Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications

Zwanenburg, Pieter R; Tol, Berend T; Obdeijn, Miryam C.; Lapid, Oren; Gans, Sarah L.; Boermeester, Marja A.

doi:10.1097/sla.0000000000003644

Cited by 50 publications

(74 citation statements)

References 129 publications

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“…They did not stratify results for various surgical categories, but they did it for surgical field conditions (i.e. clean, clean contaminated) [ 61 ]. In the same paper, subgroup analysis focusing on abdominal surgery was performed: the benefit of iNPWT over SD was no longer highlighted.…”

Section: Resultsmentioning

confidence: 99%

Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature

et al. 2021

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Background Immunocompromised patients are at higher risk of surgical site infection and wound complications. However, optimal management in the perioperative period is not well established. Present systematic review aims to analyse existing strategies and interventions to prevent and manage surgical site infections and other wound complications in immunocompromised patients. Methods A systematic review of the literature was conducted. Results Literature review shows that partial skin closure is effective to reduce SSI in this population. There is not sufficient evidence to definitively suggest in favour of prophylactic negative pressure wound therapy. The use of mammalian target of rapamycin (mTOR) and calcineurin inhibitors (CNI) in transplanted patient needing ad emergent or undeferrable abdominal surgical procedure must be carefully and multidisciplinary evaluated. The role of antibiotic prophylaxis in transplanted patients needs to be assessed. Conclusion Strict adherence to SSI infection preventing bundles must be implemented worldwide especially in immunocompromised patients. Lastly, it is necessary to elaborate a more widely approved definition of immunocompromised state. Without such shared definition, it will be hard to elaborate the needed methodologically correct studies for this fragile population.

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Section: Resultsmentioning

confidence: 99%

Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature

et al. 2021

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“…We chose to use iNPWT for the management of these two challenging cases of degloving injuries. Several meta-analyses have shown efficacy in the prevention of wound dehiscence in high-risk cases [24][25][26][27][28][29][30][31][32][33] . We decided that the benefit obtained with use of iNPWT exceeded the cost of treatment, considering the cost of social welfare that would be incurred if these elderly patients were unable to walk.…”

Section: Discussionmentioning

confidence: 99%

Incisional Negative Pressure Wound Therapy with Reinforcement of Subcutaneous Drainage (Hybrid-iNPWT)

Kitano

Kitagawa²,

Taniguchi³

et al. 2021

International Journal of Surgical Wound Care

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Introduction: Incisional negative pressure wound therapy (iNPWT) is a preventive measure for postoperative wound dehiscence in which negative pressure is applied to the suture wound. Indeed, insufficient drainage in the deep layer is associated with an increased risk of developing subcutaneous hematoma and wound complications. Here, we report two cases of lower limb degloving injury successfully managed by iNPWT, with the reinforcement of subcutaneous drainage (hybrid-iNPWT). Case presentation: Case 1 was that of an 87-year-old man who sustained a deep, dissecting hematoma of the left lower leg associated with the sensation of severe tightness and pain. After emergency incision and removal of the hematoma in the deep fascia, we performed a primary closure of the flap wound. A negative pressure of 80 mmHg was applied to the sutured wound via foam dressing (iNPWT). Concurrently, we connected the negative pressure device with a subcutaneous drainage tube inserted under the flap (hybrid-iNPWT). The flap survived without recurrence of hematoma. Case 2 was that of an 89-year-old woman with a right lower leg degloving injury. The skin and subcutaneous tissues were detached from the underlying fascia. After primary closure of the flap, hybrid-iNPWT was performed at a subatmospheric pressure of 80 mmHg. The patient was discharged without any complications related to wound healing. Discussion: The aim of using hybrid-iNPWT was to apply negative pressure not only to the surface of the sutured wound but also to the posterior portion of the flap. The intensity of the negative pressure provided by the iNPWT device was higher than that of the conventional suction drainage tube system. Hybrid-iNPWT can be an alternative solution for hematoma prevention and may allow early ambulation in the management of lower limb degloving injuries in elderly patients.

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“…The authors concluded that ciNPWT was a viable option for various surgical indications to reduce the rate of wound healing deficits, SSI and hospital length of stay (level I) [29]. In three other meta-analyses, a positive influence of ciNPWT on postoperative wound healing, reducing the rate of SSI and, to a lesser extent, wound dehiscence and seroma formation, was confirmed (level I) [30][31][32].…”

Section: General Surgerymentioning

confidence: 92%

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

et al. 2020

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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.

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Meta-analysis, Meta-regression, and GRADE Assessment of Randomized and Nonrandomized Studies of Incisional Negative Pressure Wound Therapy Versus Control Dressings for the Prevention of Postoperative Wound Complications

Cited by 50 publications

References 129 publications

Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature

Surgical site infection prevention and management in immunocompromised patients: a systematic review of the literature

Incisional Negative Pressure Wound Therapy with Reinforcement of Subcutaneous Drainage (Hybrid-iNPWT)

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

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