The Usefulness of Closed Incision Negative Pressure Wound Therapy After Spinal Fusion: A Systematic Review and Meta-Analysis

Lambrechts, Mark J.; D’Antonio, Nicholas D.; Issa, Tariq Z.; Levy, Hannah A; Yalla, Goutham R; Berthiaume, Emily A.; Ciesielka, Kerri-Anne; Kepler, Christopher K.; Canseco, José A.

doi:10.1016/j.wneu.2022.09.048

Cited by 6 publications

(5 citation statements)

References 39 publications

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“…The literature outside of orthopaedic oncology has shown that the use of NPWT decreases the rates of wound complications and SSI. Lambrechts et al performed a meta-analysis comparing the use of incisional NPWT with a standard dressing in spine surgery and found decreased rates of SSI with use of NPWT but no difference in the odds of reoperation for wound debridement 23 . Additionally, a recent randomized controlled trial on the use of incisional NPWT following major lower-extremity amputations in patients with peripheral artery disease also showed decreased odds of SSI and decreased time to complete residual limb healing 24 .…”

Section: Discussionmentioning

confidence: 99%

Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Surgical Site Infections?

LiBrizzi

Sabharwal

Forsberg

et al. 2023

Journal of Bone and Joint Surgery

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Background: Surgical site infections (SSIs) represent a major complication following oncologic reconstructions. Our objectives were (1) to assess whether the use of postoperative drains and/or negative pressure wound therapy (NPWT) were associated with SSIs following lower-extremity oncologic reconstruction and (2) to identify factors associated with the duration of postoperative drains and with the duration of NPWT. Methods: This is a secondary analysis of the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial, a multi-institution randomized controlled trial of lower-extremity oncologic reconstructions. Data were recorded regarding the use of drains alone, NPWT alone, or both NPWT and drains, including the total duration of each postoperatively. We analyzed postoperative drain duration and associations with tourniquet use, intraoperative thromboprophylaxis or antifibrinolytic use, incision length, resection length, and total operative time, through use of a linear regression model. A Cox proportional hazards model was used to evaluate the independent predictors of SSI. Results: Overall, 604 patients were included and the incidence of SSI was 15.9%. Postoperative drains alone were used in 409 patients (67.7%), NPWT alone was used in 15 patients (2.5%), and both postoperative drains and NPWT were used in 68 patients (11.3%). The median (and interquartile range [IQR]) duration of drains and of NPWT was 3 days (IQR, 2 to 5 days) and 6 days (IQR, 4 to 8 days), respectively. The use of postoperative drains alone, NPWT alone, or both drains and NPWT was not associated with SSI (p = 0.14). Increased postoperative drain duration was associated with longer operative times and no intraoperative tourniquet use, as shown on linear regression analysis (p < 0.001 and p = 0.03, respectively). A postoperative drain duration of ≥14 days (hazard ratio [HR], 3.6; 95% confidence interval [CI], 1.3 to 9.6; p = 0.01) and an operative time of ≥8 hours (HR, 4.5; 95% CI, 1.7 to 11.9; p = 0.002) were independent predictors of SSI following lower-extremity oncologic reconstruction. Conclusions: A postoperative drain duration of ≥14 days and an operative time of ≥8 hours were independent predictors of SSI following lower-extremity oncologic reconstruction. Neither the use of postoperative drains nor the use of NPWT was a predictor of SSI. Future research is required to delineate the association of the combined use of postoperative drains and NPWT with SSI. Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

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Section: Discussionmentioning

confidence: 99%

Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Surgical Site Infections?

LiBrizzi

Sabharwal

Forsberg

et al. 2023

Journal of Bone and Joint Surgery

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“…36,41,45,[49][50][51][52] However, results in the literature are mixed, and other studies do not show this relationship. [6][7][8][9]13,33,[53][54][55][56][57][58] In the context of DIEP flaps, wound dehiscence is frequently attributed to suturing under tension and the extended length of the incision. 39,59 In this regard, the utilization of ciNPWT holds significant promise in preventing wound dehiscence by offering valuable physical support and functioning as a protective splint against the tensile forces acting on the wound.…”

Section: Discussionmentioning

confidence: 99%

“…This contradicts several studies demonstrating decreased surgical site infection rates with ciNPWT. [5][6][7][8][9]11,13,14,30,33,36,41,[43][44][45][46][47][48][49][50][51][52][54][55][56][57][58][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] However, the occurrence of infection in DIEP flaps is infrequent, with a recent meta-analysis reporting a donor site infection rate of 4.79%. 77 Mechanistically, ciNPWT acts as a barrier that prevents contamination of the surgical site with bacteria before reepithelization, encourages drainage of excess interstitial fluid, increases lymphatic flow, improves blood flow, and induces angiogenesis, theoretically decreasing the risk of infection and expediting healing.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanistically, ciN-PWT promotes healing by facilitating wound approximation, angiogenesis, and fluid management, and by decreasing bacterial load. 4 ciNPWT has been investigated in a variety of surgical specialties, [5][6][7][8][9] and its use continues to grow in breast reconstruction. A systematic review and meta-analysis recently demonstrated reduced overall wound complications and flap necrosis using ciN-PWT in implant-based breast reconstruction, and several reviews have shown benefit in primary wound closure.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

Dunson,

Kogan,

Grosser

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Closed-incision negative pressure wound therapy (ciNPWT) has shown promise in reducing surgical wound complications. Among its numerous benefits, it allows for exudate management and tension offloading from wound edges. The purpose of this systematic review and meta-analysis was to assess the efficacy of prophylactic ciNPWT versus conventional dressings on abdominal donor site complications in microsurgical breast reconstruction (MR). Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in January 2023. PubMed and Embase were searched to identify all relevant studies. Data collected included rates of total wound complications, wound dehiscence, infection, seroma, and length of hospital stay. Results: A total of 202 articles were screened, and eight studies (1009 patients) met the inclusion criteria. Use of ciNPWT was associated with a significantly lower rate of wound dehiscence (OR, 0.53; 95% confidence interval, 0.33–0.85; P = 0.0085, I 2 = 0%). There was no significant difference in the rate of total wound complications [odds ratio (OR), 0.63; 95% CI, 0.35–1.14; P = 0.12, I 2 = 69%], donor site infection (OR, 0.91; 95% CI, 0.42–1.50; P = 0.47, I 2 = 13%), seroma (OR, 0.74; 95% CI, 0.22–2.49; P = 0.63, I 2 = 57%), or length of hospital stay (SMD, 0.089; 95% CI, –0.13–0.35; P = 0.37, I 2 = 29%). Conclusions: Although exudate management by ciNPWT fails to reduce surgical site infection, seroma formation, and overall length of stay, ciNPWT tension offloading properties seem to be associated with lower rates of wound dehiscence when compared with conventional dressings in abdominal-based autologous breast reconstruction.

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“…Mekanisme kerja yang tepat dari NPWT belum diketahui secara pasti dan masih terus dilakukan penelitian lebih lanjut. Terdapat beberapa hipotesa tentang mekanisme peningkatan proses penyembuhan luka melalui NPWT, yaitu: kontraksi luka, stabilitas lingkungan luka, penghilangan eksudat dan deformasi jaringan lunak [12].…”

Section: Pendahuluanunclassified

Negative pressure wound therapy (NPWT) as management of surgical site infection (SSI) in spinal fusion surgery

Mislan,

Waluyo,

Arista

2024

mki

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Surgical Site Infection (SSI) following spinal fusion surgery may lead to patient morbidity, increased treatment costs, and possible recurrent medical interventions. Negative Pressure Wound Therapy (NPWT) has demonstrated promise in the management of SSI as well as assisting in surgical wound healing. This literature review aimed to evaluate the effectiveness of NPWT as a prophylactic, and treatment of SSI in spinal fusion surgery. The literature review method is conducted by searching research articles comparing NPWT and Standard Wound Dressing (SWD) effectiveness with the relevant cohort or Randomized Controlled Trial (RCT) research design using Embase, Scopus, PubMed, and ScienceDirect databases. The application treads of NPWT for surgical wounds in spinal fusion surgery were also described. The research articles were limited from 2017 to 2022. Six articles fit in criteria of inclusion, three articles were prophylactic management research, and the others were the management of treatment research. Analysis of the articles indicated that NPWT as prophylactic could effectively reduce the incidence of postoperative surgical site infections. NPWT as treatment had less time duration, lower risk of sponge fragment retainment, and fewer procedures to achieve wound closure in spinal fusion surgery. There is currently a lack of strong clinical evidence of its efficacy, so rigorous randomized prospective clinical trials are needed.

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The Usefulness of Closed Incision Negative Pressure Wound Therapy After Spinal Fusion: A Systematic Review and Meta-Analysis

Cited by 6 publications

References 39 publications

Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Surgical Site Infections?

Does the Use of Negative Pressure Wound Therapy and Postoperative Drains Impact the Development of Surgical Site Infections?

Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

Negative pressure wound therapy (NPWT) as management of surgical site infection (SSI) in spinal fusion surgery

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