Negative pressure therapy is effective in abdominal incision closure

Kugler, Nathan W.; Carver, Thomas; Paul, Jasmeet S.

doi:10.1016/j.jss.2016.04.032

Cited by 23 publications

(16 citation statements)

References 16 publications

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“…SSSI occurred in 16.3% of all patients within 30 days after reversal of double loop ileostomy. However, using SSD 20% developed SSSI that is in accordance with published data for contaminated wounds . With the use of an iNPWT system the SSSI rate decreased to 12.5%.…”

Section: Discussionsupporting

confidence: 82%

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Decreased superficial surgical site infections, shortened hospital stay, and improved quality of life due to incisional negative pressure wound therapy after reversal of double loop ileostomy

Poehnert

Hadeler

Schrem

et al. 2017

Wound Repair Regeneration

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This single-center prospective, controlled observational study investigates the impact of incisional negative pressure wound therapy on wound healing processes and its potency to prevent superficial surgical site infections (SSSI) after reversal of a double loop ileostomy. Furthermore, this study gains insight in socioeconomic aspects, like duration of hospital stay and, for the first time, patient's quality of life during the incisional negative pressure wound treatment. To address this question, an interventional group of 24 patients treated with incisional negative pressure wound therapy (Prevena incisional wound management system, KCI, Germany) and a respective control cohort of 25 patients treated with a standard sterile dressing were observed for 30 days in the postoperative course. Postoperative incisional negative pressure wound therapy resulted in statistically significant decreasing duration of hospital stay (6 days vs. 9 days, p 5 0.019) and lower rates of SSSIs (12.5% vs. 20.0%, p 5 0.478) in accordance with a not statistically significant decreased necessity of postoperative antibiotic therapy (12.5% vs. 36%, p 5 0.051). To survey subjective items of well-being and quality of life, all patients were asked to answer a questionnaire. Patients of both groups noticed increasing quality of life after reversal of their ileostomy. However, patients treated with an incisional negative pressure wound therapy had a superior improvement of a variety of subjective items, resulting in an overall much better satisfaction with the course of wound healing. Our findings suggest, that incisional negative pressure wound therapy seems to be a reasonable therapeutic option to reduce incidence of SSSIs and to have a beneficial impact to patient's quality of life, as well as, socio-economic aspects.

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Section: Discussionsupporting

confidence: 82%

“…One of these techniques is incisional negative wound pressure therapy (iNPWT) which seems to be a promising technique to reduce SSSI in abdominal surgery . By improving the removal of wound edema, increasing local blood flow and stimulating the lymph clearance, the wound exudate removal is promoted.…”

mentioning

confidence: 99%

Decreased superficial surgical site infections, shortened hospital stay, and improved quality of life due to incisional negative pressure wound therapy after reversal of double loop ileostomy

Poehnert

Hadeler

Schrem

et al. 2017

Wound Repair Regeneration

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show abstract

“…CDC class III or IV wounds often resulting from emergent intervention, which are often beyond the surgeon's control. [15,16] VSD technique has demonstrated benefit intreatment of soft tissue infection, skin defects, and complicated wounds, on the basis of drains out seepage, pus, and necrotic tissues through negative-pressure [17] ; however, no studies have evaluated its utility in the setting of a high-risk abdominal wound closures in contaminated cohort. In our research, there were no significant differences of system infection between the 2 patient groups, for routine perioperative antibiotics, like pneumonia, peritonitis or abscess, sepsis, and we found that the placement of a VSD resulted in a statistically significantly lower incidence of overall wound infection.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic vacuum sealing drainage (VSD) in the prevention of postoperative surgical site infections in pediatric patients with contaminated laparotomy incisions

et al. 2017

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Surgical site infection (SSI) continues to be an issue in abdominal surgery, especially for contaminated (class III) and dirty-infected (class IV) wounds. Vacuum sealing drainage (VSD) was reported effective in the management of various types of wounds or skin grafts. Our goal was to investigate the efficacy of prophylactic VSD to better orient their medicosurgical care of high-risk incisions following laparotomy in a pediatric population.A total of 331 pediatric patients with contaminated (class III) and dirty-infected (class IV) wounds following emergency laparotomy were retrospectively reviewed between January 2005 and January 2013. Among them, 111 cases were placed with prophylactic VSD when incisions were closed. Clinical outcomes, including, overall surgical site complication, device effectiveness, and mean postoperative LOS were evaluated based on VSD usage or not.VSD was applied for an average of 5.8 days (range, 5–7 days), with 3 to 15 mL sucked fluid. The overall SSIs rate was 3% for patients with prophylactic VSD and 17% for patients with convention dressing (OR, 0.27; 95% CI, 0.10–0.71, P = 0.004). In patients with prophylactic VSD, only 1 of 96 wound developed postoperative incision dehiscence, which is significant reduced compared with patients for conventional dressings (OR, 0.12; 95% CI, 0.01–0.95; P = 0.017) (Table 2). It also exhibited a decreased mean postoperative LOS (P < 0.001) for prophylactic VSD over conventional dressings.Our study demonstrated beneficial postoperative clinical effects of prophylactic VSD for high-risk laparotomy incisions following emergency laparotomy, such as shorter length of hospitalization, which may be attributed to the reduced overall SSIs rate.

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“…A total of 35 articles discussed prophylactic VSD (pVSD) for abdominal incisions with primary suture, of which 6 were RCTs 32 , 33 , 34 , 35 , 36 , 37 and 29 were observational studies. 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 …”

Section: Recommendationsmentioning

confidence: 99%

“… 34 Eleven observational studies of abdominal surgeries, including pediatric contaminated surgery, gynecological malignancy surgery, cesarean section surgery, and liver transplantation surgery, also showed that pVSD reduced the incidence of incision infections. 44 , 45 , 49 , 50 , 52 , 57 , 59 , 65 One RCT showed that pVSD reduced postoperative pain and the need for anesthetics 34 ; however, although the incidence of SSIs decreased, the difference was not significant.…”

Section: Recommendationsmentioning

confidence: 99%

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

Sun

et al. 2019

Chinese Journal of Traumatology

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Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chinese Trauma Surgeon Association organized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries. Eleven questions regarding the use of VSD in abdominal surgeries were addressed: (1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions? (2) Can VSD be preventively used for a high-risk abdominal incision with primary suture? (3) Can VSD be used in severely contaminated/infected abdominal surgical sites? (4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome? (5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage? (6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula? (7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess? (8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects? (9) Does VSD increase the risk of bleeding? (10) Does VSD increase the risk of intestinal wall injury? (11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2–4. Weak recommendations were made regarding questions 1 and 5–11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

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Negative pressure therapy is effective in abdominal incision closure

Cited by 23 publications

References 16 publications

Decreased superficial surgical site infections, shortened hospital stay, and improved quality of life due to incisional negative pressure wound therapy after reversal of double loop ileostomy

Decreased superficial surgical site infections, shortened hospital stay, and improved quality of life due to incisional negative pressure wound therapy after reversal of double loop ileostomy

Prophylactic vacuum sealing drainage (VSD) in the prevention of postoperative surgical site infections in pediatric patients with contaminated laparotomy incisions

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries—Update and systematic review

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