Negative Pressure Wound Therapy Research Articles

Prophylactic closed-incisional negative pressure wound therapy following posterior instrumented spinal fusion: a single surgeon's experience and cost-benefit analysis.

Surgical site infections (SSIs) following spine surgery are associated with morbidity and resource utilization. Applying prophylactic closed-incisional negative pressure wound therapy (ciNPWT) during posterior instrumented fusion has mixed results in reducing rates of wound complications and SSI. We evaluated the clinical efficacy and potential cost-savings associated with ciNPWT in high-risk patients receiving posterior instrumented spinal fusion. We retrospectively reviewed patients receiving posterior instrumented spinal fusion for any surgical indication between July 1, 2017 and December 31, 2019, and compared rates of wound dehiscence, SSI, and reoperation for wound complications between standard surgical dressings and ciNPWT. Surgical dressing selection was based on the senior author's assessment of infection risk factors. A total of 229 patients (n = 85 standard surgical dressings, n = 144 ciNPWT) were included. The ciNPWT group had significantly more risk factors for wound-related complications, including older age (61.8 vs. 58.5 years, p = 0.042), diabetes mellitus (36.8% vs. 23.5%, p = 0.037), more instrumented levels (5.6 vs. 3.9, p < 0.0001), estimated blood loss (1298 vs. 998 mL, p = 0.036), and deformity was the predominant operative indication (29.9% vs. 17.7%, p = 0.040). Prophylactic ciNPWT was associated with significantly lower rates of wound dehiscence (21.5% vs. 34.1%, p = 0.036) and SSI (8.3% vs. 21.2%, p = 0.005). Number needed to treat with ciNPWT to prevent one SSI was 8 patients. The cost of preventing one SSI was $4,560. Cost-benefit analysis demonstrated a potential mean savings of $21,662 per operative SSI prevented and $270,775 per 100 patients undergoing posterior instrumented fusion with ciNPWT. Prophylactic ciNPWT use is a cost-effective means of reducing rates of wound dehiscence and SSI following posterior instrumented fusion.

“Effectiveness and safety of negative pressure wound therapy in patients with deep sternal wound infection: a systematic review and meta-analysis”

Background: Deep sternal wound infection (DSWI) is a severe and life-threatening complication following cardiovascular surgery. Negative pressure wound therapy (NPWT) has emerged as a promising therapeutic bridging option for DSWI. In this systematic review and meta-analysis, we aimed to evaluate the impact of NPWT on clinical outcomes in patients with DSWI. Material and Methods: A comprehensive literature search was conducted according to the PRISMA guideline in electronic databases, including PubMed, Embase, and Cochrane Library. Data extraction was performed independently by two reviewers, and risk of bias was assessed by ROBINS-I tool. The primary outcomes assessed were mortality rate and reinfection rate. The secondary outcomes assessed were length of hospital stay and intensive care unit stay. Results: In this systematic review identified a total of 36 studies, comprising 3,681 patients with DSWI who received treatment. The meta-analysis revealed that NPWT was associated with a significant reduction in mortality rate (RR 0.46, 95% CI 0.35-0.61, P&lt;0.000001) and reinfection rate (RR 0.43, 95% CI: 0.25-0.74, P=0.002) compared to conventional wound management. Furthermore, pooling of these studies showed significant difference between the NPWT and conventional treatment groups in length of hospital stay (mean difference: -4.49, 95% CI: -8.14, -0.83; P=0.02) and length of ICU stay (mean difference: -1.11, 95% CI: -2.18, -0.04; P=0.04). Conclusion: This systematic review and meta-analysis provide evidence that NPWT is superior to conventional treatment for patients with DSWI following cardiovascular surgery.

The Infected Diabetic Foot: Does Negative Pressure Wound Therapy with Irrigation Reduce Bioburden and Improve Wound Healing?

The aim of this study was to compare the microbial loads of patients with diabetic foot infections treated with negative pressure wound therapy (NPWT) with and without irrigation with polyhexamethylene biguanide (NPWTi-P). This is a post hoc analysis of combined data of two randomized clinical trials. We evaluated people with diabetes treated with moderate and severe diabetic foot infections that required surgery. Tissue specimens were obtained after the initial surgery and following a second planned return to the operating room after 48-72 h of NPWT or NPWTi-P, prior to the second surgery. We used quantitative polymerase chain reaction (qPCR) to determine the total microbial loads (Log10 16S copies per gram of tissue). There was no difference in mean quantitative bacterial cultures among patients that received NPWT and NPWTi-P (before first surgery Log10: NPWT = 6.4 ± 1.8, NPWTi-P = 7.5 ± 1.7 vs before second surgery Log10: NPWT = 6.7 ± 1.8, NPWTi-P = 7.6 ± 1.9 p = .12). There was no difference in wound healing (59.5% vs 50.0%, p = .51) or time to heal (127 ± 109.3 vs 143 ± 95.9), p = .71). There were fewer re-infections in people that received traditional NPWT (28.6% vs 56.3%, p = .05). Level of Clinical Evidence: Level 1.

BN SO54 - Complex Management of a Gastrocutaneous Fistula Following Pancreatic Necrosectomy: A Case Report

Abstract Background Gastrocutaneous fistulas are rare but serious complications that can arise following the surgical treatment of necrotizing pancreatitis. This post-operatory complication can be refractory to conservative management and may be further aggravated by severe skin injuries and malnutrition. This case report describes the comprehensive and multidisciplinary approach of a challenging case of gastrocutaneous fistula, ultimately requiring re-intervention. Method A 78-year-old female with a history of severe necrotizing pancreatitis underwent pancreatic necrosectomy by laparotomy. Postoperatively, she developed a gastric fistula, initially repaired with a double-layered suture. Recurrence led to a gastrocutaneous fistula with continuous gastric drainage and chemical burn of the surrounding skin. Initial conservative management included insertion of a nasogastric tube for gastric decompression, followed by placement of a PEG tube to redirect the drainage and prevent further skin damage and an esophagojejunal feeding tube to bypass the fistula and maintain nutrition. Nevertheless, the fistula persisted, resulting in significant skin erosion and deterioration of the patient’s condition. Results Given the failure of conservative measures and a concurrent diagnosis of a pancreatic fistula, a surgical approach was deemed necessary. The patient was transferred to a specialized hospital center, where she underwent fistulectomy with partial gastrectomy and wound closure. Negative pressure wound therapy (NPWT) was applied to the ulcerated skin to promote healing. This approach led to the successful closure of the gastrocutaneous fistula and healing of the skin wound. The patient showed marked clinical recovery, with no signs of infection or fistula recurrence and the nutritional status was successfully managed through enteral feeding leading to a notable functional recovery. Conclusion This case underlines the complexity of managing gastrocutaneous fistulas, demonstrating the efficacy of combining surgical and supportive therapies, serving as a reference for similar future cases and emphasizing the need for comprehensive management strategies for complex postoperative complications.

FRAGMENTED THIGH INJURY: TREATMENT WITH PREBIOTICS, NANOPARTICLES, AND CELL THERAPY

The purpose of this study was to investigate the possibility of staged local treatment of an infected mine-explosive wound using a gel containing Bacillus spp., cerium oxide nanoparticles, and cell therapy. Object and Methods. The article presents a clinical case demonstrating the effective staged treatment of a 57-year-old patient with a fragmentary fracture of the right femur and a large purulent wound of the right thigh. The patient underwent Ex-fix rod-type femur-tibia stabilization and resection of a post-traumatic aneurysm of the right superficial femoral artery. In the first stage of treatment, two sessions of negative pressure wound therapy (NPWT) were applied, with pressures ranging from 75-115 mm Hg and a session duration of 4-5 days. In the second stage, local treatment involved a combination of antiseptics and probiotics (Bacillus spp.) alongside cerium oxide nanoparticles. By the 7th day, the eradication of pathogenic microflora was achieved, allowing for the third stage of treatment—application of autologous mesenchymal stem cells. Results: The treatment of combat trauma has become increasingly relevant in Ukraine and globally due to its complexity and the rising proportion of multiple and combined injuries, which account for 25-60% of cases. Infectious complications occur in 25% of combat trauma cases and are responsible for 70% of related deaths. Most structural and functional disorders associated with wound infections develop at the time of injury, intensify over time, and require immediate surgical intervention, improvements in local treatment methods, and new approaches for wound closure. Conclusions: The use of a combination of probiotics and NPWT therapy led to a rapid reduction of the inflammatory process. Clinical observations showed accelerated wound cleansing from fibrin and necrotic tissue. The combined treatment significantly reduced the size and depth of wound due to the formation of active pink granulation tissue (observed by days 8-9) and marginal epithelialization by days 10-13. During this period, no pathogenic flora were detected, allowing for the subsequent application of autologous mesenchymal stem cells. This treatment approach reduced the need for antibacterial drugs and prevented the need for additional surgical interventions. The inclusion of cerium oxide nanoparticles was an effective enhancement for cell transplantation, facilitating stem cell delivery and contributing to the treatment of large wounds.

Surgical site infections in caesarean wounds.

The increasing incidence of surgical site infections (SSIs) following caesarean sections highlights the necessity for updated protocols that address risk factors throughout the preoperative, intraoperative, and postoperative stages. Negative Pressure Wound Therapy (NPWT) and hydrocolloid dressings have demonstrated potential for improving wound management and reducing complications, particularly by enhancing dressing integrity. Nevertheless, the application of NPWT requires careful consideration and adherence to local trust guidelines to ensure both its safety and efficacy.

A Review on Cost Effectiveness of Negative Pressure Wound Therapy Vs Traditional Dressing In Diabetic Wounds.

A Review on Cost Effectiveness of Negative Pressure Wound Therapy Vs Traditional Dressing In Diabetic Wounds.

Closed-incision negative pressure wound therapy (NPWT) in elderly patients following sacral pressure sore reconstruction

BackgroundPressure sores significantly affect elderly patients, with the sacrum being especially vulnerable, often due to its proximity to the anus and potential for fecal contamination. Despite preventive measures such as frequent repositioning and specialized cushions, some sores still necessitate surgical intervention. Postoperative care focuses on monitoring, hygiene, and pressure alleviation. This study assessed the efficacy of Closed-Incision Negative Pressure Wound Therapy (CI-NPWT) for postoperative wound management in patients with sacral pressure sores treated with local flaps.MethodsA retrospective analysis was performed on sacral sore patients who underwent reconstructive surgery from March 2019 through April 2023. Surgical procedures involved debridement and wound coverage using gluteal artery perforator-based fasciocutaneous flaps, followed by postoperative monitoring. Patients were grouped into conventional monitoring or NPWT management, with the latter utilizing the INFOV.A.C. The therapy unit was calibrated to 125 mmHg. Data on patient demographics, flap metrics, fluid drainage amounts, and six-month postoperative outcomes were collected, and then analyzed with SPSS Statistics.ResultsIn this study of 52 patients with sacral pressure sores, the NPWT group (n = 25) showed significantly fewer flap complications and a lower drainage volume on the seventh postoperative day (mean 17.2 cc) compared to the conventional dressing group (mean 27.8 cc, P < 0.05). No postoperative complications were observed in the NPWT group, whereas the conventional group (n = 27) experienced one infection and three cases of dehiscence. Both groups achieved a 100% flap survival rate.ConclusionClosed-incision negative pressure wound therapy (CI-NPWT) shows promise in reducing wound dehiscence and infection rates in elderly patients undergoing sacral pressure sore reconstruction with local flaps. However, further research with larger, randomized studies is needed to confirm its effectiveness as an alternative to conventional postoperative care.Trial registration.The study was retrospectively registered by the Institutional Review Board of Seoul Metropolitan Government-Seoul National University Boramae Medical Center (No. 20–2023–25, Date: Mar. 24 2023).

A new portable negative pressure wound therapy device: a prospective study investigating clinical outcomes.

Closed surgical incision sites at high risk of complications, and with exudate or leakage, are increasingly being managed with closed incision negative pressure wound therapy (ciNPWT) to reduce tissue stress and increase the force necessary to disrupt the incision. This study was undertaken to investigate the performance and safety of a canister-based, single-use NPWT (suNPWT) system when used on closed surgical incision sites. The investigation was designed as a prospective, open, non-comparative, multicentre study aimed at confirming the safety and performance attributes of the suNPWT system when applied to low-to-moderately exuding closed surgical incisions. The primary performance measure was the wound remaining closed from baseline to the last follow-up visit on day 14. Secondary performance measures included: wound and periwound condition; wear time of the system; product consumption; adherence to therapy; and patients' pain progress. Details of adverse events were also collected. Some 35 patients were recruited. The closed surgical incisions responded well to treatment with the tested suNPWT system. All wounds remained closed throughout the investigation. Consistent with other studies of ciNPWT reporting low infection rates, the current study observed either no or low exudation in 90.4% of wounds at the final visit, together with absence of surgical site infection. Pain severity levels were low, both at dressing change and during delivery of negative pressure. No serious adverse device events were reported. In this study, the suNPWT system supported the healing of closed surgical incisions with no safety concerns relating to its use.

The application effect of autologous platelet-rich plasma combined with negative pressure sealing drainage technology in pressure ulcer wound repair.

This study aimed to evaluate the efficacy of combining autologous platelet-rich plasma (PRP) with negative pressure wound therapy (NPWT) for the repair of pressure ulcers. We included 90 patients with pressure ulcers from General Technology Gemstone Flower Healthcare Jilin City Hospital of Chemical Industry between January 2021 and December 2023. Patients were randomly assigned to either a control group or an observation group, with 45 patients in each. The control group received NPWT alone, while the observation group received a combination of PRP and NPWT. Outcomes were compared between the groups, including clinical efficacy, wound recovery time (infection control time, wound healing time, hospital stay), levels of inflammatory markers (C-reactive protein, erythrocyte sedimentation rate, white blood cell count), pain scores (numerical rating scale), Pressure Ulcer Scale for Healing scores, and incidence of complications. The observation group demonstrated a total effective rate of 95.56% (43/45), significantly higher than the control group's 80.00% (35/45) (P < .05). Additionally, the observation group had significantly shorter infection control times, wound healing times, and hospital stays (P < .05). Two weeks post-surgery, the observation group had significantly lower levels of C-reactive protein, erythrocyte sedimentation rate, and white blood cell count, as well as reduced numerical rating scale and Pressure Ulcer Scale for Healing scores (P < .05). The incidence of complications was 6.67% (3/45) in the observation group compared to 33.33% (15/45) in the control group, with a significant difference (P < .05). Combining autologous PRP with NPWT significantly improves clinical outcomes, reduces inflammatory responses, decreases pain, accelerates wound healing, and lowers complication rates in patients with pressure ulcers.

RETRACTION: Effect of platelet-rich plasma combined with negative pressure wound therapy in treating patients with chronic wounds: A meta-analysis.

H. Chen , T.-J. Xu , H. Yu , J.-L. Zhu , Y. Liu , L.-P. Yang , "Effect of platelet-rich plasma combined with negative pressure wound therapy in treating patients with chronic wounds: a meta-analysis," International Wound Journal 21, no. 4 (2024): e14758, https://doi.org/10.1111/iwj.14758. The above article, published online on 23 April 2024, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons, Ltd. Following an investigation by the publisher, the parties have concluded that this article was accepted solely on the basis of a compromised peer review process. Therefore, the article must be retracted. The authors did not respond to the notice of retraction.

Evaluation of CellerateRX® Utility in Reducing Groin Complications after Femoral Exposure

OBJECTIVEVascular procedures involving groin incisions for femoral exposure often have complications that delay wound healing. These complications include but are not limited to development of seromas, hematomas, or infection requiring reintervention leading to readmission, increased length of stay, and increased morbidity & mortality, including limb loss. In this prospective study, we evaluate the utility of CellerateRX® surgical powder in preventing postoperative groin complications. We compare outcomes of groin incisions that received standard surgical wound care and those that were additionally packed with CellerateRX® powder. METHODSGroin incisions required for femoral exposure in vascular surgery procedures were considered. The control group included cases between 2020-2021. Exclusion criteria included patients less than 18 years of age, those with a bovine allergy, those with an active groin infection, or those undergoing a repeat femoral exposure. Bilateral groin incisions were counted as two separate constituents in the overall sample. The perioperative protocol in the management of these patients included one-hour preoperative vancomycin (15 mg/kg IV)/ceftriaxone (2 g IV), double skin preparation with 4% chlorhexidine, hair removal with surgical clippers, IobanTM, postoperative doxycycline (100 mg PO/IV BID for 24 hours), and negative pressure wound therapy or a muscle flap in high-risk patients. Patients between 2022-2023 who met the described inclusion criteria were enrolled into the experimental group. The only change to the perioperative protocol of the experimental group was the addition of CellerateRX® powder to the surgical wound before closure. Patients were followed for 6 months. The primary outcome was the number of groin complications that required return to the operating room (e.g., seroma, hematoma, infection). RESULTSThe control group consisted of 137 groins, 17 (13%) of which developed complications—7 (5.2%) seromas, two (1.5%) hematomas, five (3.7%) soft tissue infections, and three (2.2%) skin necrosis cases. The treatment group consisted of 20 groins, 3 (15%) of which developed complications—two seromas and one soft tissue infection. A two-tailed Fisher’s exact test demonstrated no statistically significant association between the presence of complications and the treatment group (p=.49, α=.05). CONCLUSIONSBased on the results of this study, we cannot conclude that packing wounds with CellerateRX® powder alters the risk of developing postoperative groin complications compared to standard wound care. Although the number of hematomas and skin necrosis were not observed in the treatment group, the observed differences may be due to the small sample size.

Negative Pressure Wound Therapy with Instillation for Periprosthetic Infection after Breast Reconstruction: A Systematic Review.

Periprosthetic infection after breast reconstruction is not uncommon and can result in loss of the implant pocket and negative patient outcomes. Management of these infections typically involves removal of the prosthesis, treatment with antibiotics, and delayed reconstruction upon infection resolution. The impact of adjunctive use of negative pressure wound therapy with instillation and dwell (NPWTi-d) on breast pocket salvage rates, time to implant reinsertion, and related outcomes was examined. A systematic literature search using PubMed, Cochrane, OVID, Scopus, and Embase was conducted to identify peer-reviewed articles written in English and published between January 2004 and April 2023 that examined NPWTi-d use in the breast pocket with a history of periprosthetic infection after breast reconstruction. Of the 1703 publications, 6 studies met inclusion criteria, representing 115 patients and 122 breasts. The overall breast pocket salvage rate with NPWTi-d across studies was approximately 92%. In the 6 studies that included prosthesis type and radiation history, overall salvage rates were 97.8% (45 of 46) for pockets containing implants and 93.8% (15 of 16) for pockets containing tissue expanders. Salvage rates were 85.7% (12 of 14) and 91.7% (53 of 58) for irradiated and nonirradiated breasts, respectively. Mean time to implant reinsertion ranged from 2.3 to 10.3 days. In this review, antibiotic therapy along with adjunctive use of NPWTi-d for periprosthetic infections after breast reconstructions was associated with high rates of breast pocket salvage and reduced time to implant reinsertion. Larger prospective and randomized trials are needed to better understand and optimize the effectiveness of NPWTi-d in this population.

Effectiveness of Negative-Pressure Wound Therapy with Instillation Compared to Standard Negative-Pressure Wound Therapy and Traditional Gauze Layer Dressing for the Treatment of Acute Traumatic Wounds: a Randomized Controlled Trial

Effectiveness of Negative-Pressure Wound Therapy with Instillation Compared to Standard Negative-Pressure Wound Therapy and Traditional Gauze Layer Dressing for the Treatment of Acute Traumatic Wounds: a Randomized Controlled Trial

RETRACTION: The effect of negative pressure wound therapy on the outcome of diabetic foot ulcers: A meta-analysis.

N. Zhang , Y. Liu , W. Yan , F. Liu , "The effect of negative pressure wound therapy on the outcome of diabetic foot ulcers: A meta-analysis," International Wound Journal 21, no. 4 (2024): e14886, https://doi.org/10.1111/iwj.14886. The above article, published online on 23 April 2024, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons, Ltd. Following an investigation by the publisher, the parties have concluded that this article was accepted solely on the basis of a compromised peer review process. Therefore, the article must be retracted. The authors did not respond to the notice of retraction.

Combining Negative Pressure Wound Therapy with Shoelace Technique for Effective Closure of Soft Tissue Defect: A Case Series

This study investigates a novel approach to wound management that combines negative pressure wound therapy (NPWT) with the shoelace technique for closure of soft tissue defects. We retrospectively reviewed three cases treated between August 2022 and January 2023, where NPWT combined with the shoelace technique facilitated effective wound closure without general anesthesia. This approach shows significant potential in managing various wound etiologies, including pressure ulcers, postoperative dehiscence, and soft tissue defects resulting from hematomas. The outcomes demonstrated promising healing with minimal complications, suggesting a viable alternative for patients unable to undergo traditional surgical procedures. Despite the study’s limitations, such as a small sample size and subjective clinical judgments, the results advocate for further research and standardization of this technique.

Clinical efficacy and mechanism of the combination of autologous platelet-rich gel and recombinant human acidic fibroblast growth factor in the management of refractory diabetic foot.

This study aims to explore the influence of combining autologous platelet-rich gel (APG) with continuous vacuum-sealed drainage (CVSD) and the exogenous recombinant human acidic fibroblast growth factor (rh-aFGF) on the healing processes of diabetic foot ulcers (DFU). The primary objective is to elucidate the complex molecular mechanisms associated with DFU, providing innovative perspectives for its treatment. Ninety patients diagnosed with DFU were randomly allocated into three distinct groups. Group A underwent CVSD following wound cleansing to facilitate healing. In Group B, in addition to conventional treatment, negative pressure wound therapy was applied, and rh-aFGF was introduced into normal saline for lavage, building upon the procedures of Group A. Group C received APG along with the interventions applied in Group B. The clinical efficacy of each group was systematically observed and analyzed. Additionally, changes in plasma oxidative stress, inflammatory markers, vascular endothelial growth factor (VEGF), and pigment epithelium-derived factor (PEDF) were assessed both before treatment and 14 days post-treatment. Following treatment, all groups exhibited commendable clinical efficacy. Group C demonstrated a superior wound healing rate, reduced frequency of dressing changes, and shorter wound healing duration (P< 0.05). Compared to baseline measurements, the levels of superoxide dismutase and PEDF increased, while malondialdehyde, VEGF, interleukin-6, interleukin-8, and monocyte chemotactic factor MCP-1 decreased in the wound tissue across all groups. Notably, Group C showed the most significant improvement in clinical efficacy and fortification of molecular mechanisms against oxidative stress (all P< 0.05). The integrative therapeutic approach combining APG with CVSD and rh-aFGF demonstrates notable efficacy in advancing wound healing. This effectiveness is evident through the reduced frequency of dressing changes and alleviation of wound-related pain. Additionally, the treatment regimen improves the cure rate for challenging, refractory wounds. These favorable outcomes can be attributed to the reduction of oxidative stress levels, attenuation of the local inflammatory response, and the enhancement of the balance between PEDF and VEGF.

Commentary Innovations in Tissue Regeneration and Wound Healing: A Comparative Study of Nigeria and South Africa

Tissue regeneration and wound healing represent critical areas in medical science, with significant advance-ments in recent years. These fields involve restoring damaged tissues and promoting recovery, which are essential for improv-ing patient outcomes and quality of life. Innovations such as biomaterials, stem cell therapy, advanced wound dressings, and regenerative medicine have significantly impacted these areas. This study provides a comparative analysis of innovations in tissue regeneration and wound healing in Nigeria and South Africa. The focus includes technological advancements, research contributions, and statistical data to highlight progress and challenges in both countries. Data from various healthcare institu-tions, research publications, and government reports form the basis of this analysis.Additionally, surgical innovations that minimize wound occurrence and improve wound healing, such as mini-mally invasive surgery, negative pressure wound therapy (NPWT), and the use of advanced suture materials, are transforming clinical outcomes in both Nigeria and South Africa. Minimally invasive techniques reduce tissue damage, leading to smaller wounds and faster recovery. NPWT has proven effective in managing chronic wounds and reducing infection rates, while an-timicrobial and absorbable sutures have lowered complications related to wound closure. Cold plasma therapy and stem cell applications are also emerging as promising approaches for chronic wound care and tissue regeneration. These innovations, coupled with the efforts in regenerative medicine and biomaterials, are providing both nations with effective tools to manage wound healing more efficiently. This comparative study aims to shed light on the current state of tissue regeneration and wound healing in these nations, offering insights into the advancements made, the effectiveness of various approaches, and the potential future devel-opments in this vital medical field.

Upper Thoracic Pyogenic Spondylitis With a Paravertebral Abscess Treated With a Combination of Cranked Minimally Invasive Spinal Instrumentation and Negative Pressure Wound Therapy: A Case Report

Upper Thoracic Pyogenic Spondylitis With a Paravertebral Abscess Treated With a Combination of Cranked Minimally Invasive Spinal Instrumentation and Negative Pressure Wound Therapy: A Case Report

Comparative analysis of negative pressure wound therapy (PICO) and standard dressing application after arterial vascular reconstructions.

Surgical site infections following arterial reconstructions with femoral exposures are common and potentially preventable. Negative pressure wound therapy has emerged as a potential solution to minimize groin wound complications. Our study evaluates efficacy of a negative pressure therapy (PICO dressing) in reducing groin wound complications after vascular reconstructions. A retrospective single center comparative analysis of vascular reconstructions involving common femoral artery dissection was performed between July 2021 and June 2023. Patients were divided into two groups: patients treated with PICO device and patients who received standard dressing (non-PICO). Patient demographics, comorbidities, vascular evaluation, and procedure indications were compared. Previous interventions, incision orientation and procedure types were noted. The wound complication categories were graded according to the Szilagyi classification: grade 1 (superficial infection/minor dehiscence), grade 2 (deep infection/major dehiscence), and grade 3 (artery or prosthetic involvement). Statistical significance level was determined at p < .05 for all analyses. A total of 217 groin dissections in 184 patients were analyzed with 132 and 85 groin dissections in the PICO and non-PICO groups, respectively. The baseline characteristics were similar between the groups in terms of age, sex, BMI, and procedure indications. Prior endovascular procedures and re-operative groin surgeries were more prevalent in the PICO group. The use of antibiotics post-operatively for groin wound complication was greater in the non-PICO group. The incidence of wound complications was higher in the non-PICO group (29.4% vs 10.6%, p < .001). Multivariate logistic regression analysis determined that PICO dressing as well as hybrid and endovascular index procedures were associated with lower risks of groin complications. PICO dressing decreased the incidence of groin wound complications in patients undergoing open vascular reconstructions. This study highlights the value of adjunctive negative pressure therapy in reduction of wound complications after arterial reconstructions in the inguinal region.