The Role of Closed Incision Negative Pressure Therapy in Abdominal Wall Reconstruction: A Current Review of the Evidence.

Abstract

Complex ventral hernia repairs (VHRs) are often complicated by surgical-site occurrences such as infection, seroma, hematoma, dehiscence, necrosis, as well as hernia recurrence and mesh contamination. A review of current literature was conducted to determine whether the application of negative pressure therapy to closed incisions post abdominal wall reconstruction (AWR)/VHR reduces the risk of postoperative wound complications and hernia recurrence. The PubMed/MEDLINE databases were searched for studies published through January 2018. Higher quality publications that met the following criteria were included: adult patients undergoing AWR/VHR; comparison of closed incision negative pressure therapy with conventional dressings; and documentation of wound complications and/or hernia recurrence. Six clinical articles including case report, retrospective controlled review, technique modification papers, systematic review, and meta-analysis are discussed. Scientific mechanism of action and economic analysis are also included. There are no level 1 randomized prospective controlled trials directly looking at closed incision negative pressure therapy dressings in AWR/VHR patients. For patients undergoing AWR/VHR, overall current evidence supports a decreased incidence in wound complications when using closed incision negative pressure therapy dressings compared with conventional dressings such as gauze.