Surgical Site Infection Rate Drops to 0% Using a Vacuum-Assisted Closure in Contaminated/ Dirty Infected Laparotomy Wounds

Abstract

Wound site infections increase costs, hospital stay, morbidity, and mortality. Techniques used for wounds management after laparotomy are primary, delayed primary, and vacuum-assisted closures. The objective of this study is to compare infection rates between those techniques in contaminated and dirty/ infected wounds. Eighty-one laparotomized patients with Class III or IV surgical wounds were enrolled in a three-arm randomized prospective study. Patients were allocated to each group with the software Research Randomizer® (Urbaniak, G. C, & Plous, S., Version 4.0). Presence of infection was determined by a certified board physician according to Centers for Disease Control's Criteria for Defining a Surgical Site Infection. Twenty-seven patients received primary closure, 29 delayed primary closure, and 25 vacuum-assisted closure, with no exclusions for analysis. Surgical site infection was present in 10 (37%) patients treated with primary closure, 5 (17%) with primary delayed closure, and 0 (0%) patients receiving vacuum-assisted closure. Statistical significance was found between infection rates of the vacuum-assisted group and the other two groups. No significant difference was found between the primary and primary delayed closure groups. The infection rate in contaminated/dirty-infected laparotomy wounds decreases from 37 and 17 per cent with a primary and delayed primary closures, respectively, to 0 per cent with vacuum-assisted systems.

Ether-Based Polyurethane Foam for Vacuum-Assisted Closure (V.A.C.) of Complicated Postoperative Abdominal Wound Dehiscence

“…Other studies [13,14] concluded that the biological interaction between the foam and the wound base has similarities with a nonspecific foreign body-like reaction and results from yet unknown pathways. Recent studies [15,16] brought more light to the matter. https://doi.org/10.37358/MP.20.2.5348…”

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

“…A total of 35 articles discussed prophylactic VSD (pVSD) for abdominal incisions with primary suture, of which 6 were RCTs 32 , 33 , 34 , 35 , 36 , 37 and 29 were observational studies. 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 …”

“… 34 Eleven observational studies of abdominal surgeries, including pediatric contaminated surgery, gynecological malignancy surgery, cesarean section surgery, and liver transplantation surgery, also showed that pVSD reduced the incidence of incision infections. 44 , 45 , 49 , 50 , 52 , 57 , 59 , 65 One RCT showed that pVSD reduced postoperative pain and the need for anesthetics 34 ; however, although the incidence of SSIs decreased, the difference was not significant.…”

“…A total of six RCTs investigated multiple abdominal surgeries, among which three showed that pVSD reduced the incidence of SSIs,32, 35, 36 two showed that pVSD did not reduce the incidence of SSIs,33, 37 and one showed that VSD reduced the incidence of SSIs, but the differences were not significant 34 . Eleven observational studies of abdominal surgeries, including pediatric contaminated surgery, gynecological malignancy surgery, cesarean section surgery, and liver transplantation surgery, also showed that pVSD reduced the incidence of incision infections 44, 45, 49, 50, 52, 57, 59, 65. One RCT showed that pVSD reduced postoperative pain and the need for anesthetics 34 ; however, although the incidence of SSIs decreased, the difference was not significant.…”

Clinical therapeutic evaluation of vacuum sealing drainage and precise ultrasound‑guided debridement in the treatment of non‑lactational mastitis

“…This technology may intermittently or continuously generate a pressure lower than atmospheric pressure at the wound surface and promote wound healing through a series of physiological mechanisms ( 8 ). VSD may be applied to various types of wounds, including infected wounds, skin graft wounds and wounds without skin or soft tissue ( 9 , 10 ). This technique has outstanding advantages in clinical application, e.g.…”