The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: A systematic review and meta-analysis

Shiroky, Jonah; Lillie, Erin; Muaddi, Hala; Sevigny, Marika; Choi, Woo Jin; Karanicolas, Paul J.

doi:10.1016/j.surg.2020.01.018

Cited by 70 publications

(72 citation statements)

References 60 publications

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“…A meta-analysis comparing all studies on negative pressure therapy for closed surgical incisions (i.e. Prevena system) found a reduction in surgical site infections by approximately 40% compared to conventional wound treatment [37]. One study used the Prevena system on perineal wounds after neoadjuvant radio-chemotherapy followed by abdominoperineal resection of the rectum, which are known to result in wound healing disorders in up to 40% of cases.…”

Section: Discussionmentioning

confidence: 99%

Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

Wagner

Wetz

Wiegering

et al. 2021

Langenbecks Arch Surg

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Purpose Traditionally, previous wound infection was considered a contraindication to secondary skin closure; however, several case reports describe successful secondary wound closure of wounds “preconditioned” with negative pressure wound therapy (NPWT). Although this has been increasingly applied in daily practice, a systematic analysis of its feasibility has not been published thus far. The aim of this study was to evaluate secondary skin closure in previously infected abdominal wounds following treatment with NPWT. Methods Single-center retrospective analysis of patients with infected abdominal wounds treated with NPWT followed by either secondary skin closure referenced to a group receiving open wound therapy. Endpoints were wound closure rate, wound complications (such as recurrent infection or hernia), and perioperative data (such as duration of NPWT or hospitalization parameters). Results One hundred ninety-eight patients during 2013–2016 received a secondary skin closure after NPWT and were analyzed and referenced to 67 patients in the same period with open wound treatment after NPWT. No significant difference in BMI, chronic immunosuppressive medication, or tobacco use was found between both groups. The mean duration of hospital stay was 30 days with a comparable duration in both patient groups (29 versus 33 days, p = 0.35). Interestingly, only 7.7% of patients after secondary skin closure developed recurrent surgical site infection and in over 80% of patients were discharged with closed wounds requiring only minimal outpatient wound care. Conclusion Surgical skin closure following NPWT of infected abdominal wounds is a good and safe alternative to open wound treatment. It prevents lengthy outpatient wound therapy and is expected to result in a higher quality of life for patients and reduce health care costs.

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Section: Discussionmentioning

confidence: 99%

Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

Wagner

Wetz

Wiegering

et al. 2021

Langenbecks Arch Surg

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show abstract

“…NPWT should not be used alone on infected wounds, rather it can be used as an adjunct therapy with antibiotics, debridement, and local antibacterial agents. Shiroky et al [ 16 ] and Benrashid [ 17 ] both reported that NPWT could reduce the incidence of surgical wound infection, conversely Costa et al [ 18 ] found no difference in infection rate when comparing negative pressure treatment to use of a normal dressing.…”

Section: Discussionmentioning

confidence: 99%

A Prospective Randomized Study: The Usefulness and Efficacy of Negative Pressure Wound Therapy with Lipidocolloid Polyester Mesh Compared to Traditional Negative Pressure Wound Therapy for Treatment of Pressure Ulcers

et al. 2020

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To improve healing of pressure ulcer wounds, it is important to optimize the conditions of the area surrounding the wound. Negative pressure wound therapy (NPWT) promotes wound healing, however, the removal of NPWT can cause pain or focal bleeding, delaying wound healing or causing infection. In this study, we reviewed the efficacy of the lipidocolloid non-adherent dressing (Urgotul®) as a wound contact layer. A total of 38 patients from the same facility who applied NPWT from April 2016 to October 2019 were included and divided into two groups; NPWT with the lipidocolloid non-adherent dressing (group 1, experimental group, 19 patients) and NPWT only (group 2, control group, 19 patients). The condition of the wound was examined prior to NPWT application, at one week, and again at three weeks after application. No significant differences were found between groups for general characteristics, bacterial culture or photo analysis. However, when comparing groups based on the time of examination, there was a significant reduction of the wound size in group 1 (p = 0.001) but not in group 2 (p = 0.082). Therefore, the current study finds that using the lipidocolloid non-adherent dressing as a wound contact layer in NPWT stimulates healing by shrinking the size of the pressure ulcer wound.

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“…The authors concluded that ciNPWT was a viable option for various surgical indications to reduce the rate of wound healing deficits, SSI and hospital length of stay (level I) [29]. In three other meta-analyses, a positive influence of ciNPWT on postoperative wound healing, reducing the rate of SSI and, to a lesser extent, wound dehiscence and seroma formation, was confirmed (level I) [30][31][32].…”

Section: General Surgerymentioning

confidence: 93%

Closed-incision negative-pressure wound management in surgery—literature review and recommendations

et al. 2020

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Summary Background Wound healing deficits and subsequent surgical site infections are potential complications after surgical procedures, resulting in increased morbidity and treatment costs. Closed-incision negative-pressure wound therapy (ciNPWT) systems seem to reduce postoperative wound complications by sealing the wound and reducing tensile forces. Materials and methods We conducted a collaborative English literature review in the PubMed database including publications from 2009 to 2020 on ciNPWT use in five surgical subspecialities (orthopaedics and trauma, general surgery, plastic surgery, cardiac surgery and vascular surgery). With literature reviews, case reports and expert opinions excluded, the remaining 59 studies were critically summarized and evaluated with regard to their level of evidence. Results Of nine studies analysed in orthopaedics and trauma, positive results of ciNPWT were reported in 55.6%. In 11 of 13 (84.6%), 13 of 15 (86.7%) and 10 of 10 (100%) of studies analysed in plastic, vascular and general surgery, respectively, a positive effect of ciNPWT was observed. On the contrary, only 4 of 12 studies from cardiac surgery discovered positive effects of ciNPWT (33.3%). Conclusion ciNPWT is a promising treatment modality to improve postoperative wound healing, notably when facing increased tensile forces. To optimise ciNPWT benefits, indications for its use should be based on patient- and procedure-related risk factors.

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The impact of negative pressure wound therapy for closed surgical incisions on surgical site infection: A systematic review and meta-analysis

Cited by 70 publications

References 60 publications

Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

Successful surgical closure of infected abdominal wounds following preconditioning with negative pressure wound therapy

A Prospective Randomized Study: The Usefulness and Efficacy of Negative Pressure Wound Therapy with Lipidocolloid Polyester Mesh Compared to Traditional Negative Pressure Wound Therapy for Treatment of Pressure Ulcers

Closed-incision negative-pressure wound management in surgery—literature review and recommendations

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