 42 days.…”