Abstract
Background Incisional negative wound pressure therapy (iNPWT) is a relatively novel dressing technique with the aim of reducing postoperative wound infections and dehiscence in high-risk wounds after all kinds of surgical procedures. There is a lack of theoretical knowledge about the way those dressing would ameliorate wound healing. One aspect is the reduction of superficial tension, but significant remaining seroma might still cause deep wound infections. The aim of this study was the evaluation of technical modifications of the standard iNPWT dressing to increase seroma evacuation. Methods iNPWT dressings were applied on the porcine abdominal wall, and an incremental pressure ramp from 50 to 200 mmHg was performed. The resulting wound pressures were measured using (i) balloon manometry and (ii) esophageal manometry catheter. Seroma evacuation was analyzed with a seroma model. All measurements were performed with (i) standard iNPWT dressing, (ii) wound gauze diverted through the incision, and (iii) placement of suction drain tube into iNPWT. Results Due to the modifications of the iNPWT dressing, the vacuum applied by the iNPWT dressing could be transferred into the wound and was not only restricted to superficial layers. More importantly, placement of wound gauzes or suction drain tubes led to complete extraction of wound seroma. The placement of the suction drain tube showed the best combination of increased intrawound pressure as well as seroma evacuation. Conclusion Addition of a suction drain tube to the iNPWT dressing leads to an improved function of the iNPWT dressing in our ex vivo model.
Highlights
Negative pressure wound therapy (NPWT) is an established treatment strategy to treat complicated wounds such as dirty-infected primary wounds or wounds showing impaired wound healing due to a superficial surgical site infection with subsequent open wound treatment
Evidence was published that presented the possibility to install the NPWT dressing over the closed incision [4], being termed incisional negative pressure wound therapy
Due to the clinical observation of an insufficient seroma evacuation of the incisional negative pressure wound therapy (iNPWT) system, we evaluated two different strategies to ameliorate seroma evacuation: (1) inserting a strip of Cutimed Sorbact® wound gauze (BSN medical, Hamburg, Germany) through the incision (Figure 1(b)) and (2) inserting the tube of a suction drain in the wound bed and diverting it through the incision leading into the V.A.C. foam (Figure 1(c))
Summary
Negative pressure wound therapy (NPWT) is an established treatment strategy to treat complicated wounds such as dirty-infected primary wounds or wounds showing impaired wound healing due to a superficial surgical site infection with subsequent open wound treatment. The most recent Cochrane collaboration’s meta-analysis still gives no clear recommendation on the use of this technique [12] with regard to the reduction of SSI or postoperative seroma. Another meta-analysis, which mainly considered studies in orthopedic surgeries, calculated a seroma reduction of 1.97 ml on day 5 in favor of iNPWT use [13]. All measurements were performed with (i) standard iNPWT dressing, (ii) wound gauze diverted through the incision, and (iii) placement of suction drain tube into iNPWT. Addition of a suction drain tube to the iNPWT dressing leads to an improved function of the iNPWT dressing in our ex vivo model
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