Negative Pressure Wound Therapy for At-Risk Surgical Closures in Patients With Multiple Comorbidities

SLR- March 2014- Jessica Minder

Reference: Masden; D. Goldstein; J. Endara; M. Xu; K. Steinberg; J. Attinger; C. Negative Pressure Wound Therapy for At-Risk Surgical Closures in Patients with Multiple Comorbidities: A Prospective Randomized Controlled Study.  Ann Surg. 2012 Jun;255(6):1043-7.

Scientific Literature Review
 

Reviewed by: Jessica L. Minder, DPM
Residency Program: Inova Fairfax Hospital

Podiatric Relevance: Few techniques have been utilized to improve wound healing on closed surgical incisions in patients with multiple comorbidities, apart from medical optimization and local wound care. With the advent and success of Negative Pressure Wound Therapy (NPWT) in the setting of open wounds in mind, the authors seek to evaluate the efficacy of NPWT on closed surgical incisions in patients with multiple comorbidities in the setting of at-risk surgical closures.
 

Methods: Patients aged 18 or older who were scheduled for primary or delayed primary closure of lower extremity or abdominal wounds at a tertiary wound care center were included in this prospective study. Exclusion criteria included lower extremity amputations distal to the forefoot due to greater difficulty in application of NPWT dressings. Patients were randomized into a NPWT group (placement of VAC system to closed surgical incision at settings of 125 mm Hg continuous pressure for three days) and a control group with a standard silver-impregnated dry post-operative dressing. At blinded post-operative visits, incisions were evaluated for infection and dehiscence as primary outcome measures. 

Results: A total of 93 patients were included in the final analysis, with 37 patients in the control group and 44 in the NPWT group, and no statistical differences between the groups with respect to demographics, preoperative comorbidities, type of operation, or operative details were identified. Between the two groups, there was no statistically significant difference in the incidence of infection or in the time to develop infections. Furthermore, there was no statistically significant difference in the incidence of dehiscence or time to develop dehiscence between the two groups. Overall, 35 percent of the dry dressing group and 40 percent of the NPWT group had a wound infection, dehiscence, or both.
 

Conclusions: Despite the theoretical advantages of NPWT on closed surgical incisions, no statistically significant difference was identified in comparison to a silver-impregnated dry dressing with regards to infection or dehiscence. This study represents the largest prospective study comparing NPWT to a control group for use in closed incisions in the setting of multiple comorbidities. Future studies with a larger sample size, longer treatment time period of NPWT, and application of NPWT to anatomical locations of the hindfoot and ankle where increased tension is reproducible would benefit the podiatric surgeon.