Topical negative pressure wound therapy to prevent wound complications following caesarean delivery in high‐risk obstetric patients: A randomised controlled trial

Abstract

Background and AimsWe investigated whether the use of a prophylactic negative pressure wound therapy (NPWT) system in women undergoing caesarean would decrease wound complications in a high‐risk population.Materials and MethodsA randomised controlled trial was performed. Women with risk factors for wound complications undergoing caesarean delivery were randomised to a standard dressing or NPWT placed over their caesarean wound. We standardised the closure of the subcutaneous fat and skin layers, both with Vicryl. Patients were followed for wound complications for up to 6 weeks after their caesareans. The incidence of wound complications was the primary outcome. The single‐use NPWT system, PICO, was provided by Smith and Nephew for use in this trial. The trial was registered on clinicaltrials.gov, # NCT03082664.ResultsWe report here on 154 women randomised to either a standard dressing or to the NPWT. Wound complication rates were equivalent between groups, with 19.4 and 19.7% (P = 0.43) of women with follow‐up information available experiencing wound complications.ConclusionWe found no difference in wound complications in women with risk factors treated with a prophylactic NPWT system or standard wound dressing at the time of caesarean birth.

A Systematic Review and Meta-analysis of Two Negative Pressure Wound Therapy Devices to Manage Cesarean Section Incisions

“…38 41 All studies reported on either composite, superficial, or deep SSI, except Gonzalez et al who only reported overall wound complications. 36 The majority of studies stated that all patients received antibiotic prophylaxis, except for some studies where their use was not mentioned. 34 36 37 The majority (>98%) of patients in the Gillespie et al's study received antibiotic prophylaxis.…”

“…Key study characteristics are outlined in Table 1 . Six RCTs evaluated the −80 mm Hg device, 34 35 36 37 38 39 of which two RCTs 36 39 were available as conference abstracts only. Five RCTs evaluated the −125 mm Hg device.…”

“…36 The majority of studies stated that all patients received antibiotic prophylaxis, except for some studies where their use was not mentioned. 34 36 37 The majority (>98%) of patients in the Gillespie et al's study received antibiotic prophylaxis. 35…”