Abstract
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.
Highlights
Wound complications following surgery may include dehiscence, prolonged secretion and infection
Operative interventions for hand trauma were frequently associated with postoperative wound healing deficits
We identified seven meta-analyses analysing the impact of Closed-incision negative-pressure wound therapy (ciNPWT) used for various surgical procedures
Summary
Wound complications following surgery may include dehiscence, prolonged secretion and infection. Surgical site infections (SSI) account for approximately 20% of all hospital-acquired infections and result in a prolonged length of stay, increased readmission rate and higher treatment costs [1]. In 2 to 5% of patients undergoing inpatient elective surgery, SSI develop after an average length of stay of 9.7 days [1, 2]. Costs of SSI treatment are estimated to amount to 3.5 to 10 billion dollars in the United States per year [2]. Several risk factors associated with SSI have been identified and can be divided into intrinsic (i.e. patient-related) and extrinsic (i.e. procedure-related) factors. Intrinsic risk factors can be subdivided into modifiable (e.g. obesity, alcoholism and smoking, and diabetes, immunosuppression) and nonmodifiable (patient age, skin quality and/or microbial environment) [1]. Extrinsic factors can be based on the type of surgical procedure, surgical pro-
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