Negative Pressure Wound Therapy Research Articles

Randomized comparative study of negative pressure wound therapy versus compression dressing on split-thickness skin grafts of the lower limbs in an elderly population.

Failure to adequately secure the skin graft to the lower limbs recipient bed can result in loss of the graft. Our objective was to compare the healing of split-thickness skin grafts three weeks postoperatively, using either negative pressure wound therapy (NPWT) or conventional compression bandaging. In this multicenter randomized controlled study, patients with tissue loss ranging from 50 cm2 to 600 cm2 on the lower limbs and treated with split-thickness skin grafts were included in three French hospitals. A digital photographic evaluation was performed at 3 weeks. During 9 years, 70 patients were included in the study and allocated to a treatment group. The grafted area was similar in both groups. Loss of graft was significantly reduced in the NPWT group with 14.6 cm2 compared to 29 cm2 in the control group (p = 0.0003). The hospital stay was also significantly reduced in the NPWT group, at 4 days versus 6.5 days in the control group (p = 0.0284). In the NPWT group, 60% reported pain compared to 22.9% in the control group (p = 0.0048). The use of NPWT dressings improves skin graft take by reducing necrosis, improving the graft's adherence to the recipient site, and reducing hospital length-of-stay.

INTERNATIONAL DELPHI CONSENSUS ON WOUND CLOSURE AND DRESSING MANAGEMENT IN TOTAL HIP ARTHROPLASTY

The purpose of this modified Delphi study was to obtain consensus on wound closure (including best practices for each tissue layer of closure) and dressing management in total hip arthroplasty (THA), using an evidence-based approach.The Delphi panel included 20 orthopedic surgeons from Europe and North America. Eighteen statements were identified (14 specific to THA and 4 relating to both THA and total knee arthroplasty) using a targeted literature review. Consensus was developed on the statements with up to three rounds of anonymous voting per topic. Panelists ranked their agreement with each statement on a five-point Likert scale. An a priori threshold of 75% was required for consensus.In Round 1, 15 of 18 statements achieved consensus via a structured electronic questionnaire. In Round 2, the 3 statements that did not achieve consensus were revised during a virtual face to face meeting. An additional 2 statements were edited for clarity. In Round 3, the 5 revised statements achieved consensus via a structured electronic questionnaire. Wound closure related interventions that were recommended for use in THA included: 1) barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); 2) subcuticular sutures over skin staples (lower risk of infections and higher patient preference); 3) mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); 4) negative pressure wound therapy over other dressings (lower wound complications and reoperations and fewer dressing changes); 5) triclosan coated sutures (lower risk of surgical site infection).Using a modified Delphi approach, a panel of 20 orthopedic surgeons achieved consensus on 18 statements pertaining to multi-layer wound closure and dressing management in THA. This study forms the basis for identifying critical evidence gaps within wound management to help reduce variability in outcomes during THA.

Precision in Prevention: Tailoring Single-Use Negative Pressure Wound Therapy Utilization Through Artificial Intelligence-Based Surgical Site Complications Risk and Cost Modeling.

Background: Surgical site complications (SSCs) are common, yet preventable hospital-acquired conditions. Single-use negative pressure wound therapy (sNPWT) has been shown to be effective in reducing rates of these complications. In the era of value-based care, strategic allocation of sNPWT is needed to optimize both clinical and financial outcomes. Materials and Methods: We conducted a retrospective analysis using data from the Premier Healthcare Database (2017-2021) for 10 representative open procedures in orthopedic, abdominal, cardiovascular, cesarean delivery, and breast surgery. After separating data into training and validation sets, various machine learning algorithms were used to develop pre-operative SSC risk prediction models. Model performance was assessed using standard metrics and predictors of SSCs were identified through feature importance evaluation. Highest-performing models were used to simulate the cost-effectiveness of sNPWT at both the patient and population level. Results: The prediction models demonstrated good performance, with an average area under the curve of 76%. Prominent predictors across subspecialities included age, obesity, and the level of procedure urgency. Prediction models enabled a simulation analysis to assess the population-level cost-effectiveness of sNPWT, incorporating patient and surgery-specific factors, along with the established efficacy of sNPWT for each surgical procedure. The simulation models uncovered significant variability in sNPWT's cost-effectiveness across different procedural categories. Conclusions: This study demonstrates that machine learning models can effectively predict a patient's risk of SSC and guide strategic utilization of sNPWT. This data-driven approach allows for optimization of clinical and financial outcomes by strategically allocating sNPWT based on personalized risk assessments.

Negative Pressure Wound Therapy for Gas Gangrene of the Fingertip with Prolonged Infection

Negative Pressure Wound Therapy for Gas Gangrene of the Fingertip with Prolonged Infection

Wound Fluid Extracellular Microvesicles: A Potential Innovative Biomarker for Wound Healing.

Extracellular vesicles, or microvesicles, are a large family of membrane-bound fluid-filled sacs that cells release into the extracellular environment. Extracellular microvesicles (EMVs) are essential for cell-to-cell communications that promote wound healing. We hypothesize a correlation between the concentration of EMVs in wound fluid and the percentage of wound healing in treated chronic, nonhealing, wounds. A prospective, multicenter, randomized, single-blind clinical trial was conducted to evaluate EMV concentration in relation to wound healing percentages. Wound fluid samples were obtained from 16 patients with stage IV trunk pressure ulcers. Patients were divided equally into two groups: (1) control group on negative pressure wound therapy (NPWT) alone and (2) study group with NPWT plus porcine extracellular matrix dressing. NPWT was replaced two times a week, and porcine extracellular matrix applied once weekly for all subjects. An NPWT canister device, called a wound vacuum-assisted closure, containing wound fluid was collected from each patient every 4 weeks. EMVs were isolated and the concentration measured by nanoparticle tracking analysis. The study group's total healing percentage was around 89% after 12 weeks compared with the control group's percentage of about 52% (P ≤ 0.05). Using R programming software, simple linear regression was carried out to investigate the hypothesis. Data demonstrated significant positive correlation (R2 = 0.70; P = 0.05) between EMV concentrations and the healing percentage. There is a positive correlation between EMV concentration and wound healing percentages. Results propose that the EMVs in wound fluid could serve as a biomarker for healing.

Reducing the incidence of problematic seroma formation and skin necrosis post lymphadenectomy – TRIPLE ACTION Topical TXA, negative pressure wound therapy and prolonged drainage

Reducing the incidence of problematic seroma formation and skin necrosis post lymphadenectomy – TRIPLE ACTION Topical TXA, negative pressure wound therapy and prolonged drainage

The Utility of Prevena Negative Pressure Wound Therapy on Groin Incisions for Critical Limb-Threatening Ischemia: A Single Institution Experience.

Incisional negative pressure wound therapy (iNPWT) is an adjunctive treatment that uses constant negative pressure suction to facilitate healing. The utility of this treatment modality on vascular operations for critical limb-threatening ischemia (CLTI) has yet to be elucidated. This study compares the incidence of postoperative wound complications between the Prevena Incision Management System, a type of iNPWT, and standard wound dressings for vascular patients who also underwent plastic surgery closure of groin incisions for CLTI. We performed a retrospective cohort study of 40 patients with CLTI who underwent 53 open vascular surgeries with subsequent sartorius muscle flap closure. Patient demographics, intraoperative details, and wound complications were measured from 2015 to 2018 at the University of California San Francisco. Two cohorts were generated based on the modality of postoperative wound management and compared on wound healing outcomes. Of the 53 groin incisions, 29 were managed with standard dressings, and 24 received iNPWT. Patient demographics, comorbidities, and operative characteristics were similar between the 2 groups. Patients who received iNPWT had a significantly lower rate of infection (8.33% vs 31.0%, P = 0.04) and dehiscence (0% vs 41.3%, P < 0.01). Furthermore, the iNPWT group had a significantly lower rate of reoperation (0% vs 17.2%, P = 0.03) for wound complications within 30 days compared with the control group and a moderately reduced rate of readmission (4.17% vs 20.7%, P = 0.08). Rates of infection, reoperation, and dehiscence were significantly reduced in patients whose groin incisions were managed with iNPWT compared with standard wound care. Readmission rates were also decreased, but this difference was not statistically significant. Our results suggest that implementing iNPWT for the management of groin incisions, particularly in patients undergoing vascular operations for CLTI, may significantly improve clinical outcomes.

The ACS-NSQIP Analysis of Negative Pressure Wound Therapy Following Pancreatectomy for Pancreatic Diagnoses

The ACS-NSQIP Analysis of Negative Pressure Wound Therapy Following Pancreatectomy for Pancreatic Diagnoses

En-bloc excision of sacral squamous cell carcinoma with immediate reconstruction.

Sacral squamous cell carcinoma is an uncommon condition that may arise in scars following burns or in chronic wounds, such as an untreated pilonidal cyst. The aim of the present technical note is to describe a surgical technique aimed at minimizing local recurrence rates by en-bloc resection as well as providing immediate plastic reconstruction: 1. right-sided extended vertical rectus abdominis myo-cutaneous (VRAM) flap; 2. abdomino-perineal excision of the rectum with end colostomy; 3. en-bloc excision of the mass inclusive of gluteus maximus muscles and distal sacrectomy; 4. sacrectomy defect covered with VRAM flap; 5. bilateral gluteal defects covered with single-layer dermal substitute of bovine collagen and elastin hydrolysate followed by immediate split-thicknessskin grafting from bilateral thigh donor sites, and negative pressure wound therapy dressings. This approach resulted in a favorable outcome at 2-year follow-up in a male patient presenting with a large locally advanced sacral squamous cell carcinoma involving the external anal sphincter muscle.

Current aspects of the treatment of combat surgical trauma

Objective. The history of providing assistance to victims with gunshot wounds dates back more than one century, but nevertheless surgical treatment of gunshot wounds is still relevant to this day. High-quality primary surgical treatment of a gunshot wound is the key to a speedy recovery of the patient (N.I. Pirogov). The pathogenesis of gunshot wounds determines the specific tactics of surgical treatment. Gunshot wounds are zonal in nature. According to the results of morphological studies, it can be concluded that a significant part of the changes in the zone of molecular concussion of the wound canal are reversible, and the complexity of pathogenesis and the lack of reliable criteria for assessing the condition of tissues does not exclude the possibility of leaving areas with reduced viability in the wound after treatment. For maximum effect during surgical treatment of gunshot wounds, non-viable tissues should be removed with minimal damage to viable ones. To meet these requirements, it is often impossible to visually assess the boundary between damaged and parabiotic tissues objectively intraoperatively. The use of modern physical methods of wound wrapping and preparing them for plastic closure, such as low-frequency ultrasound, hydrosurgical methods and VAC therapy allows you to radically clean the wound surface with minimal damage to viable tissues and perform plastic closure operations on soft tissue defects at an early date.Purpose of a study: to improve the methods of primary surgical treatment in patients with combat surgical trauma using low-frequency ultrasound.Material and methods. Our study is based on the analysis of the treatment results of 93 patients aged 10 and 70 years old. All patients had combat surgical trauma of various etiology and localization. Of these, 36 (38.7%) patients in main group underwent ultrasound cavitation of the wound canal and wound defects during primary surgical treatment (PST), followed by primary or primary delayed plastic surgery within a period not exceeding 48 hours after PST. Methods of plastic wound closure were both flaps with axial circulation and autodermotransplantation. In the remaining 57 (61.3%) patients of comparison group, primary surgical treatment was not performed, or was performed at the stages of evacuation, with further conservative treatment. Upon admission to the clinic, he underwent secondary surgical treatment, opening of purulent lumps, as well as staged necrectomies, while wound plastic surgery was performed after wound cleansing and was mainly represented by autodermotransplantation.Results. It was revealed that in the main group, the treatment time of patients in the main group was reduced by 2 times compared with the comparison group (16.3 and 34.2 bed days, respectively). The effectiveness of engraftment of autodermotransplants was evaluated according to V.I. Petrov's scheme. Lysis of autodermotransplants was noted 1.9 times less frequently in the main study group. It was also noted that there were no purulent complications in main group, unlike comparison group – 20.6%, the number of marginal necrosis was 2.6% in main group and 22.4% – in comparison group, lysis of autodermotransplanates in main group was 7.8%, in comparison group – 13.8%.Conclusion. This study allows us to conclude that the advantage of using ultrasonic cavitation during the usual surgical treatment of gunshot wounds followed by primary or primary delayed plastic surgery.

A new mechanism in negative pressure wound therapy: interleukin-17 alters chromatin accessibility profiling.

Negative pressure wound therapy (NPWT) is extensively employed in clinical settings to enhance the healing of wounds. Despite its widespread use, the molecular mechanisms driving the efficacy of NPWT have not been fully elucidated. In this study, skin wound-healing models were established, with administration of NPWT. Vimentin, collagen I, and MMP9 of skin tissues were detected by immunofluorescence (IF). Gene expression analysis of skin wound tissues was performed by RNA-sequencing (RNA-seq). Protein expression was assayed by a western blotting or IF assay, and mRNA levels were quantified by quantitative PCR. Chromatin accessibility profiles of fibroblasts following NPWT or IL-17 exposure were analyzed by ATAC-seq. In rat wound-healing models, NPWT promoted wound repair by promoting re-epithelialization, extracellular matrix (ECM) synthesis and proliferation, which mainly occurred in the early stage of wound healing. These differentially expressed genes (DEGs) in NPWT wounds versus control wounds were enriched in the IL-17 signaling pathway. IL-17 was identified as an up-regulated factor following NPWT in skin wounds. Moreover, the IL-17 inhibitor secukinumab (SEC) could abolish the promoting effect of NPWT on wound healing. Importantly, chromatin accessibility profiles were altered following NPWT and IL-17 stimulation in skin fibroblasts. Our findings suggest that NPWT upregulates IL-17 to promote wound healing by altering chromatin accessibility, which is a novel mechanism for NPWT's efficacy in wound healing.

Comparative Effectiveness of Negative Pressure Wound Therapy With and Without Oxidized Regenerated Cellulose (ORC)/Collagen/Silver-ORC Dressing.

Negative pressure wound therapy (NPWT) and oxidized regenerated cellulose (ORC)/collagen/silver-ORC (OCSO) dressings have individually demonstrated effectiveness in supporting wound healing, but few studies have examined their combined use. This retrospective data analysis compared wound outcomes following outpatient NPWT with and without OCSO dressings. A search of de-identified records from the U.S. Wound Registry resulted in 485 cases of wounds managed with NPWT with OCSO dressings. A matched cohort of patients who received NPWT without any collagen dressing (n=485) was created using propensity scoring. For patients in the NPWT+OCSO group, OCSO was applied topically on or after the day of NPWT initiation and stopped on or before the day of NPWT termination. Wounds managed with NPWT+OCSO were significantly more likely to improve and/or heal compared to wounds that received NPWT alone (p=0.00029). The relative wound area reduction was 40% for patients receiving NPWT+OCSO, compared to 9% for patients receiving only NPWT (p=0.0099). The median time to achieve 75-100% granulation coverage with no measurable wound depth was shorter by 8 days with NPWT+OCSO in all wound types (p=0.00034), and by 14 days in surgical wounds (p=0.0010), than with NPWT alone. This is the first study examining the clinical outcomes associated with the integration of NPWT and OCSO dressings compared to the use of NPWT alone. These data support the novel practice of applying NPWT concurrently with OCSO dressings. This retrospective comparative analysis using real world data demonstrated improved healing outcomes with integrated use of NPWT with OCSO dressings versus NPWT alone.

The Evolution of Commercial Negative Pressure Wound Therapy Systems over the Past Three Decades.

Since the introduction of the first commercial negative pressure wound therapy (NPWT) system nearly three decades ago, several key technological innovations have led to wide adoption of the therapy. This is a review of the history and innovation of commercial NPWT systems for adjunctive management of open wounds. Technical modifications have broadened NPWT options to include innovative dressing interfaces, tubing configurations, power sources, capability of topical wound solution instillation or irrigation, canister versus canister-free configurations, smart technology, and disposable versus larger reusable therapy units. While these options complicate product selection, they have greatly expanded the potential to manage a wide variety of wounds in patients who previously may not have been candidates for NPWT. Basic yet mandatory requirements of NPWT include delivering an accurate level of negative pressure to the wound bed, maintaining a seal, removing wound surface exudate through the dressing interface, and patient adherence to prescribed therapy. Meeting these requirements is challenging in the face of variable wound types, wound locations, exudate levels and exudate viscosity. While there are a growing number of marketed NPWT systems, each may have different characteristics and performance. Evaluating the functionality of each system and relevant accessories is complicated, especially as additional manufacturers enter the market. Understanding key innovations and specific challenges they are intended to solve may aid healthcare providers in selecting appropriate NPWT technologies for patients. Evolving technology including artificial intelligence will likely play a major role in re-defining NPWT safety, simplicity, and reliability.

Negative Pressure Wound Therapy to Reduce Surgical Site Infections after CRS/HIPEC.

Surgical site infections (SSIs) are a common cause of morbidity after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal malignancy. Negative pressure wound therapy (NPWT) has been proposed as a method to reduce the rates of SSIs; however, there is paucity in the literature on the efficacy in this population. The goal of this study was to determine whether routine use of NPWT in patients undergoing CRS/HIPEC could reduce the risk of developing SSI. We performed a retrospective before-after study to assess the rates of SSI with NPWT compared with a standard postoperative surgical dressing (SSD) in all patients undergoing CRS/HIPEC from November 2013 to December 2021 at a single tertiary care center. The primary outcome was rate of SSI. A multivariate logistic regression analysis was performed to evaluate for risk factors for SSI. A total of 178 patients were treated with CRS/HIPEC over the study period. Seventy patients had placement of SSD, and 108 patients had placement of NPWT. Rates of SSI were 11.4% (8/70) and 5.6% (6/108) in the two groups, respectively (p = 0.16). On multivariate analysis, patients treated with NPWT had a significantly lower risk of developing an SSI (OR 0.24 [0.06, 0.92], p = 0.037). Patients living >50 km from the hospital had significantly higher risk of developing SSI (OR 2.03 [1.09, 3.78], p = 0.026). These results suggest that routine use of NPWT can reduce the risk of developing an SSI in patients undergoing CRS/HIPEC for peritoneal malignancy.

Foam dressing and micropower vacuum dressing promote diabetic foot ulcer wound healing by activating the PI3K/AKT/mTOR pathway in rats.

Foam dressing (FD) and micropower vacuum dressing (MVD) have been applied in the treatment of diabetic foot ulcer (DFU). However, research about the mode of action on the efficacy of the two dressings is extremely rare. This study proposed to explore the mechanism involved in diabetic wound healing under FD or MVD treatment. Macroscopical study was performed to evaluate the effectiveness of FD and MVD on wound healing in a rat model of DFU. Morphological analysis in the wound skin tissue was conducted by hematoxylin and eosin staining. Meanwhile, inflammatory cytokines in serum were measured by enzyme linked immunosorbent assay. The protein expression of phosphatidylinositol 3 kinase, protein kinase B and mammalian target of rapamycin (PI3K/AKT/mTOR) and their phosphorylation levels were determined by western blotting. We found that wound healing in rats with DFU was enhanced with the application of FD and MVD. The therapeutic efficacy of FD was superior to MVD. Compared with diabetic foot group, the concentrations of inflammatory cytokines, tumor necrosis factor alpha, interleukin-1β and interleukin-6, were significantly down-regulated. Besides, the phosphorylation levels of PI3K, AKT and mTOR were up-regulated under FD or MVD treatment. We demonstrated that the treatment of FD and MVD effectively promoted the wound skin healing through activating the PI3K/AKT/mTOR pathway. Our research may provide a new idea for exploring the mode of action of dressing application in healing of DFU.

Negative Pressure Wound Therapy-A Vacuum-Mediated Positive Pressure Wound Therapy and a Closer Look at the Role of the Laser Doppler.

Background: Negative pressure wound therapy (NPWT) is an intensely investigated topic, but its mechanism of action accounts for one of the least understood ones in the area of wound healing. Apart from a misleading nomenclature, by far the most used diagnostic tool to investigate NPWT, the laser Doppler, also has its weaknesses regarding the detection of changes in blood flow and velocity. The aim of the present study is to explain laser Doppler readings within the context of NPWT influence. Methods: The cutaneous microcirculation beneath an NPWT system of 10 healthy volunteers was assessed using two different laser Dopplers (O2C/Rad-97®). This was combined with an in vitro experiment simulating the compressing and displacing forces of NPWT on the arterial and venous system. Results: Using the O2C, a baseline value of 194 and 70 arbitrary units was measured for the flow and relative hemoglobin, respectively. There was an increase in flow to 230 arbitrary units (p = 0.09) when the NPWT device was switched on. No change was seen in the relative hemoglobin (p = 0.77). With the Rad-97®, a baseline of 92.91% and 0.17% was measured for the saturation and perfusion index, respectively. No significant change in saturation was noted during the NPWT treatment phase, but the perfusion index increased to 0.32% (p = 0.04). Applying NPWT compared to the arteriovenous-vessel model resulted in a 28 mm and 10 mm increase in the venous and arterial water column, respectively. Conclusions: We suspect the vacuum-mediated positive pressure of the NPWT results in a differential displacement of the venous and arterial blood column, with stronger displacement of the venous side. This ratio may explain the increased perfusion index of the laser Doppler. Our in vitro setup supports this finding as compressive forces on the bottom of two water columns within a manometer with different resistances results in unequal displacement.

783 Understanding Barriers to the Implementation of Negative Pressure Wound Therapy in Acute Pediatric Burn Care

783 Understanding Barriers to the Implementation of Negative Pressure Wound Therapy in Acute Pediatric Burn Care

Managing incisional wounds with Prevena VAC therapy in lower-extremity vascular surgery: A comparative study.

Vascular surgical site infections have been reported with an overall incidence of 5-10% for patients undergoing arterial interventions and as high as 10-20% for lower-limb bypass grafting procedures. Given that vascular surgery patients are known to be at a higher risk of postoperative wound infections and other complications, our objective was to evaluate a potential method to reduce such complications. This study compares the rate of wound healing complications between incisional negative pressure wound therapy (NPWT) and conventional dressings in vascular surgery patients with infra-inguinal incisions. The primary endpoint is complete closure of the wound at the 2-week follow-up appointment. Secondary endpoints include frequency infections requiring antibiotics, need for wound revision, and wound dehiscence. A prospective cohort study with retrospective control group was performed following infra-inguinal vascular surgeries for peripheral arterial disease at the Mount Carmel Health System. The patients included in this study were those who underwent a lower-extremity vascular procedure with primary closure of an incision distal to the groin between January 2014 and July 2018. Patients that had received an infra-inguinal incision with primary closure were included. Patients in the experimental group who had a Prevena Wound VAC were compared with a retrospectively obtained control arm treated with conventional dressings. Data regarding wound healing and complications, specifically infections and wound dehiscence, were obtained. A total of 201 patients were recruited in our study: 64 in the Prevena group and 137 in the control group. There was a significant reduction in the number of open wounds in the Prevena group compared to the control group at the 2-week follow-up (10.9% Prevena vs 33.6% control; p = .0005). When evaluated in aggregate, there was a statistically significant reduction in the number of patients who succumbed to any complication in the Prevena arm compared with traditional dressings (13 (20.3%) Prevena vs 72 (52.6%) control; p < .0001). The results of our study suggest there should be a significant consideration for the use of NPWT as a prophylactic measure to reduce the risk of wound complications of primarily closed infra-inguinal incisions in vascular surgery patients following common vascular procedures. Its use is particularly effective for patients at enhanced risk of infection, especially those with poor vascularization from BMI, smoking, and diabetes. This leads to decreased trends in antibiotic use, ED visits, readmissions, and surgical revisions, which translates to decreased utilization of hospital resources and economic burden.

Improvement in community wound management: why simple changes in clinical practice matter

Background/Aims Wounds continue to be an increasing burden to society, healthcare systems and patients. Wound care is an urgent challenge that requires new management strategies to help facilitate wound healing. This study aimed to evaluate an early intervention wound project facilitated by the COMPASS programme in a Swedish community setting in terms of treatment outcomes and health economic benefits. Methods An evaluation of wound care practice was completed using data collected on all wounds treated in 1 week in March 2021 (n=97). Single-use negative pressure wound therapy (sNPWT) was then introduced, alongside specialist education for all nurses. A post-intervention evaluation was carried out the following year with data on all wounds treated in 1 week in October 2022 (n=36). The samples were compared in terms of proportion of static and deteriorating wounds, wound characteristics, average number of dressing changes per wound and proportion of wounds requiring the patient to be admitted to hospital or referred to a specialist. Costs of care were calculated and compared for the two samples. Results Wounds in the post-intervention dataset were in a better overall condition (size and depth), with a lower proportion being classified as static or deteriorating (58.8% vs 44.4%). There was a non-significant difference in the average number of dressing changes required per week, with post-intervention wounds requiring fewer changes. A significantly lower proportion of patients required a referral to a specialist in the post-intervention sample compared to the pre-intervention sample (43.3% vs 16.7%; P&lt;0.01). Conclusions Implementing a sNPWT pathway, alongside nurse education and increased involvement of nurses with specialist knowledge, can help to improve wound care outcomes and reduce the burden of wounds on nursing time and healthcare resources.

Is Barbed Better? Evaluation of Triclosan-Coated Barbed Suture on Wound Complications Following Emergency Laparotomy.

Emergent laparotomy is associated with significant wound complications including surgical site infections (SSI) and fascial dehiscence (FD). Triclosan-coated barbed suture (TCB) for fascial closure has been shown to reduce local complications but primarily in elective settings. We sought to evaluate the effect of TCB emergency laparotomy fascial closure on major wound complications. Adult patients undergoing emergency laparotomy were prospectively evaluated over 1-year. Patients were grouped into TCB vs polydioxanone (PDS) for fascial closure. Subanalysis was performed on patients undergoing single-stage laparotomy. Primary outcomes were SSI and FD. Multivariate analysis identified independent factors associated with SSI and FD. Of the 206 laparotomies, 73 (35%) were closed with TCB and 133 (65%) were closed with PDS. Trauma was the reason for laparotomy in 73% of cases; damage control laparotomy (DCL) was performed in 27% of cases. The overall rate of SSI and FD was 18% and 10%, respectively. Operative strategy was similar between groups, including DCL, wound vac use, skin closure, and blood products. SSI events trended lower with TCB vs PDS closure (11% vs. 21%; p = .07), and FD was significantly lower with TCB versus PDS (4% vs. 14%; p < .05, Fig 1). Subanalysis of trauma and non-trauma cases showed no difference in SSI or FD. Multivariable analysis found that TCB decreased the likelihood of FD (OR .07; p < .05, Fig 2) following emergency laparotomy. Increased odds of FD were seen in DCL (OR 3.1; p < 0.05). Emergency laparotomy fascial closure with TCB showed significantly decreased rates of FD compared to closure with PDS, and a strong trend toward lower SSI events. TCB was independently associated with decreased FD rates after emergency laparotomy.