Use of negative pressure wound therapy over clean, closed surgical incisions

Abstract

Stannard JP, Gabriel A, Lehner B. Use of negative pressure wound therapy over clean, closed surgical incisions. Int Wound J 2012; 9 (Suppl. 1):32-39 ABSTRACTThe literature has reported that surgical site infections account for 17-22% of health care-associated infections, while surgical wound dehiscence rates range from 0·25% to 3·0% (post laparatomies), 1·6% to 42·3% (postcaesarean incisions) and 0·5% to 2·5% (sternal incisions). These types of incisional complications can become a significant cost burden to the health care system because of lengthy hospital stays and readmissions, additional nursing care and added surgical procedures. Therefore, the type of therapy used for surgical incisions plays a critical role in the healing process. The success of negative pressure wound therapy (NPWT; V.A.C. ® Therapy; KCI USA, Inc., San Antonio, TX) for open wounds has been well documented and has led to its use over clean, closed surgical incisions. This review will focus on clinician experience and literature review of incisional NPWT and will include clinical cases describing NPWT's successful use over surgical incisions.

Negative Pressure Wound Therapy Is Associated With Resolution of Incisional Drainage in Most Wounds After Hip Arthroplasty

“…In addition, we found no cases of PJI that appeared to be related to the NPWT application. Our findings of no wound-related complications are consistent with prior literature in other fields [5,7,[17][18][19][20]23]. Reddix et al studied the effect of NPWT on wound complications (eg, dehiscences, infections) associated with the treatment of acetabular fractures in morbidly obese patients and found no wound complications in 19 consecutive patients over 5 years [13].…”

Cost-effectiveness analysis alongside a pilot study of prophylactic negative pressure wound therapy

“…Additionally, most cost-effectiveness studies have focused on the treatment of chronic, difficult-to-heal wounds [6,10,11]. NPWT is increasingly used prophylactically following surgery for high-risk clean wounds [13], particularly in obese patients at greater risk of developing SSIs [14]. As obesity is a growing problem in Australia and other developed countries understanding the clinical effectiveness and cost-effectiveness of interventions for preventing SSIs in obese patients is important.…”

Sternal Wound Complications Following Cardiac Surgery

“…No cases of superficial or deep sternal wound infections were noted although the group had an estimated 6% risk for DSWI [118]. This form of NPT was noted to be easy to apply, welltolerated by the patients, and was also judged to be cost-effective when utilized in patients with increased demonstrated risk for DSWI [117]. Since the time of the original report, we have used this novel wound treatment system in over 200 high risk patients and continue to observe reduce rates of sternal wound complications (unpublished data).…”

“…However a more recent randomized controlled trial evaluating the impact of gentamicin-soaked collagen sponge on poststernotomy wound infection did not show a n a d v a n t a g e o f t h i s a p p r o a c h o v e r controls [116]. Based on the aforementioned successes with NPT in the treatment of documented DSWI we and others have recently evaluated the application of NPT to clean, closed incisions as a method to prevent complications in high-risk wounds [117,118]. We initially applied this form of "well wound therapy" in a cohort of 57 adult cardiac surgery patients known to be at increased risk for DSWI based on a validated risk stratification model [13].…”