Comparative Study of Multifunctional Irrigation‐assisted Vacuum Drainage, Vacuum Sealing Drainage and the Penrose Drain in Treating Severe Multi‐space Deep Fascial Infection in the Head and Neck

Abstract

Background We aimed to compare multifunctional irrigation‐assisted vacuum drainage (MIVD), vacuum sealing drainage (VSD) and the Penrose drain in treating severe multi‐space deep fascial infection (DFI) in head and neck. Methods A retrospective study was conducted on 113 patients who had suffered from severe multi‐space DFI in head and neck and underwent surgical treatment. Patients were divided into the MIVD group, the VSD group, and the Penrose group according to their treatment. Baseline characteristics and clinical outcome data regarding infection control, clinicians’ workload, surgical procedure required, and cost were analyzed. Results Duration of antibiotic administration was significantly shorter using MIVD and VSD than Penrose drains (p = 0.002 with MIVD, p = 0.008 with VSD). Hospital stay in the MIVD group was shorter than the Penrose group (p = 0.034). Compared to the other two groups, more times of manual irrigation were needed in higher frequency in the Penrose group (p < 0.001). Longer Incision and more surgical operation were required in the VSD group than the other two groups (p < 0.001). The treatment cost in the VSD group was higher than the MIVD group (p = 0.045) and the Penrose group (p < 0.001). Conclusions In the treatment of severe multi‐space DFI in head and neck, MIVD and VSD are superior to the Penrose drain in infection control and reduction in clinicians’ workload. Meanwhile, MIVD, with fewer surgical procedures required and less cost, seems to be a more promising method than VSD.

The efficacy of negative‐pressure wound therapy for head and neck wounds: A systematic review and update

“…Gu et al found that white blood cell (WBC) counts after the operation were significantly lower in the NPWT group 26 . Additionally, the frequency of MIC (times/day) and the number of debridements required were significantly lower in the NPWT group, as reported by Qian et al and Liu et al, respectively 21,22 . Lastly, Lin et al identified significantly higher complication and infection prevention rates associated with NPWT compared to conventional wound care 27 .…”

“…Most studies compared NPWT to a control group of regular wound therapy, while Liu et al (2021) compared simultaneous VAC placement to staged application 21 . The multi‐irrigation drain system values in Qian et al 22 were not included but will be explored later.…”

“…In an attempt to overcome this, a color‐coding system similar to that used traditionally only with the Cochrane risk of bias tool was employed, and each domain was marked as either low (green), unclear (yellow), or high (red) risk of bias (see Figure 6). 1,6‐9,11,12,21‐43 Assessments showed most studies to have at least one domain at a high or unclear risk of bias.…”

“…On the one hand, authors like Cao et al warn that in their experience, the benefits of washing away pathogens, pus, clots, and necrotic tissue from infected wounds may be outweighed by the fact that it causes a degree of trauma in its own right and thus may interrupt the healing process and increase the odds of secondary swelling 12 . However, on the other hand, Qian et al were such firm believers in the benefits of irrigation that they created a custom‐made multifunctional irrigation‐assisted vacuum drainage device which permits continuous irrigation 22 . Their comparative study demonstrated the positive effect of reduced hospitalization time.…”

“…26 Additionally, the frequency of MIC (times/day) and the number of debridements required were significantly lower in the NPWT group, as reported by Qian et al and Liu et al, respectively. 21,22 Lastly, Lin et al identified significantly higher complication and infection prevention rates associated with NPWT compared to conventional wound care. 27 However, many outcomes, such as mean time to recovery, dressing change time, and cost of treatment, were not significantly different between the groups in some studies.…”