Negative Pressure Wound Therapy System Research Articles

Meta-Analysis of Comparative Trials Evaluating a Prophylactic Single-Use Negative Pressure Wound Therapy System for the Prevention of Surgical Site Complications

Background: We report the first meta-analysis on the impact of prophylactic use of a specific design of negative pressure wound therapy (NPWT) device on surgical site complications.Methods: Articles were identified in which the specific single-use NPWT device (PICO⋄, Smith & Nephew) was compared with standard care for surgical site infection (SSI), dehiscence, or length of stay (LOS). Risk ratio (RR) ±95% confidence interval (CI) (SSI; dehiscence) or mean difference in LOS ±95% CI was calculated using RevMan v5.3.Results: There were 1863 patients (2202 incisions) represented by 16 articles. Among 10 randomized studies, there was a significant reduction in SSI rate of 51% from 9.7% to 4.8% with NPWT intervention (RR 0.49 [95% CI 0.34–0.69] p < 0.0001). There were six observational studies assessing reduction in SSI rate of 67% from 22.5% to 7.4% with NPWT (RR 0. 32 [95% CI 0.18–0.55] p < 0.0001). Combining all 16 studies, there was a significant reduction in SSI of 58% from 12.5% to 5.2% with NPWT (RR 0.43 [95% CI 0.32–0.57] p < 0.0001). Similar effects were seen irrespective of the kind of surgery (orthopedic, abdominal, colorectal, or cesarean section), although the numbers needed to treat (NNT) were lower in operations with higher frequencies of complications. There was a significant reduction in dehiscence from 17.4% to 12.8% with NPWT (RR 0.71 [95% CI 0.54–0.92] p < 0.01). The mean reduction in hospital LOS by NPWT was also significant (−0.47 days [95% CI −0.71 to −0.23] p < 0.0001).Conclusions: The significant reduction in SSI, wound dehiscence, and LOS on the basis of pooled data from 16 studies shows a benefit of the PICO single-use NPWT system compared with standard care in closed surgical incisions.

Abstract: Use of Negative Pressure Wound Therapy with Instillation in Acute Post-Surgical Breast Reconstruction Infections—Retrospective Review

INTRODUCTION: In recent years, combining instillation of a topical wound solution with negative pressure wound therapy (NPWT) has facilitated wound cleansing. Furthermore, published studies have positively reported on the use of a NPWT system with automated instillation and a dwell time (NPWTi-d) that provides a method of cyclically instilling and dwelling topical solutions to help improve healing outcomes of acute and chronic wounds. Our purpose was to analyze our outcomes of patients who received adjunctive NPWTi-d with a polyhexanide solution to address surgical site occurrences (SSO) following first stage expander-implant breast reconstruction. METHODS: A retrospective record review was conducted. Patient data were extracted from the electronic medical record by means of manual review and stored in a database. Adult patient records were included for analysis if the patient underwent a mastectomy followed by immediate or delayed expander reconstruction, had infection of at least one pocket confirmed via culture, had received oral and systemic antibiotics for at least one week, and subsequently received NPWTi-d. All procedures were completed between January 1, 2016 and February 1, 2017. Demographics, surgical approach, comorbidities and expander salvage rate were recorded and analyzed. Six female patients with a median age of 50.8 were included in the analysis. Five of 6 patients had undergone sub-pectoral expander reconstruction and one patient received pre-pectoral expander reconstruction. Antibiotics were also continued based on specific cultures. All surgical site infections were thoroughly debrided and irrigated. Adjunctive NPWTi-d was initiated: instillation of a polyhexanide solution with a 20-minute dwell time, followed by 3.5 hours of -125 mmHg negative pressure. Duration of therapy ranged from 1–3 days. RESULTS: Salvage of the expander was achieved in all 6 patients. None of the pockets showed signs of infection after application of NPWTi-d. Healthy granulation tissue was present in all NPWTi-d treated pockets. All breast incisions were successfully closed with good cosmetic results and without further sequelae. CONCLUSION: Tissue expanders could be salvaged in all 6 patients with SSOs in this series who received NPWTi-d. This small sample size does not allow for a reliable extrapolation to the general population. Although further studies are needed, the results from these 6 patients suggest that NPWTi-d may represent an important new adjunctive therapy option in device salvage for breast reconstruction patients.

A survey of caesarean section surgical site infections with PICO™ Single Use Negative Pressure Wound Therapy System in high-risk patients in England and Ireland

This article reports audit data from the introduction of the PICO™ System for caesarean section patients with high body mass index (BMI) in four hospitals in the UK and Ireland. PICO was used on closed surgical incisions following caesarean section in 399 patients with BMI ≥35kg/m2. Thirty-six out of 399 patients (9.0%) developed signs of surgical site infection (SSI), a rate lower than a previously reported incidence of 19.3% in a similar population. The readmission incidence was 0.8%. Therefore the use of PICO on closed surgical incisions may be associated with low incidence of SSI and readmission in this high-risk group.

Prophylactic Wound Vacuum Therapy after Cesarean Section to Prevent Wound Complications in the Obese Population: A Randomized Controlled Trial (the ProVac Study).

Objective The objective of this study was to perform a randomized controlled feasibility trial investigating negative pressure wound therapy (NPWT) system versus a standard postcesarean wound care (WC) on the development of a postoperative surgical site infection (SSI) and/or a wound dehiscence in obese women. Study Design This is a randomized controlled feasibility trial of obese women undergoing an unscheduled cesarean delivery. Women with an initial body mass index ≥ 30 kg/m2 who were ≥ 4 cm dilated were included. Women were assigned to either a NPWT or standard WC. The primary outcome was a composite of wound morbidity at 4 weeks postpartum including SSI and/or wound opening (clinicaltrials.gov, NCT02128997). Continuous variables were analyzed with t-test and Wilcoxon rank-sum tests and categorical variables with Fisher's exact test. Results Of 136 women randomized, 67 received NPWT and 69 received standard WC. The 4-week follow-up rate was 88%. Maternal clinical and surgical characteristics were similar between the groups. The prevalence of the composite wound morbidity outcome was not different between those with NPWT and standard WC (4.9 vs. 6.9%; p = 0.71). Conclusion Routine clinical use of a NPWT system after cesarean delivery did not result in a significant reduction of wound morbidity over standard WC.

Reply: Effects of Negative-Pressure Wound Therapy on Primary Closed Defects after Superficial Circumflex Iliac Artery Perforator Flap Harvest: Randomized Controlled Study

Sir: We thank the authors for their interest in our article.1 Recently, incisional negative-pressure wound therapy has been used to enhance healing for surgical incisions in patients with a high risk of wound dehiscence. As shown in this article, the application of negative-pressure wound therapy has many benefits. However, before applying negative-pressure wound therapy to patients, clinicians need to know the limited benefits and possible complications by understanding the physics and physiology of the therapy. The following are answers to your questions. First, it became a common belief that when using negative-pressure wound therapy dressing, tissue pressure increases proportional to the amount of negative pressure applied.2,3 The additional tissue pressure, with a pressure setting of −150 mmHg with continuous pressure mode, was +2 to 10 mmHg in noncircumferential wounds. This increased tissue pressure has a minimal effect on healthy tissues. However, in ischemic wounds and tissues with compromised perfusion, tissue perfusion might be jeopardized. There are many clinical reports of minimizing the tissue pressure increase by using a lower pressure setting.4–6 In these cases, lowering the pressure to −50 mmHg over the incisional wound can be an option. However, our series involves healthy donor sites and furthermore uses the cyclic mode to minimize the chance of possible tissue ischemia caused by the compression effect. This compression, in our hands, is enough to give the tie-over bolster fixation effect. This will minimize shearing of the skin and thus allow faster healing and reduce seroma/hematoma formation as shown in the article. Second, using the Jackson-Pratt drain is within good practice when closing a wound with dead space. By maintaining the negative pressure of the drain, hematoma collection will be minimized. One cannot compare the effect of the drain to the negative-pressure wound therapy applied on the skin because it is used for different purposes. The negative-pressure wound therapy over the skin will improve perfusion of the skin and play a role in fixation. If one were to see the fluid drain to the negative-pressure wound therapy system, it would mean that either the Jackson-Pratt drain was not functioning or secure closure of the skin was not performed. Third, the PeriScan PIM 3 System does not use a probe but rather uses a 785-nm, 70-mW laser (Perimed AB, Stockholm, Sweden) to calculate the blood perfusion of the closed margin. The measurement is performed immediately after the dressing is removed. DISCLOSURE Dr. Hong and Dr. Suh are consultants for Daewoong Pharmaceutical Company. No financial support was received regarding this study. Hyunsuk Peter Suh, M.D., Ph.D.Min Young Jang, R.N.Joon Pio (Jp) Hong, M.D., Ph.D., M.M.M.Seoul Asan Medical CenterUniversity of Ulsan College of MedicineSeoul, Republic of Korea

Does Negative-Pressure Wound Therapy for the Open Abdomen Benefit the Patient? A Retrospective Cohort Study.

Negative-pressure wound therapy (NPWT) is the most modern and sophisticated method of temporary abdominal closure. The aim of the study was to determine the significant predictors for mortality in patients with NPWT. University Clinical Centre Maribor, Slovenia MATERIALS AND METHODS:: The authors performed a retrospective cohort study of all patients treated with NPWT between January 1, 2011, and December 31, 2014. In the univariate analysis, the type of wound closure, more than 7 NPWT changes, the total days with NPWT, and time to wound closure were significantly associated with death of the patient. In the multivariate analysis, only the number of more than 7 NPWT changes was found as a significant predictor for death (P = .038). Negative-pressure wound therapy is a method of choice for the treatment of open abdomen if there is a clear indication. However, clinicians should try all measures to remove the NPWT system and close the abdomen as soon as possible because prolonged use is associated with significantly higher mortality.

The use of PICO negative pressure wound therapy system for a patient following incision and drainage of breast abscess: A case study that shows the cost benefit of the PICO system for this patient and a Breast Care Nurse Specialists perspective

The use of PICO negative pressure wound therapy system for a patient following incision and drainage of breast abscess: A case study that shows the cost benefit of the PICO system for this patient and a Breast Care Nurse Specialists perspective

Evaluation of negative-pressure wound therapy for patients with diabetic foot ulcers: systematic review and meta-analysis.

ObjectivesThe aim of this study was to perform an updated systematic review and meta-analysis to assess the clinical efficacy, safety, and cost-effectiveness of negative-pressure wound therapy (NPWT) in the treatment of diabetic foot ulcers (DFUs).MethodsWe searched the Cochrane Library, MEDLINE, EMBASE, Ovid, and Chinese Biological Medicine databases up to June 30, 2016. We also manually searched the articles from reference lists of the retrieved articles, which used the NPWT system in studies of vacuum-assisted closure therapy. Studies were identified and selected, and two independent reviewers extracted data from the studies.ResultsA total of eleven randomized controlled trials, which included a total of 1,044 patients, were selected from 691 identified studies. Compared with standard dressing changes, NPWT had a higher rate of complete healing of ulcers (relative risk, 1.48; 95% confidence interval [CI]: 1.24–1.76; P<0.001), shorter healing time (mean difference, −8.07; 95% CI: −13.70– −2.45; P=0.005), greater reduction in ulcer area (mean difference, 12.18; 95% CI: 8.50–15.86; P<0.00001), greater reduction in ulcer depth (mean difference, 40.82; 95% CI: 35.97–45.67; P<0.00001), fewer amputations (relative risk, 0.31; 95% CI: 0.15–0.62; P=0.001), and no effect on the incidence of treatment-related adverse effects (relative risk, 1.12; 95% CI: 0.66–1.89; P=0.68). Meanwhile, many analyses showed that the NPWT was more cost-effective than standard dressing changes.ConclusionThese results indicate that NPWT is efficacious, safe, and cost-effective in treating DFUs.

A Retrospective Comparison of the Performance of Two Negative Pressure Wound Therapy Systems in the Management of Wounds of Mixed Etiology.

Objective: Negative pressure wound therapy (NPWT) has been shown to be effective in the management of chronic and surgical wounds. The two most widely used modalities of NPWT are vacuum-assisted closure (V.A.C.) therapy (KCI, Inc., San Antonio, Texas) and the RENASYS NPWT system (Smith & Nephew, Hull, United Kingdom). This evaluation compares the performance of the two systems in the management of wounds of mixed etiology.Approach: The evaluation is based on retrospective evaluation of more than 1,000 patients treated with NPWT in a community setting in Canada.Results: Patients were well matched according to their baseline characteristics, including age, sex, and wound characteristics. No difference was seen between the two NPWT systems in terms of the percentage of patients reaching their predetermined treatment goal (90.0% and 93.6%, respectively). The time taken to achieve the treatment goal (median 8 weeks in both groups), percentage reduction in wound area (64.2% and 65.3%, respectively), and weekly rate of reduction in wound area (9.7% and 9.4%, respectively; p = 0.156).Innovation: This evaluation is believed to comprise the largest cohort of patients treated with NPWT published to date and is one of the few studies that have attempted to provide a direct comparison of the performance of alternative NPWT systems.Conclusion: Findings suggest that there are no clinically meaningful differences in the efficacy and performance of the two most widely used NPWT devices, based on consideration of a number of wound outcomes.

A New Procedure for Wrapped-Negative Pressure Wound Therapy for Congestion After Arterialized Venous Flap Surgery.

Negative pressure wound therapy (NPWT) is a method for treating wound. However, there are no case reports using NPWT for treating congestion after arterialized venous flap. Therefore, this study reported favorable outcomes after using a single-use NPWT system for managing congestion. A 39-year-old man had his index finger caught by a press machine. The finger had a soft tissue defect at the ventral part. An arterialized venous flap taken from the right forearm was transplanted. Perfusion of the flap was favorable, but on postoperative day 5, congestion and the edema of the flap were found. Then, NPWT was initiated. The congestion and edema in the flap were improved without complications such as flap necrosis and wound infection. At 4 months postoperatively, the morphology of the finger was favorable. In this study, NPWT was speculated to force the deeper blood vessels within the flap to dilate with inducing drainage and the simultaneous reduction in excess blood flow to the cortical layer, resulting in the improvement of congestion. Negative pressure wound therapy was used for treating congestion after the transplantation of arterialized venous flap, and the wound was favorably managed.

Injectable Pore-Forming Hydrogel Scaffolds for Complex Wound Tissue Engineering: Designing and Controlling Their Porosity and Mechanical Properties.

Traumatic soft tissue wounds present a significant reconstructive challenge. The adoption of closed-circuit negative pressure wound therapy (NPWT) has enabled surgeons to temporize these wounds before reconstruction. Such systems use porous synthetic foam scaffolds as wound fillers at the interface between the negative pressure system and the wound bed. The idea of using a bespoke porous biomaterial that enhances wound healing, as filler for an NPWT system, is attractive as it circumvents concerns regarding reconstructive delay and the need for dressing changes that are features of the current systems. Porous foam biomaterials are mechanically robust and able to synthesize in situ. Hence, they exhibit potential to fulfill the niche for such a functionalized injectable material. Injectable scaffolds are currently in use for minimally invasive surgery, but the design parameters for large-volume expansive foams remain unclear. Potential platforms include hydrogel systems, (particularly superabsorbent, superporous, and nanocomposite systems), polyurethane-based moisture-cured foams, and high internal phase emulsion polymer systems. The aim of this review is to discuss the design parameters for such future biomaterials and review potential candidate materials for further research into this up and coming field.

Experimental comparison of abdominal drainage systems

BackgroundIn an experimental study the performance of different closed abdominal drainage systems was tested. MethodsA vacuum bottle designed for Redon Drainage, a flexible plastic bulb designed for Jackson-Pratt drains and a V.A.C.® Negative Pressure Wound Therapy System were used. In a porcine cadaveric study mimicking the abdominal cavity the intrinsic pressure (IP) at one and three minutes (T0, T3) and the amount of evacuated fluid were measured. ResultsThe Redon and Jackson drainage displayed a rapid decline to IP values of almost zero comparing T0 and T3. Only the V.A.C.® system was able to preserve constant values of negative IP values measured at both time points. Only the V.A.C.® system was able to remove almost the whole amount of inserted fluid. ConclusionsIn an experimental setting the V.A.C.® system was superior to the other two tested systems in delivering constant negative IP and the amount of evacuated fluid.

Negative Pressure Wound Therapy in Maxillofacial Applications.

Negative pressure wound therapy has greatly advanced the field of wound healing for nearly two decades, by providing a robust surgical adjunct technique for accelerating wound closure in acute and chronic wounds. However, the application of negative pressure wound therapy in maxillofacial applications has been relatively under utilized as a result of the physical articulations and contours of the head and neck that make it challenging to obtain an airtight seal for different negative pressure wound therapy systems. Adapting negative pressure wound therapies for maxillofacial applications could yield significant enhancement of wound closure in maxillofacial applications. The current review summarizes the basic science underlying negative pressure wound therapy, as well as specific maxillofacial procedures that could benefit from negative pressure wound therapy.

Long-term outcomes of sandwich ventral hernia repair paired with hybrid vacuum-assisted closure

BackgroundSandwich ventral hernia repair (SVHR) may reduce ventral hernia recurrence rates, although with an increased risk of surgical site occurrences (SSOs) and surgical site infections (SSIs). Previously, we found that a modified negative pressure wound therapy (hybrid vacuum-assisted closure [HVAC]) system reduced SSOs and SSIs after ventral hernia repair. We aimed to describe our outcomes after SVHR paired with HVAC closure. MethodsWe conducted a 4-y retrospective review of all complex SVHRs (biologic mesh underlay and synthetic mesh overlay) with HVAC closure performed at our institution by a single surgeon. All patients had fascial defects that could not be reapproximated primarily using anterior component separation. Descriptive statistics were used to report the incidence of postoperative complications and hernia recurrence. ResultsA total of 60 patients (59.3 ± 11.4 y, 58.3% male, 75% American Society of Anesthesiologists class ≥3) with complex ventral hernias being underwent sandwich repair with HVAC closure. Major postoperative morbidity (Dindo–Clavien class ≥3) occurred in 14 (23.3%) patients, but incidence of SSO (n = 13, 21.7%) and SSI (n = 4, 6.7%) was low compared with historical reports. Median follow-up time for all patients was 12 mo (interquartile range 5.8-26.5 mo). Hernia recurrence occurred in eight patients (13.3%) after a median time of 20.6 months (interquartile range 16.4- 25.4 months). ConclusionsUse of a dual layer sandwich repair for complex abdominal wall reconstruction is associated with low rates of hernia recurrence at 1 year postoperatively. The addition of the HVAC closure system may reduce the risk of SSOs and SSIs previously reported with this technique and deserves consideration in future prospective studies assessing optimization of ventral hernia repair approaches.

Comparison of the effect of negative pressure wound therapy with and without installation of polyhexanide on the bacterial kinetic in chronic wounds

Abstract Background Negative pressure wound therapy (NPWT) has established successfully as a treatment option for acceleration of wound healing in a broad range of clinical indications. Systematic research investigating the bacterial kinetics on wounds is lacking and no studies are available comparing the microbiological difference of repeated instillation of polyhexanide (PHMB) against continuous NPWT without instillation of an antiseptic. The aim of this study was to investigate the bacterial bio-burden on wounds and to measure the bacterial kinetic during application of NPWT with and without intermitted instillation of 0.02% PHMB. Methods A cohort of 18 patients with chronic (n = 16) and acute (n = 2) wounds was treated either with NPWT alone or with additional intermitted instillation of 0.02% PHMB. Wound healing and bacterial load were assessed at every dressing change. All wounds were closed by split-thickness skin grafts or local Reverdin flaps. According to the manufacturer of the investigated NPWT system (V.A.C. therapy unit, Kinetic Concepts Inc. KCI) wounds were filled with a polyurethane sponge (pore size 0.4–0.6 mm) and occluded with a polyurethane foil (KCI Inc., USA). The NPWT-device was connected to the wound and operated at 100 mm Hg sub-atmospheric pressure utilizing an alternating pressure cycle of 5 min of suction followed by 2 min pause. The automated intermittent instillation lasted for 4–20 s, the exposure time was 20 min. After 60 min of NPWT, the instillation was started again. Results Seven split-thickness skin grafts, 3 Reverdin-flaps and one combined closure (Reverdin + split-thickness skin grafts) exhibited excellent wound healing after successful transplantation 4 weeks after intervention. The quality of wound granulation was excellent in all wounds, regardless of NPWT application with or without instillation of 0.02% PHMB. The bacterial spectrum remained mostly unchanged after treatment and had no influence on the outcome. Conclusion It was demonstrated that management of infected wounds with NPWT, with or without instillation of 0.02% PHMB, did not reduce the number of bacteria on wounds. Bacteria proliferate below a NPWT dressing and increase in numbers. Independently of bacterial kinetics, all wounds showed excellent granulation and healed with no complications. This observation challenges the concept that bacterial bioburden correlates with impaired wound healing.

Acute compartment syndrome after intramedullary nailing of tibial shaft fracture. Three case reports

Acute compartment syndrome(ACS) is an urgent state in orthopedic surgery, which most often occurs secondarily to tibial shaft fracture. Delayed diagnosis of ACS can lead to very serious complications, including limb inefficiency or amputation. The diagnosis of ACS is based on characteristic clinical signs, like pain, paresthesia, pallor, paralysis, pulsessness, and poikilothermia. In patients with disorted logic contact diagnosis may be difficult and introduction of intercompartmental pressure measurement into diagnostic process may be useful. In this article three clinical cases of acute compartment syndrome after tibial diaphyseal fracture treated with intramedullary reamed locking nail from Departement of Trauma and Orthopedic Surgery will be presented. Profile of those patients fully corresponds to characteristic of patients that are most at risk for this type of complication. All patients were treated with urgent fasciotomy. Additionally, in treatment of wounds after fasciotomy also negative pressure wound therapy system and hyperbaric oxygen therapy were used. The final outcome of patients’ treatment correlates with time elapsed since the onset of symptoms.

Simplified Negative Pressure Wound Therapy Device for Application in Low-Resource Settings.

Negative pressure wound therapy (NPWT) provides proven wound healing benefits and is often a desirable wound treatment methodology. Unfortunately, NPWT devices are not widely available in low-resource settings. To overcome the identified NPWT barriers, a simplified NPWT (sNPWT) system was designed and iteratively improved during field-based testing. The sNPWT technology, our device design iterations, and the design-based results of our field tests are described in this article. The sNPWT system includes a bellows hand pump, an occlusive drape, and a tube with tube connectors, connecting the drape to the pump. The most critical property of an sNPWT system is that it must be airtight. The details of the design iterations, which are needed to achieve an occlusive system, are explained. During the design process, the sNPWT system was tested during the earthquake relief in Haiti. This testing found that a liquid sealant was necessary to seal the drape to the periwound skin. A study conducted in Rwanda verified that a liquid latex sealant was safe to use, and that the tube connector must be connected to the drape with an airtight method during the manufacturing process. This work has shown that sNPWT is feasible in low-resource settings. Since the completion of the clinical testing, the design has been further evolved, and the developers are working with contract manufacturers to produce the final design and preparing for regulatory approval applications.

Negative-Pressure Wound Therapy in the Management of High-Grade Ventral Hernia Repairs

BackgroundDespite improved operative techniques, open ventral hernia repair (VHR) surgery in high-risk, potentially contaminated patients remains challenging. As previously reported by our group, the use of a modified negative-pressure wound therapy system (hybrid-VAC or HVAC) in patients with grade 2 hernias is associated with lower surgical site occurrence (SSO) and surgical site infection (SSI) rates. Accordingly, the authors aim to evaluate whether the HVAC would similarly improve surgical site outcomes following VHR in patients with grade 3 hernias. MethodsA 4-year retrospective review (2011–2014) was conducted of all consecutive, modified ventral hernia working group (VHWG) grade 3 hernia repairs with HVAC closure performed by a single surgeon (FEE) at a single institution. Operative data and 90-day outcomes were evaluated. Overall outcomes (e.g., recurrence, reoperation, mortality) were reviewed for the study group. ResultsA total of 117 patients with an average age of 56.7±11.9 years were classified as grade 3 hernias and underwent open VHR with subsequent HVAC closure. Fifty patients were male (42.7 %), the mean BMI was 35.2 (±9.5), and 60.7 % had a history of prior hernia repair. The average fascial defect size was 201.5 (±167.3) cm2 and the mean length of stay was 14.2 (±9.3) days. Ninety-day outcomes showed an SSO rate of 20.7 % and an SSI rate of 5.2 %. The overall hernia recurrence rate was 4.2 % (n=6) with a mean follow-up of 11 ± 7.3 months. ConclusionModified VHWG grade 3 ventral hernias are associated with significant morbidity. In our series utilizing the HVAC system after VHR, the observed rate of SSO and SSI compared favorably to reported series. Further prospective cost-effective studies are warranted to validate these findings.

Our First Experience With Negative Pressure Incision Management System Implemented on the Clean Surgical Incision in the Renal Transplantation Recipient: A Case Report

Multiple comorbidities and environmental factors increase the complications of incisional wounds in patients. It was demonstrated in previous prospective and randomized studies that negative pressure wound therapy (NPWT) reduced wound infection and other complications in clean, closed surgical incisions. In this case report, the Prevena incision management system was implemented on the clean, closed surgical incision of a 52-year-old female patient, who was given a renal transplantation from cadaver postoperatively in the operating theater. It was removed from the patient on the fifth day after the operation. Following the removal of Prevena, the wound and surrounding skin of the patient were observed. Wound healing was complete, and no skin lesion or tool-related complication was found around the wound due to NPWT. The Prevena NPWT system can be conveniently and safely implemented on the operational incision in renal transplant recipients in order to prevent surgical wound complications.

Low-cost Negative-pressure Wound Therapy Using Wall Vacuum: A 15 Dollars by Day Alternative.

Negative-pressure wound therapy (NPWT) has been marketed for about 20 years and remains popular. The only real obstacle to NPWT is the cost; therefore, we designed an inexpensive NPWT connected to a wall vacuum. Here, we report the feasibility and safety of this product, which we call PROVACUUM (Z-Biotech, Saint-Avertin, France). As a first step, the constraints imposed on the manufacturer were equipment quality similar to that of commercial NPWT systems, with an average treatment cost of $15/d. Then, we conducted a prospective study of patients with indications for NPWT from September 2013 to January 2015. Data collected included ease of use, quality of materials, and occurrence of complications during treatment. We enrolled 23 patients with a mean age of 50.8 years. The average duration of treatment was 8.5 days (range, 3-21 days). The dressings were changed every 3.3 days (range, 2-4 days). Two hematomas occurred that required surgical revision and the transfusion of 2 units after large debridement of pressure ulcer. No other adverse events or infections occurred. The surgeons found that our device was similar to commercial NPWT devices. We developed an inexpensive NPWT that costs an average of $15/d. Our process is not intended to replace portable or stand-alone devices with batteries, but rather offers a less expensive alternative for hospitalized patients and makes NPWT accessible to the most precarious countries and institutions.