Closed-incision negative-pressure wound management in surgery—literature review and recommendations

Abstract

Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.

Incisional negative pressure wound therapy to reduce surgical-site infections in major limb amputations: a meta-analysis

“…Depending on the postinterventional bleeding from the wound, repetitive changes are necessary within the first 5 days after surgery (11,15,16). Thus, not only does the microenvironment of the wound gets disrupted but a change of dressing is done at the bedside under semi-sterile circumstances, which leads to a higher risk of surgical-site infection (1,17). iNPWT is applied directly after surgery, which guarantees for more sterility and does not need a change of dressings mostly within the first 4-5 days after surgery (18).…”

“…Lower extremity amputation bears a high risk for postsurgical wound infections (1). Multi-morbid patients with diabetes-induced peripheral arterial disease represent the main subjects of major lower limb amputations (2).…”

Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites

“…Our study findings add to the body of literature on this topic. Several studies have shown promising results with ciNPT for general wound management [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Smolle et al demonstrated a reduction in wound complications in patients who received ciNPT for orthopaedic surgical sites (total joint arthroplasty) and colorectal laparotomy sites [ 14 ].…”

“…Several studies have shown promising results with ciNPT for general wound management [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Smolle et al demonstrated a reduction in wound complications in patients who received ciNPT for orthopaedic surgical sites (total joint arthroplasty) and colorectal laparotomy sites [ 14 ]. A randomised control trial conducted by Tanaydin et al compared ciNPT with standard adhesive dressings (fixation strips) in breast reduction mammoplasty surgical sites and found that ciNPT was associated with reduced wound complications ( p < 0.04) and an improvement in scar quality [ 17 ].…”