Prophylactic Single-use Negative Pressure Dressing in Closed Surgical Wounds After Incisional Hernia Repair

Abstract

Objective: A randomized controlled trial (RCT) was undertaken to evaluate whether the prophylactic application of a specific single-use negative pressure (sNPWT) dressing on closed surgical incisions after incisional hernia (IH) repair decreases the risk of surgical site occurrences (SSOs) and the length of stay. Background: The sNPWT dressings have been associated to several advantages like cost savings and prevention of SSOs like seroma, hematoma, dehiscence, or wound infection (SSI) in closed surgical incisions. But this beneficious effect has not been previously studied in cases of close wounds after abdominal wall hernia repairs. Methods: An RCT was undertaken between May 2017 and January 2020 (ClinicalTrials.gov registration number NCT03576222). Participating patients, with IH type W2 or W3 according to European Hernia Society classification, were randomly assigned to receive intraoperatively either the sNPWT (PICO)(72 patients) or a conventional dressing at the end of the hernia repair (74 patients). The primary endpoint was the development of SSOs during the first 30 days after hernia repair. The secondary endpoint included length of hospital stay. Statistical analysis was performed using IBM SPSS Statistics Version 23.0. Results: At 30 days postoperatively, there was significatively higher incidence of SSOs in the control group compared to the treatment group (29.8% vs 16.6%, P < 0.042). There was no SSI in the treatment group and 6 cases in the control group (0% vs 8%, P < 0.002). No significant differences regarding seroma, hematoma, wound dehiscence, and length of stay were observed between the groups. Conclusion: The use of prophylactic sNPWT PICO dressing for closed surgical incisions following IH repair reduces significatively the overall incidence of SSOs and the SSI at 30 days postoperatively.

Risks and Prevention of Surgical Site Infection After Hernia Mesh Repair and the Predictive Utility of ACS-NSQIP

“…It was concluded pNPWT should be used in high-risk wounds or obese patients undergoing open VHR, or when anterior compartment separation is used. 85…”

The European Hernia Society Prehabilitation Project: A Systematic Review of Intra-Operative Prevention Strategies for Surgical Site Occurrences in Ventral Hernia Surgery

“…Eight papers were identified in this review that exclusively addressed prophylactic incisional (closed-wound) negative pressure wound therapy after ventral hernia repair. One had to be discarded because a full text was not found ( 27 – 33 ). All studies seem consistent in reporting lower rates of SSI and SSO when using pNPWT ( Table 3 ).…”

“…Moreover, SSOPI occurred less frequently in the pNPWT group ( p < 0.001). Most recently Bueno-Lledo and colleagues showed a reduction of SSOs from 29.8% to 16.6% ( p = 0.042) comparing 146 patients after ventral hernia repair ( 33 ). This was mainly based on a lower incidence of SSI of 0% in the pNPWT group vs. 8% in the control group ( p = 0.002).…”

Use of Closed Incision Negative Pressure Therapy (ciNPT) in Breast Reconstruction Abdominal Free Flap Donor Sites

“…Our study findings add to the body of literature on this topic. Several studies have shown promising results with ciNPT for general wound management [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Smolle et al demonstrated a reduction in wound complications in patients who received ciNPT for orthopaedic surgical sites (total joint arthroplasty) and colorectal laparotomy sites [ 14 ].…”

“…The association between diabetes and obesity with poor wound outcomes following DIEP surgeries has been previously well documented [ 5 , 6 , 17 , 18 , 19 ]. Negative pressure dressings have been identified as superior in certain abdominal operations for higher risk patients [ 7 , 8 , 9 , 10 ] and their use is being trialed in more abdominal surgeries such as donor site closure as in our study population. The use of ciNPT showed improved outcomes to a level proportionate to patients without raised risk profiles, although without statistical significance.…”