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

Chen, Bailin; Hao, Fa‐Bao; Yang, Yang; Shang, Qingjuan; Guo, Chunbao

doi:10.1097/md.0000000000006511

Cited by 14 publications

(19 citation statements)

References 16 publications

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“…VSD is a negative-pressure technique that drains seepage, pus, and necrotic tissues [ 9 ] to reduce opportunities for bacterial growth at the wound site. More importantly, VSD can eliminate wound lacuna, which contains pus and necrotic tissues that can hinder the anti-infective function of paraspinal muscle and granulation tissues.…”

Section: Discussionmentioning

confidence: 99%

Improved vacuum sealing drainage for treatment of surgical site infection following posterior spinal internal fixation

Zhang

Li²

2018

Medicine

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Rationale:Surgical site infection (SSI) following spine surgeries involving internal fixation often require removing the instrument; however, this can cause spinal instability. Previous reports have demonstrated the usefulness of vacuum sealing drainage (VSD) therapy, but the cases require wound opening, aseptic condition to replace the VSD device, and a secondary operation to close the wound. Thus, to improve the VSD treatment and develop a maneuverable procedure, make sense in spine surgery.Patients concerns:A 59-year-old male patient with a T12 vertebral fracture was affected by SSIs after spinal osteotomy with internal fixation.Diagnoses:The patient complained of wound exudation and had a fever 3 weeks after posterior spinal surgery. Initial serum investigations showed elevated white blood cell count and bacterial cultures of wound exudate were positive for Enterococcus faecalis. Therefore, SSI is confirmed.Interventions:The infection was not controlled after 2 debridements, so the patient was treated with VSD treatment. The VSD foam dressings containing a drainage tube were placed into the wound from the exudation site of the wound until they contacted the internal fixation devices. After covering external fixation devices, continuous drainage was performed for 24 h. The VSD device was replaced every 4 to 5 days until the wound effusion stopped. All of the operations were performed at the bedside without complex manipulation or secondary closure under harsh aseptic condition.Outcomes:Wound exudation decreased remarkably and the infection was controlled 2 weeks after the application of VSD treatment. After 5 weeks, inflammatory indicators all decreased to normal levels and the exudate of the wound had stopped. The VSD treatment was then terminated and the drainage site of the wound was sutured. After 7 weeks, complete wound healing was achieved and no infection recurred during the 6-month follow-up.Lessons:VSD could be a reliable treatment for SSIs that require preservation of internal fixation. Complete opening of the wound during the VSD treatment and secondary wound closure surgery were avoided.

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Section: Discussionmentioning

confidence: 99%

Improved vacuum sealing drainage for treatment of surgical site infection following posterior spinal internal fixation

Zhang

Li²

2018

Medicine

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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%

“…This topic included 20 related articles: one RCT, 93 and 19 were retrospective studies. 33 , 49 , 53 , 55 , 56 , 65 , 68 , 94 , 95 , 96 , 97 , 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 …”

Section: Recommendationsmentioning

confidence: 99%

“…A case report of an open abdomen due to acute pancreatitis showed that VSD (ABThera kit, KCI, USA) helped aspirate large amounts of exudate in the abdominal cavity and facilitated infection management. 65 …”

Section: Recommendationsmentioning

confidence: 99%

See 2 more Smart Citations

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 Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

et al. 2018

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IMPORTANCE Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. OBJECTIVE To evaluate the association of prophylactic NPWT with SSI rates in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. DATA SOURCES The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched without language restrictions for relevant articles from inception until December 2017. The latest search was performed on December 31, 2017. The bibliographies of retrieved studies were further screened for potential additional studies. STUDY SELECTION Randomized clinical trials and nonrandomized studies were included. Unpublished reports were excluded, as were studies that examined NPWT (or standard nonpressure) dressings only without a comparator group. Studies that evaluated the use of NPWT in open abdominal incisions were also excluded. Disagreement was resolved by discussion, and if the question remained unsettled, the opinion of the senior author was sought. A total of 198 citations were identified, and 189 were excluded. DATA EXTRACTION AND SYNTHESIS This meta-analysis was conducted according to PRISMA guidelines. Data were independently extracted by 2 authors. A random-effects model was used for statistical analysis. MAIN OUTCOMES AND MEASURES The primary outcome measure was SSI, and secondary outcomes included seroma and wound dehiscence rates. These outcomes were chosen before data collection. RESULTS Nine unique studies (3 randomized trials and 2 prospective and 4 retrospective studies) capturing 1266 unique patients were included. Of these, 1187 patients with 1189 incisions were included in the final analysis (52.3% male among 7 studies reporting data on sex; mean [SD] age, 52 [15] years among 8 studies reporting data on age). Significant clinical and methodologic heterogeneity existed among studies. On random-effects analysis, NPWT was associated with a significantly lower rate of SSI compared with standard dressings (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52; P < .001). However, no difference in rates of seroma (pooled OR, 0.38; 95% CI, 0.12-1.23; P = .11) or wound dehiscence (pooled OR, 2.03; 95% CI, 0.61-6.78; P = .25) was found. On sensitivity analysis, focusing solely on colorectal procedures, NPWT significantly reduced SSI rates (pooled OR, 0.16; 95% CI, 0.07-0.36; P < .001). CONCLUSIONS AND RELEVANCE Application of NPWT on closed laparotomy wounds in general and colorectal surgery is associated with reduced SSI rates but similar rates of seroma and wound dehiscence compared with conventional nonpressure dressings.

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

Cited by 14 publications

References 16 publications

Improved vacuum sealing drainage for treatment of surgical site infection following posterior spinal internal fixation

Improved vacuum sealing drainage for treatment of surgical site infection following posterior spinal internal fixation

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

Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery

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