Abstract
Background: In this study, we aimed to analyze the clinical efficacy of closed-incision negative pressure wound therapy (CiNPWT) when combined with primary closure (PC) in a patient with pressure ulcers, based on one single surgeon’s experience at our medical center. Methods: We retrospectively reviewed the data of patients with stage III or IV pressure ulcers who underwent reconstruction surgery. Patient characteristics, including age, sex, cause and location of defect, comorbidities, lesion size, wound reconstruction methods, operation time, debridement times, application of CiNPWT to reconstructed wounds, duration of hospital stay, and wound complications were analyzed. Results: Operation time (38.16 ± 14.02 vs. 84.73 ± 48.55 min) and duration of hospitalization (36.78 ± 26.92 vs. 56.70 ± 58.43 days) were shorter in the PC + CiNPWT group than in the traditional group. The frequency of debridement (2.13 ± 0.98 vs. 2.76 ± 2.20 times) was also lower in the PC + CiNPWT group than in the traditional group. The average reconstructed wound size did not significantly differ between the groups (63.47 ± 42.70 vs. 62.85 ± 49.94 cm2), and there were no significant differences in wound healing (81.25% vs. 75.38%), minor complications (18.75% vs. 21.54%), major complications (0% vs. 3.85%), or mortality (6.25% vs. 10.00%) between the groups. Conclusions: Our findings indicate that PC combined with CiNPWT represents an alternative reconstruction option for patients with pressure ulcers, especially in those for whom prolonged anesthesia is unsuitable.
Highlights
Pressure ulcers are associated with specific positions that place prolonged pressure on the skin and underlying soft tissue, occurring most frequently in patients with spinal cord injury, dementia, or other conditions involving long-term immobilization
To investigate the clinical benefits of primary closure (PC) + closed-incision negative pressure wound therapy (CiNPWT), we retrospectively reviewed data for patients with stage III or IV pressure ulcers who underwent surgery performed by a single surgeon at Tri-Service General Hospital, Taiwan, between January 2011 and March 2021
Our results indicated that PC + CiNPWT was associated with fewer debridement procedures, shorter operation times, and a shorter duration of hospitalization than other traditional forms of pressure ulcer reconstruction surgery
Summary
Pressure ulcers are associated with specific positions that place prolonged pressure on the skin and underlying soft tissue (e.g., sacral ulcers in the supine position, ischial ulcers in the sitting position), occurring most frequently in patients with spinal cord injury, dementia, or other conditions involving long-term immobilization. Previous studies have demonstrated that application of NPWT to a wound sutured under tension may decrease tension across the suture site by distributing the traction forces concentrated at the suture point to the skin flap, and by increasing skin flap perfusion [8,9,10,11,12,13,14,15,16,17] In this manner, NPWT effectively approximates both skin flaps, increases tissue perfusion, reduces the dead space in the wound, and promotes marginal apposition of the wound edge, thereby improving the success rate of wound healing in patients undergoing direct closure. Conclusions: Our findings indicate that PC combined with CiNPWT represents an alternative reconstruction option for patients with pressure ulcers, especially in those for whom prolonged anesthesia is unsuitable
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