EFFICACY OF NEGATIVE PRESSURE WOUND THERAPY IN LAPAROTOMY WOUNDS: PROTOCOL FOR A SYSTEMATIC REVIEW AND META-ANALYSIS

Background/Objectives: Surgical Site Infections (SSIs) rank among the most common complications following stoma takedown and lead to increased morbidity, increased Length of Hospital Stay (LOS), and higher healthcare costs. Negative Pressure Wound Therapy (NPWT) systems have emerged as a promising option for optimizing wound management and minimizing SSI rates. This systematic review and meta-analysis compares postoperative outcomes of NPWT and conventional Non-Pressure Dressings following stoma reversal. Methods: A search of the literature published up to 1 September 2024 was conducted across MEDLINE/PubMed, and the Cochrane Central Register of Controlled Trials (CENTRAL), and Scopus, as well as ClinicalTrials.gov. Only Randomized Controlled Trials (RCTs) were included. The primary outcome was SSI rate, while secondary outcomes included time to complete wound healing, LOS, and patient-reported wound cosmesis. Quality assessment was performed using the Cochrane Risk of Bias 2 (RoB 2) tool. The results were synthesized using means and Standard Deviations for continuous variables, counts and percentages for categorical variables, and presented as Odds Ratios (OR) or Mean Differences (MD) with 95% Confidence Intervals, using random or fixed effects models based on heterogeneity (I2). Results: Six RCTs, including 328 patients, were ultimately eligible for inclusion. No significant difference was revealed in SSI rates between the NPWT and conventional dressing groups (OR = 0.95; 95% CI: 0.27-3.29; p = 0.94; I2 = 38%). Time to complete wound healing was significantly lower in the NPWT group compared to conventional dressings (MD = -3.78 days; 95% CI: -6.29 to -1.27; p = 0.003). Two studies reported a lower rate of wound healing complications other than SSIs in the NPWT group (OR = 0.22; 95% CI: 0.05-1.09; p = 0.06). No substantial differences were observed in terms of LOS (MD = -0.02 days; 95% CI: -1.22 to 1.17; p = 0.97) and patient-reported wound cosmesis (SMD = 0.31; 95% CI: -0.49 to 1.11; p = 0.44). The review's limitations include potential risk of bias, variability in study designs, and heterogeneity between studies. Conclusions: NPWT contributes to improved wound management through reducing wound healing time compared to Non-Pressure Dressings after stoma reversal, although it does not appear to substantially impact SSI rates, LOS, or patient-assessed wound cosmesis. Further large-scale, multicenter RCTs are necessary to validate these results and identify patient populations most likely to benefit from NPWT application.

Background: Surgical site infection (SSI) is one of the most common healthcare-associated infections. The use of negative pressure wound therapy (NPWT) has shown to decrease the overall rate of SSI, wound dehiscence, and length of hospital stay in surgical conditions. This study aims to determine the impact of NPWT applied on closed surgical incisions on patients with coexisting ostomy undergoing exploratory laparotomy. Methods: A retrospective study on patients who underwent exploratory laparotomies from 2017 to 2019 was conducted. NPWT was compared to standard post-operative surgical wound dressing. A sub-analysis of patients with ostomies was performed. Results: A total of 286 patients who underwent exploratory laparotomy were identified; 51 patients received NPWT and 235 received standard dressing. The NPWT group had a higher percentage of patients with an ostomy (37.3% vs 20.4%, P=.016), of which 25.5% were colostomies (vs 12.3%) and 11.8% were ileostomies (vs 8.1%) with P=.002. No significant difference in the overall rate of SSI (7.8% vs 5.5%, P= .517), wound dehiscence (7.8% vs 2.1 %, P=.057), and seroma formation (3.9% vs 2.1%, P=.612) were observed. The mean length of ICU stay (3.5 vs 7.0, P=.051) and unplanned reoperation (5.9% vs 16.6%, P=.051) were lower in the NPWT group compared to the control group. Sub analysis of patients with stoma found no significant difference in SSI. Conclusions: In our study, the use of NPWT on closed surgical incision wound was not associated with the reduction of SSI in patients with ostomies. Large studies are needed to ascertain significant benefits in patients with ostomies. Keywords: negative pressure wound therapy, surgical site infection, ostomy, exploratory laparotomy

Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. To evaluate the association of prophylactic NPWT with SSI rates in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched without language restrictions for relevant articles from inception until December 2017. The latest search was performed on December 31, 2017. The bibliographies of retrieved studies were further screened for potential additional studies. Randomized clinical trials and nonrandomized studies were included. Unpublished reports were excluded, as were studies that examined NPWT (or standard nonpressure) dressings only without a comparator group. Studies that evaluated the use of NPWT in open abdominal incisions were also excluded. Disagreement was resolved by discussion, and if the question remained unsettled, the opinion of the senior author was sought. A total of 198 citations were identified, and 189 were excluded. This meta-analysis was conducted according to PRISMA guidelines. Data were independently extracted by 2 authors. A random-effects model was used for statistical analysis. The primary outcome measure was SSI, and secondary outcomes included seroma and wound dehiscence rates. These outcomes were chosen before data collection. Nine unique studies (3 randomized trials and 2 prospective and 4 retrospective studies) capturing 1266 unique patients were included. Of these, 1187 patients with 1189 incisions were included in the final analysis (52.3% male among 7 studies reporting data on sex; mean [SD] age, 52 [15] years among 8 studies reporting data on age). Significant clinical and methodologic heterogeneity existed among studies. On random-effects analysis, NPWT was associated with a significantly lower rate of SSI compared with standard dressings (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52; P < .001). However, no difference in rates of seroma (pooled OR, 0.38; 95% CI, 0.12-1.23; P = .11) or wound dehiscence (pooled OR, 2.03; 95% CI, 0.61-6.78; P = .25) was found. On sensitivity analysis, focusing solely on colorectal procedures, NPWT significantly reduced SSI rates (pooled OR, 0.16; 95% CI, 0.07-0.36; P < .001). Application of NPWT on closed laparotomy wounds in general and colorectal surgery is associated with reduced SSI rates but similar rates of seroma and wound dehiscence compared with conventional nonpressure dressings.

Negative pressure wound therapy for surgical wounds healing by primary closure.

People experiencing primary wound closure of their surgical wound and treated prophylactically with NPWT following surgery probably experience fewer SSI than people treated with standard dressings (moderate-certainty evidence). There is no clear difference in number of deaths or wound dehiscence between people treated with NPWT and standard dressings (low-certainty evidence). There are also no clear differences in secondary outcomes where all evidence was low or very low-certainty. In caesarean section in obese women and surgery for lower limb fracture, there is probably little difference in quality of life scores (moderate-certainty evidence). Most evidence on pain is very low-certainty, but there is probably no difference in pain between NPWT and standard dressings after surgery for lower limb fracture (moderate-certainty evidence). Assessments of cost-effectiveness of NPWT produced differing results in different indications. There is a large number of ongoing studies, the results of which may change the findings of this review. Decisions about use of NPWT should take into account surgical indication and setting and consider evidence for all outcomes.

A Commentary on “Prophylactic negative pressure wound therapy for closed laparotomy incision after ventral hernia repair: A systematic review and meta-analysis” (Int J Surg 2022; 97:106216)

Clinical efficacy of negative-pressure wound therapy combined with porcine acellular dermal matrix for repairing deep burn wounds in limbs

Effects of Negative Pressure Wound Therapy on Wound Dehiscence and Surgical Site Infection Following Instrumented Spinal Fusion Surgery—A Single Surgeon's Experience

Meta-analysis of prophylactic closed-incision negative pressure wound therapy for vascular surgery groin wounds

There is moderate-certainty evidence for no clear difference between NPWT and standard care on the proportion of wounds healed at six weeks for open fracture wounds. There is moderate-certainty evidence that NPWT is not a cost-effective treatment for open fracture wounds. Moderate-certainty evidence means that the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. It is uncertain whether there is a difference in risk of wound infection, adverse events, time to closure or coverage surgery, pain or health-related quality of life between NPWT and standard care for any type of open traumatic wound.

Background: Full-thickness wounds are a significant clinical burden, especially in patients with chronic comorbidities. They pose a major clinical challenge due to their prolonged healing times and high risk of complications. Advanced wound care strategies like negative-pressure wound therapy (NPWT), which enhances wound healing by reducing edema, promoting granulation tissue formation, and removing exudates and bioengineered skin substitutes such as high-purity type I collagen-based skin substitute (HPTC/Helicoll®) that acts as an extracellular matrix scaffold to stimulate angiogenesis and cellular proliferation, have emerged as promising interventions. This study evaluates the comparative effectiveness of NPWT combined with HPTC versus NPWT alone in promoting wound healing in full-thickness wounds.Methods: This was a prospective, randomized, open-label, parallel-group clinical trial conducted at the Department of Plastic, Reconstructive, and Aesthetic Surgery, Adichunchanagiri Institute of Medical Sciences (AIMS), Karnataka, India. This study enrolled 104 patients with full-thickness wounds, randomly allocated into two groups: Group A received NPWT combined with HPTC (n = 52), and Group B received NPWT alone (n = 52). The primary outcome was percentage wound area reduction at seven weeks, while secondary outcomes included time to complete epithelialization, proportion achieving complete closure, vascularity infiltration on histology, pain assessment using the Visual Analog Scale (VAS), quality of life (QoL) outcome using the EuroQol 5-Dimension 5-Level (EQ-5D-5L) questionnaire, and scar assessment using Vancouver Scar Scale (VSS) scores. Statistical analysis included Student’s t-test, Chi-square test, and Kaplan-Meier survival analysis.Results: Group A showed significantly higher mean wound size reduction (p < 0.01) at seven weeks, with Group A demonstrating a reduction of 89.35% ± 16.08 and Group B showing 57.85% ± 12.73 reduction, with p value <0.001 (highly significant). Complete healing was achieved in 45 patients (86.54%) of Group A compared to 22 patients (42.31%) of Group B by seven weeks, being statistically highly significant (p-value < 0.001). Mean time to wound closure was shorter in Group A (36.81 ± 12.88 days) than in Group B (43.94 ± 16.70 days), showing a statistically superior closure rate. Pain scores on the VAS, QoL Assessment using EQ-5D-5L, and scar assessment using the VSS were also significantly in favor of the combination group compared to the NPWT-alone group.Conclusion: The combination of NPWT with HPTC skin substitute (Helicoll®) significantly accelerates wound healing and faster closure, improves histopathological parameters, and has better scar outcomes in full-thickness wounds compared to NPWT alone. These findings support incorporating HPTC-based skin substitutes in complex wound care protocols, and this combination therapy represents a promising advancement in wound management.

Systematic Review and Meta-analysis of Prophylactic Negative Pressure Wound Therapy Devices for Major Lower Extremity Amputations.

Treatment of soft tissue defects with exposed bones and joints, resulting from trauma, infection, and surgical complications, represents a major challenge. The introduction of negative pressure wound therapy has changed many wound management practices. Negative pressure wound therapy has recently been used in the orthopedic field for management of traumatic or open wounds with exposed bone, nerve, tendon, and orthopedic implants. This article describes a case of a patient with a large soft tissue defect and exposed knee joint, in which negative pressure wound therapy markedly improved wound healing. A 50-year-old man presented with an ulceration of his left knee with exposed joint, caused by severe wound infections after open reduction and internal fixation of a patellar fracture. After 20 days of negative pressure wound therapy, a granulated wound bed covered the exposed bones and joint.To our knowledge, this is the first report of negative pressure wound therapy used in a patient with a large soft tissue defect with exposed knee joint. Despite the chronic wound secondary to infection, healing was achieved through the use of the negative pressure wound therapy, thus promoting granulation tissue formation and closing the joint. We suggest negative pressure wound therapy as an alternative option for patients with lower limb wounds containing exposed bones and joints when free flap transfer is contraindicated. Our result added to the growing evidence that negative pressure wound therapy is a useful adjunctive treatment for open wounds around the knee joint.

Background:The optimal management strategy for dirty abdominal wounds has yet to be determined, but studies indicate that delayed primary closure (DPC) may be a reliable method of reducing surgical site infection (SSI) rate in these wounds. In this study, of dirty laparotomy wounds following typhoid ileal perforation (TIP), the SSI rate, incidence of wound dehiscence, and length of hospital stay (LOS) are compared in wounds primarily closed to those closed in the delayed primary fashion.Patients and Methods:The study was conducted over a 12-month period. Consecutive patients aged between 0 and 15 years with typhoid ileal perforation (TIP) were enrolled and prospectively randomized to test (DPC) group and control (PC) group. Data including age, sex, diagnosis, type of wound closure, SSI, wound dehiscence, time to wound healing, and LOS were obtained and analyzed using SPSS version 16.Results:Fifteen patients were recruited into DPC group while 19 patients were allocated to the PC group. The SSI rate was 80% in the DPC group compared to 63.2% in the PC group (P = 0.451). 17.6% of patients in the DPC group and 8.8% in the PC group had wound dehiscence, respectively (P = 0.139). The difference in LOS although longer in the DPC group was not statistically significant (DPC 23.47 ± 9.2, PC 17.68 ± 18.9, P = 0.123).Conclusion:DPC did not reduce the incidence of SSI and wound dehiscence, nor shorten LOS compared to PC. Therefore, PC of dirty wounds appears safe for the pediatric population and should be advocated.

Phase II Randomized Trial of Negative-Pressure Wound Therapy to Decrease Surgical Site Infection in Patients Undergoing Laparotomy for Gastrointestinal, Pancreatic, and Peritoneal Surface Malignancies