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Negative Pressure Wound Therapy For At Risk Surgical Incisions: A Prospective Randomized Controlled Clinical Trial
Derek Masden, MD, Jesse Goldstein, MD, Matt Endara, MD, Kyle Xu, Christopher Attinger, MD.
Georgetown University Hospital, Washington, DC, USA.
In patients with compromised wound healing capabilities, few options exist to assist healing following surgical closure. Recently the use of negative pressure wound therapy (NPWT) on surgical incisions has emerged as an option. We performed a prospective randomized controlled clinical trial comparing NPWT to standard dry dressings on surgical incisions.
After IRB approval, we enrolled patients from our wound clinic that met criteria and underwent primary closure of their wounds. Patients were randomized to receive NPWT with a V.A.C. (KCITM) or dry occlusive dressing over their incision after surgery. Dressings were removed at post-operative day 3 and subsequently evaluated routinely in clinic. Endpoints included post-operative infection and wound dehiscence.
106 patients were consented to participate, 13 couldn’t be primarily closed at surgery, yielding 93 patients. 43 were randomized to receive dry dressings, and 50 to receive NPWT. 6 from each group were lost to follow up after POD 3 and excluded.
Average follow up was 113 days for all subjects.
The majority of closures occurred in lower extremities with the lower leg the most common (54%), followed by the foot (18%), thigh (17%), and trunk (11%).
There were no statistically significant differences between the two groups with regards to pre-operative co-morbidities or operative details. (Table 1)
6.8 % of the NPWT group and 13.5% of the dry dressing group developed wound infection, but this was not statistically significant (p=0.46). There was no difference in time to develop infection between the groups. For patients who developed infection, the foot wounds became infected earliest (18 days), followed by the leg (29 days), and trunk (65 days); this was statistically significant (p=0.02).
There was no statistically significant difference in the incidence of dehiscence between the NPWT and dry dressing group (36.4% vs. 29.7%; p=0.53). Mean time to dehiscence was 33 days for NPWT and 60 days for the dry dressing group, but this was not statistically significant (p=0.45). Similar to post-op infection, the foot wounds dehisced earliest (23 days), followed by the leg (33 days), and trunk wounds had the longest mean time to dehiscence (76 days); this was statistically significant (p<0.0001).
Overall, 35% of the dry dressing group and 41% of the NPWT group developed wound infections, dehiscence or both. Of these, 9 of the NPWT (21%) and 8 of the dry dressing group (22%) required reoperation. (Table 2)
There are significant rates of post-operative infection and dehiscence in patients with multiple co-morbidities undergoing closure of open wounds. It does not appear that there is any significant benefit in patients with severe comorbidities to use an incisional VAC post-operatively with regard to infection or dehiscence. Post operative wound infection and dehiscence occurs earlier with more distally located wounds.
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