Application of Negative Pressure Wound Therapy on Closed Incisions

Abstract

Negative pressure wound therapy (NPWT) is widely used for chronic and acute open wounds, with clinically proven benefits of faster wound healing by promoting granulation tissue growth and increased perfusion and facilitating epithelialization and contraction. Improved outcomes on open wounds prompted the application of NPWT on closed surgical incisions. The application of NPWT, in the immediate postoperative period, reduces surgical site infections (SSIs) and wound dehiscence by 50% in high-risk patients. The negative pressure reduces wound edema and improves local perfusion and lymphatic f low, thereby minimizing hematoma and seroma rates. The improved perfusion and oxygenation facilitate quicker wound healing as well as minimize ischemic complications like f lap necrosis. Recent literature supports enhanced wound healing and superior scar appearance as well as improved wound maturity, evidenced by 50% more force required to pull apart a sutured incision. Improved outcomes of incisional NPWT are reported from various surgical procedures on abdominal, breast, orthopedic, vascular, cardiac, and plastic surgeries. Further clinical studies and cost-benefit analysis are needed to recommend routine postoperative use of incisional NPWT in high-risk and low-risk patient population.

The potential of a canister‐based single‐use negative‐pressure wound therapy system delivering a greater and continuous absolute pressure level to facilitate better surgical wound care

“…Of note, we assumed that postoperatively, a fully repaired skin (and each of its layers) eventually recovers to 85% of the native skin stiffness but does not return to the basal stiffness level. According to the literature, the 85% level is approximately the maximum amount of stiffness that can possibly be salvaged 33 . Possible occurrences of pressure drops during therapy by means of the CL suNPWT system are not considered for the simulation data shown here…”

“…37 In the last decade, NPWT has also been widely adopted for the management of surgical incisions. 33,38 For closed incisions, post-surgical complications such as infections or dehiscence can prolong the length of hospital stays, thereby imposing additional direct and indirect costs. 39,40 Single-use, CB or CL NPWT systems are a relatively new wound care technology, which is well suited for post-surgical care, to improve the rate of healing of incision wounds and reduce the occurrence of the aforementioned complications.…”

“…According to the literature, the 85% level is approximately the maximum amount of stiffness that can possibly be salvaged. 33 Possible occurrences of pressure drops during therapy by means of the CL suNPWT system are not considered for the simulation data shown here significant for the high fluid levels in the dressing. For example, the CL-80 suNPWT system managing 80% of the expected fluid volume from a moderately exuding wound (for an anticipated dressing change once in 3 days), only delivered 24% of the pump pressure to the simulated wound (P < .05 in a two-tailed, unpaired t-test; Figure 2C).…”

Closed Incision Negative Pressure Therapy vs Standard of Care Dressing in Breast Surgery: A Systematic Review

“…Despite CINPT being considerably more expensive compared to SOC, it is more cost-effective due to decreased risk of infections and complications [ 12 , 15 ]. Readmission and reoperation rates have been assessed to be lower in patients treated with CINPT compared to control groups following abdominal wall constructions [ 23 ]. Economic analysis has demonstrated cost savings of USD218 per patient with the use of CINPT compared to SOC after breast reconstructions, including costs of therapy and complications [ 12 ].…”

Clinical Applications and Benefits of Using Closed-incision Negative Pressure Therapy with Novel Dressing: A Review Article

“…Regeneration is uncommon, although there are hopes of forming a similar structure with the parent tissue [9]. Healing results in functionality and structurally satisfactory but not identical results [10]. Alterations in the wound by the growth factors and cytokines might disrupt the healing process and extend danger to other tissues.…”