Prophylactic negative pressure wound therapy for closed laparotomy incisions after ventral hernia repair: A systematic review and meta-analysis

Guo, Chenchen; Cheng, Tao; Li, Junsheng

doi:10.1016/j.ijsu.2021.106216

Cited by 10 publications

(8 citation statements)

References 31 publications

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“…36,41,45,[49][50][51][52] However, results in the literature are mixed, and other studies do not show this relationship. [6][7][8][9]13,33,[53][54][55][56][57][58] In the context of DIEP flaps, wound dehiscence is frequently attributed to suturing under tension and the extended length of the incision. 39,59 In this regard, the utilization of ciNPWT holds significant promise in preventing wound dehiscence by offering valuable physical support and functioning as a protective splint against the tensile forces acting on the wound.…”

Section: Discussionmentioning

confidence: 99%

“…This contradicts several studies demonstrating decreased surgical site infection rates with ciNPWT. [5][6][7][8][9]11,13,14,30,33,36,41,[43][44][45][46][47][48][49][50][51][52][54][55][56][57][58][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] However, the occurrence of infection in DIEP flaps is infrequent, with a recent meta-analysis reporting a donor site infection rate of 4.79%. 77 Mechanistically, ciNPWT acts as a barrier that prevents contamination of the surgical site with bacteria before reepithelization, encourages drainage of excess interstitial fluid, increases lymphatic flow, improves blood flow, and induces angiogenesis, theoretically decreasing the risk of infection and expediting healing.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies demonstrate a benefit on rates of seroma with the use of ciN-PWT, 11,41,44,49,50,52,54,55,63 but results are mixed. [6][7][8][13][14][15]33,45,48,61 Seromas develop as a result of the accumulation of serum in internal spaces. In vivo studies have shown improved fluid flow within 4 days of ciNPWT, resulting in decreased porcine subcutaneous dead spaces and therefore reduced risk of seroma.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanistically, ciN-PWT promotes healing by facilitating wound approximation, angiogenesis, and fluid management, and by decreasing bacterial load. 4 ciNPWT has been investigated in a variety of surgical specialties, [5][6][7][8][9] and its use continues to grow in breast reconstruction. A systematic review and meta-analysis recently demonstrated reduced overall wound complications and flap necrosis using ciN-PWT in implant-based breast reconstruction, and several reviews have shown benefit in primary wound closure.…”

Section: Introductionmentioning

confidence: 99%

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Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction

Dunson,

Kogan,

Grosser

et al. 2023

Plastic and Reconstructive Surgery - Global Open

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Background: Closed-incision negative pressure wound therapy (ciNPWT) has shown promise in reducing surgical wound complications. Among its numerous benefits, it allows for exudate management and tension offloading from wound edges. The purpose of this systematic review and meta-analysis was to assess the efficacy of prophylactic ciNPWT versus conventional dressings on abdominal donor site complications in microsurgical breast reconstruction (MR). Methods: A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in January 2023. PubMed and Embase were searched to identify all relevant studies. Data collected included rates of total wound complications, wound dehiscence, infection, seroma, and length of hospital stay. Results: A total of 202 articles were screened, and eight studies (1009 patients) met the inclusion criteria. Use of ciNPWT was associated with a significantly lower rate of wound dehiscence (OR, 0.53; 95% confidence interval, 0.33–0.85; P = 0.0085, I 2 = 0%). There was no significant difference in the rate of total wound complications [odds ratio (OR), 0.63; 95% CI, 0.35–1.14; P = 0.12, I 2 = 69%], donor site infection (OR, 0.91; 95% CI, 0.42–1.50; P = 0.47, I 2 = 13%), seroma (OR, 0.74; 95% CI, 0.22–2.49; P = 0.63, I 2 = 57%), or length of hospital stay (SMD, 0.089; 95% CI, –0.13–0.35; P = 0.37, I 2 = 29%). Conclusions: Although exudate management by ciNPWT fails to reduce surgical site infection, seroma formation, and overall length of stay, ciNPWT tension offloading properties seem to be associated with lower rates of wound dehiscence when compared with conventional dressings in abdominal-based autologous breast reconstruction.

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