Prevena™, negative pressure wound therapy applied to closed Pfannenstiel incisions at time of caesarean section in patients deemed at high risk for wound infection

Abstract

The aim of our retrospective study is to report on our experience using the Prevena™ wound system in obese patients undergoing caesarean section delivery. A total of 26 cases were identified from July 2012 to October 2013. The median BMI of these women was 45.3 kg/m(2). Elective caesarean sections were performed in 20 women (77%). There were four cases (15%) of superficial dehiscence. Factors associated with wound breakdown were wound infection (p = 0.03), increasing BMI (p < 0.001) and emergency LSCS (p = 0.04). In a logistic regression model the presence of infection was the only factor which remained associated with wound breakdown. Wound disruption is a major cause of morbidity following caesarean section in morbidly obese patients. The wound complication rate in our experience was low with the Prevena™ dressing with no cases of sheath dehiscence, and no patient required a second operation. The presence of infection is the most important factor in wound breakdown and should be the focus for management protocols.

Reduction of groin wound complications in vascular surgery patients using closed incision negative pressure therapy (ciNPT): a prospective, randomised, single‐institution study

“…In order to optimise the advancement of preventive procedures, the effectiveness of ciNPT on groin wounds after vascular surgeries was evaluated. The effect of ciNPT has been demonstrated in clinical studies and case reports in a variety wound types (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). In spite of many publications, clinical studies involving groin wounds are rare.…”

“…Under the designation closed incision negative pressure therapy (ciNPT), this new technique has resulted in many significant clinical results (11,13,25,26). Since 2010, multiple studies and case reports comparing standard-of-care dressings to ciNPT have reported a decrease in SSIs in a wide spectrum of traumatic, orthopaedic, abdominal, sternal and plastic surgery incisions (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). The reason for this success may be due to the reported mechanisms of action of the ciNPT, which protects the incision from external wound contamination, strengthens the cohesiveness of the wound edges, removes fluids and infectious materials from the wound, decreases the lateral tension around the incision and facilitates oxygen saturation and blood microcirculation within the incision area (11,38,39).…”

Prophylactic Wound Vacuum Therapy after Cesarean Section to Prevent Wound Complications in the Obese Population: A Randomized Controlled Trial (the ProVac Study)

“…3 At many institutions, including our own, additional infection prevention measures are routinely utilized including weight-based preoperative antibiotics, use of Sage cloths in labor, vaginal prep prior to cesarean, and closure of the subcutaneous tissue in obese women. 9,10 As a result of these risk reduction efforts, contemporary infection rates may be lower than prior published results. Given the overall lower rate of wound morbidity, the prophylactic use of a NPWT system may provide little additional benefit to decrease the risk of wound complications.…”

“…All previous studies investigating the use of the NPWT system after cesarean delivery have been retrospective, and therefore, limited by the potential for selection bias and confounding by maternal comorbidities. 9,10 …”

“…6–8 Although the device has been shown to be associated with reduced wound infection after a cesarean delivery, the studies are all retrospective, leading to a concern for selection bias. 9,10 The absence of a randomized trial renders estimates of SSI rates in this population uncertain at best.…”