Prophylactic negative pressure wound therapy for closed laparotomy wounds: a systematic review and meta-analysis of randomised controlled trials

Abstract

Surgical site infections are a common source of post-operative morbidity and contribute significantly to healthcare costs. Patients undergoing emergency laparotomy and/or bowel surgery are particularly at risk. Prophylactic negative pressure wound therapy (NPWT) has been shown to reduce wound infection. However, to date, there has been a lack of consensus around its use for closed laparotomy wounds. We conducted a systematic review of randomised controlled trials comparing the use of prophylactic negative pressure wound therapy with standard dressings for closed laparotomy incisions. The primary outcome was incidence of incisional surgical site infection (SSI) at 30 days post-operatively. Secondary outcomes included superficial and deep SSI, skin dehiscence, fascial dehiscence and length of stay. A total of 2182 publications were identified, of which, following review of titles, abstracts and full texts, five studies met the criteria for inclusion. Across these studies, 467 patients were randomised to NPWT and 464 to standard dressings. Overall SSI rate was 18.6% (n = 87/467) versus 23.9% (n = 111/464) in the NPWT and standard dressing groups, respectively (Odds ratio 0.71, 95% CI 0.52-0.99, p = 0.04*). Deep SSI incidence was the same in both groups (2.6%). Both skin dehiscence and fascial dehiscence were slightly higher in the standard dressing group ((4.2%, n = 11/ 263 versus 3.1% (n = 8/261) and (0.9% (n = 3/324) versus 0.6% (n = 2/323)), respectively. This study observed that NPWT reduces the overall SSI for closed laparotomy wounds. It supports data recommending the use of prophylactic NPWT dressings, especially in high-risk patients in both emergency and elective circumstances.

Prophylactic Use of Negative Pressure Therapy in General Abdominal Surgery: A Systematic Review and Meta-Analysis

“…Thus, results of systematic reviews are often incorporated into clinical practice guidelines [35]. Regarding the prevention of SSIs by NPWT, three meta-analysis have been reported so far [2,10,11]. In 2018, Sahebally et al [10] reported a meta-analysis on NPWT for SSI prophylaxis, pooling six observational studies and three RCTs.…”

“…However, the current literature is not conclusive and has controversial results [1,2,4,[7][8][9]. General abdominal surgery has higher rates of SSIs compared with orthopedic, cardiothoracic, and other types of interventions [3,6] and previous meta-analyses on abdominal surgery have also reported contradicting results [2,10,11]. As a result of new trial results, we conducted this updated systematic review and meta-analysis to re-evaluate the value of prophylactic NPWT in general abdominal surgery after primary wound closure.…”

Prophylactic use of vacuum-assisted closure system for cannula sites: A case of extracorporeal biventricular assist devices for 295 days

“…Cannula site infection is a still fatal complication causing sepsis, especially in patients with extracorporeal BiVADs. In addition to antibiotics and surgical debridement, a VAC system has been used for treatment of VAD driveline and cannula site infections, 2,5–7 as well as for other types of surgical wounds, 8 to promote granulation tissue formation. Although VAC therapy of infection for those with extracorporeal VADs has already been reported, the outcome of prophylactic VAC management of BiVAD for such a long duration as in the present report is rarely reported.…”

Surgical Site Infection Wound Bundles Should Become Routine in Colorectal Surgery: A Meta-Analysis

“…A wound bundle, in general, will have more than three components and extend from pre-operative care through to rehabilitation. Newer concepts in colorectal surgery wound care include negative pressure therapy [8] and wound protective devices [9,10].…”