Negative pressure therapy is effective in abdominal incision closure

Area of Science:

• Surgical Innovation
• Wound Management
• Infection Control

Background:

• Surgical site infections (SSIs) pose a significant risk, particularly in contaminated (Class III) and dirty-infected (Class IV) wounds, with rates of 15-30% and >30% respectively.
• Current techniques for reducing SSIs in midline laparotomy incisions lack demonstrated superiority.
• Incisional negative pressure wound therapy (INPWT) shows promise in decreasing wound complications, yet its application in high-risk laparotomy incisions remains unexplored.

Purpose of the Study:

• To evaluate the efficacy of INPWT in managing high-risk midline laparotomy incisions.
• To analyze the impact of INPWT on surgical site complications in contaminated and dirty-infected wounds.

Main Methods:

• Retrospective review of adult patients undergoing laparotomy with midline closure using INPWT between January 2013 and June 2014.
• Inclusion criteria: Class III or IV wounds; loosely closed laparotomy incisions.
• INPWT applied at 125 mm Hg over gauze for 5 days, followed by open-air wound management. Data collected on immediate/delayed surgical site complications, with a primary endpoint of 30-day incisional SSI.

Main Results:

• A total of 13 high-risk wounds (1 Class III, 12 Class IV) were treated with INPWT for a median of 5 days.
• The Class III wound experienced minor skin dehiscence without superficial or deep SSI.
• Among Class IV wounds, superficial incisional SSI occurred in 25% and deep incisional SSI in 0%. The overall surgical site complication rate was 41.7%.

Conclusions:

• INPWT is a safe and effective method for closing high-risk midline laparotomy incisions.
• The SSI rates observed with INPWT are comparable to those of previously documented wound closure techniques.
• This therapy represents a viable option for managing complex abdominal incisions and reducing associated complications.