Use of Negative Pressure Therapy on Closed Surgical Incisions: A Case Series
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Abstract: Multiple patient comorbidities and environmental factors increase the risk of incisional wound complications. The literature suggests that negative pressure therapy (NPT) on clean closed surgical incisions may help reduce the risk of wound infections and other complications. In this case study, NPT was applied in the operating room to clean closed surgical wounds in four high-risk patients (two men, two women) following coronary artery bypass grafting using bilateral internal mammary arteries, transmetatarsal amputation, and abdominal hysterectomy. All wounds healed well. These results and currently available information suggest that prospective, randomized, controlled clinical studies to assess the safety, efficacy and cost-effectiveness of NPT in the prevention of postoperative wound complications are warranted. In addition, if studies confirm the validity and reliability of the proposed patient grading system discussed, it may help guide use of NPT in postsurgical patients.
From the 1Department of Orthopaedic Trauma, University of Alabama School of Medicine, Birmingham, AL; 2VA Medical Center, Durham, NC; 3The James Cancer Center and Solove Research Institute, The Ohio State University College of Medicine, Columbus, OH; 4Southeastern Orthopedics Sports Medicine and Shoulder Center, Raleigh, NC; 5Charcot and Reconstructive Foot Program, St. Luke’s Hospital, Allentown and Bethlehem, PA; 6Private practice, Fremont Rideout Health Group, Yuba City, CA; 7Georgetown University Hospital, Washington, DC; 8Department of Surgery, Otolaryngology and Orthopaedic Surgery; Georgetown University Hospital and Georgetown Limb Center, Washington, DC
Address correspondence to:
Christopher E. Attinger, MD
The Georgetown Limb Center Georgetown University Hospital
3800 Reservoir Rd
Washington, DC 20007
Email: cattinger@aol.com.
Disclaimer: While this article was peer reviewed, it was not reviewed by the WOUNDS Editorial Advisory Board. This article was originally published in Ostomy Wound Management (OWM) and was peer-reviewed by OWM’s Editorial Advisory Board.
Potential Conflict of Interest: This article was prepared with the financial support of KCI, San Antonio, TX
Certain surgical incisions and patient conditions may adversely affect optimal wound healing, which could lead to postoperative complications. For example, the rate of complications such as wound necrosis and infection for high-energy trauma wounds can range from 33% to 50%.1 For postcardiothoracic surgery, sternal wound infection remains the most dreaded complication, resulting in 1-year mortality rates of 33% from mediastinitis after coronary artery bypass and subsequent reduced long-term survival. 2,3 Patients with multiple comorbidities such as obesity, diabetes, and poor vascular status have been found to be at higher risk of complications (eg, infection, seroma, hematoma, dehiscence) associated with primary or delayed primary intention postoperative wound healing.4–6 Other primarily closed incisional wounds with a high risk of complications include wounds from hip and knee arthroplasty7; traumatic wounds with pilon, tibial plateau, and calcaneus fractures;1,8 and wounds from lower-extremity bypass,1 abdominal,9,10 and cardiothoracic procedures.11
Surgical incisional wounds have traditionally been closed by primary intention using sutures, staples, adhesives, or a combination thereof.
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