Abstract
Wound healing complications (WHCs) in the groin after vascular surgeries are a serious problem for patients and surgeons in various surgical disciplines. The incidence of WHCs of up to 44% after incisions in the groin is often responsible for prolonged hospital stay and high treatment costs. An effective reduction of WHCs for various wound types after using closed incision negative pressure therapy (ciNPT) has been documented in many case reports and clinical studies. As the majority of studies have addressed the effect of ciNPT on primary groin incision wounds, concerning groin incision wounds after revision vascular surgery are extremely scarce. The aim of this prospective, randomized clinical study was to investigate the effectiveness of ciNPT compared with conventional therapy on groin incisions after revision vascular surgery. We analyzed the cases of a total of 94 patients with 100 groin incisions. Patients were randomized and treated with either PREVENA™ (n=47 groins) or a conventional adhesive dressing (n=53 groins; control group). PREVENA™ was applied intraoperatively and was removed on day 5, 6 or 7 postoperatively. Wound evaluation was carried out on the 5th to 7th and 30th postoperative day. Compared with the control group, the ciNPT group showed a reduction in the overall incidence of WHCs assessed 30 days postoperatively (p<0.0005). With regard to prevention of revision surgeries, the ciNPT had no significant impact (p=0.056). Subgroup analysis revealed a significant effect of ciNPT for almost all wound healing risk factors. Based on our results, ciNPT provides a promising therapeutic option to reduce the frequency of postoperative WHCs and the need for revision surgeries in the groin after revision vascular surgery in patients with wound healing risk factors.
Highlights
For decades postoperative wound healing complications (WHCs) have presented serious problems for patients and surgeons in various surgical disciplines
In closed incision negative pressure therapy (ciNPT) patients with revision surgery, fewer WHCs were observed for the perioperative risk factors wound length (p=0.027) and hospital stay (p=0.017) (Table 7)
Svensson et al analysis of seven randomized clinical trial (RCT) of vascular surgery patients confirmed a reduction in the incidence of surgical site infections (SSIs) in the groin after using PREVENATM and PICOTM versus standard dressing in vascular surgery patients [10], and Singh et al found a significant effect for PREVENATM in preventing SSIs (p
Summary
For decades postoperative wound healing complications (WHCs) have presented serious problems for patients and surgeons in various surgical disciplines. Surgical site infections (SSIs) are an important cause of prolonged hospital stay, unplanned readmissions after surgery, morbidity, and death [1]. With an estimated 157,500 SSIs in the United States per year, this type of healthcare-associated infection creates an increased burden for the health care system [2]. Due to its anatomical structures and its function as a leading access for the majority of vascular surgeries and interventions, the groin shows a propensity for postoperative WHCs. Vascular surgery patients have an incidence of WHCs of up to 44% after incisions in the groin [5,6,7,8,9].
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