Abstract
BackgroundThe American Society of Surgery and American Society for Surgical Infections issued guidelines for surgical site infections (SSIs) in December 2016. These guidelines recommend a purse-string suture (PSS) for stoma closure as it facilitates granulation and enables open wound drainage. This study investigated the effect of using negative pressure wound therapy (NPWT) along with standard PSS and aimed to determine the optimal period of NPWT use.MethodsThe patients were divided into three groups as follows: Group A, postoperative wound management alone with gauze exchange as the representative of conventional PSS; Group B, the performed management was similar to that of Group A plus NPWT for 1 week; and Group C, the performed management was similar to that of Group A plus NPWT for 2 weeks. Regarding objective measures, the wound reduction rate was the primary outcome, and the incidence of SSIs, length of hospital stay, and wound healing duration were the secondary outcomes.ResultsIn total, 30 patients (male: 18, female: 12) were enrolled. The average age was 63 (range: 43–84) years. The wound reduction rate was significantly higher in Group B than in Group A on postoperative days (PODs) 7 (66.1 vs. 48.4%, p = 0.049) and 10 (78.6 vs. 58.2%, p = 0.011), whereas no significant difference was observed on POD 14. Compared with Group A, Group C (POD 7: 65.9%, POD 10: 69.2%) showed an increase in the wound reduction rate on POD 7, although the difference was not significant (p = 0.075). SSIs were observed in Groups B (n = 2) and C (n = 2) (20%) but not in Group A (0%).ConclusionsThe most effective duration of NPWT use for ileostomy closure with PSS in terms of the maximum wound reduction rate was from PODs 3 to 10. However, NPWT did not shorten the wound healing duration. NPWT may reduce the wound size but should be used with precautions for SSIs. The small sample size (30 cases), the use of only one type of NPWT system, and the fact that wound assessment was subjective and not blinded were the limitations of this study. Further studies are needed to confirm our findings.Trial registration: UMIN Clinical Trials Registry; UMIN000032174 (10/04/2018).
Highlights
The American Society of Surgery and American Society for Surgical Infections issued guidelines for surgical site infections (SSIs) in December 2016
All the patients enrolled in this study had an American Society of Anesthesiologists class I or II classification; none of them had undergone preoperative chemotherapy or radiotherapy, and none was diagnosed with renal failure
In this study, the wound reduction rate did not differ between the groups on postoperative day (POD) 3, whereas it was superior in Group B compared with that in Group A on PODs 7 and 10; no difference was detected on POD 3 possibly because of negative pressure wound therapy (NPWT) use during the inflammatory phase of the wound healing process, which could not provide the expected effects because of the presence of inflammation
Summary
The American Society of Surgery and American Society for Surgical Infections issued guidelines for surgical site infections (SSIs) in December 2016 These guidelines recommend a purse-string suture (PSS) for stoma closure as it facilitates granulation and enables open wound drainage. Since 1995, purse-string suture (PSS) for stoma closure has been reported to be useful for preventing SSIs, mainly in Europe and the United States. PSS for stoma closure is a method of suturing the dermis in an annular shape to create a semi-open wound, that significantly reduces the incidence of SSIs compared with the conventional simple wound closure [4, 5]. Guidelines in Europe and the United States recommended PSS as a method of wound closure following stoma creation [7]. Patients are often discharged from the hospital before achieving complete wound healing; monitoring the wound and expenditure related to the medical materials needed for its management become the patients’ responsibility
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