Should infected laparotomy wounds be treated with negative pressure wound therapy?

Tan, Adrian; Gollop, Nicholas D.; Klimach, Stefan; Maruthappu, Mahiben; Smith, Stephanie F

doi:10.1016/j.ijsu.2013.11.002

Cited by 13 publications

(3 citation statements)

References 7 publications

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“…NPWT is well established in the management of complex wounds, particularly in the context of diabetic foot infections, sternal wounds, and complex soft tissue wounds of the extremities [7]. NPWT has also been used to manage infected laparotomy wounds with some success by reducing length of hospital stay and promoting faster wound healing despite a lack of large-scale high quality trials [33]. However, the use of NPWT in the management of wounds after renal transplant is not well described.…”

Section: Discussionmentioning

confidence: 99%

Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

2019

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BackgroundAbdominal wall surgical site complications following renal transplantation can be challenging to manage. A sub-group of these recipients will require operative management or advanced wound care such as negative pressure wound therapy (NPWT). The aim of this study was to determine if there were any preoperative, intraoperative and postoperative characteristics in our recipients’ cohort which were associated with the requirement for such interventions.MethodsA retrospective review of medical records was performed for all recipients who sustained abdominal wall complications following renal transplantation at our centre from 2006 to 2016.ResultsA total of 64/828 recipients (7.7%) had abdominal wall complications. The mean weight for these patients was 84.9 kg (±16.6 kg) and the mean body mass index was 30.2 (±5.1). Forty-five recipients (70%) had a superficial wound dehiscence while nine (14%) had a complete fascial dehiscence. Operative intervention was required in 13/64 patients (20%) and was more likely to be required in the presence of a fascial dehiscence (9/9, 100%) or a wound collection (10/31, 32%) (p < 0.001, p = 0.021). NPWT was used in 17/64 patients (27%) and was more commonly required in patients with diabetes mellitus (10/24, 42%), a complete fascial dehiscence (5/9, 56%) or evidence of infection (16/44, 36%) (p = 0.039, p = 0.034, p = 0.008).ConclusionsThe requirement for either operative management or the use of NPWT in the management of abdominal wall complications following renal transplantation in our experience was more common in recipients with diabetes mellitus, and in the setting of either complete fascial dehiscence, abdominal wall wound collections and/ or infection.

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Section: Discussionmentioning

confidence: 99%

Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

2019

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“…The success of this treatment is the consequence of an increased wound blood flow, the increased granulation tissue formation, decreased bacterial counts, and the stimulation of wound healing pathways through shear stress mechanisms. Over the past decade, numerous uses of this wound management approach have been reported, ranging from the treatment of acute and chronic wounds, to the closure of open sternal and abdominal wounds, to the assistance with skin grafts [8].…”

Section: Negative Pressure Wound Therapymentioning

confidence: 99%

Advanced therapies of skin injuries

Maver

Stana‐Kleinschek

et al. 2015

Wien Klin Wochenschr

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The loss of tissue is still one of the most challenging problems in healthcare. Efficient laboratory expansion of skin tissue to reproduce the skins barrier function can make the difference between life and death for patients with extensive full-thickness burns, chronic wounds, or genetic disorders such as bullous conditions. This engineering has been initiated based on the acute need in the 1980s and today, tissue-engineered skin is the reality. The human skin equivalents are available not only as models for permeation and toxicity screening, but are frequently applied in vivo as clinical skin substitutes. This review aims to introduce the most important recent development in the extensive field of tissue engineering and to describe already approved, commercially available skin substitutes in clinical use.

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“…The use of various skin closure techniques has been studied with the aim of reducing SSI, for example, the purse-string closure method has been reported to have considerable success [5,6]. Similarly, the use of routine negative pressure wound therapy (NPWT) has been postulated as an alternative method to mitigate the risk of developing SSI [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Application of PREVENA (Surgical Incision Protection System) in reducing surgical site infections following reversal of ileostomy or colostomy: the PRIC study protocol

Low

Nugent

O’Sullivan

et al. 2022

Int J Colorectal Dis

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Aim There is a current lack of evidence in the literature to support the routine use of negative pressure wound therapy (NPWT) to reduce the risk of surgical site infections (SSI) in the setting of ileostomy or colostomy reversal. The aim of this study is to examine whether routine NPWT confers a lower rate of SSI than conventional dressings following reversal of ileostomy or colostomy. Methods The PRIC study is a randomized, controlled, open-label, multi-centre superiority trial to assess whether routine NPWT following wound closure confers a lower rate of SSI following reversal of ileostomy or colostomy when compared to conventional dressings. Participants will be consecutively identified and recruited. Eligible participants will be randomized in a 1:1 allocation ratio, to receive either the NPWT (PREVENA) dressings or conventional dressings which will be applied immediately upon completion of surgery. PREVENA dressings will remain applied for a duration of 7 days. Surgical wounds will then be examined on post-operative day seven as well as during follow-up appointments in OPD for any evidence of SSI. In the interim, public health nurses (PHN) will provide out-patient support services incorporating wound assessment and care as part of a routine basis. Study investigators will liaise with PHN to gather the relevant data in relation to the time to wound healing. Our primary endpoint is the incidence of SSI within 30 days of stoma reversal. Secondary endpoints include measuring time to wound healing, evaluating wound healing and aesthetics and assessing patient satisfaction. Conclusion The PRIC study will assess whether routine NPWT following wound closure is superior to conventional dressings in the reduction of SSI following reversal of ileostomy or colostomy and ascertain whether routine NPWT should be considered the new standard of care.

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Should infected laparotomy wounds be treated with negative pressure wound therapy?

Cited by 13 publications

References 7 publications

Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

Abdominal wall complications following renal transplantation in adult recipients – factors associated with interventional management in one unit

Advanced therapies of skin injuries

Application of PREVENA (Surgical Incision Protection System) in reducing surgical site infections following reversal of ileostomy or colostomy: the PRIC study protocol

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