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During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
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Closed incision negative pressure wound therapy may decrease wound complications in major lower extremity

Heepeel Chang1, Thomas S Maldonado1, Caron B Rockman1

  • 1Division of Vascular and Endovascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY.

Journal of Vascular Surgery
|July 25, 2020
PubMed
Summary
This summary is machine-generated.

Closed incision negative pressure wound therapy (NPWT) reduced wound complications in major lower extremity amputations (LEAs) for vascular patients. This therapy is a viable option for preventing complications in high-risk LEA patients.

Keywords:
Above-knee amputationAmputationBelow-knee amputationNegative pressure wound therapyPeripheral artery disease

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Area of Science:

  • Vascular Surgery
  • Wound Care
  • Infection Prevention

Background:

  • Major lower extremity amputations (LEAs) in vascular patients frequently lead to wound complications and significant morbidity.
  • Closed incision negative pressure dressing has shown promise in preventing surgical site infections (SSIs), but its efficacy in LEAs is less documented.

Purpose of the Study:

  • To evaluate if closed incision negative pressure wound therapy (NPWT) reduces complication rates compared to standard dressings in patients undergoing major LEAs.
  • To assess the impact of NPWT on wound complications in patients with peripheral vascular disease undergoing major lower extremity amputations.

Main Methods:

  • A retrospective review of 54 consecutive lower extremity amputations (23 NPWT, 31 standard dressing) from a prospectively maintained database (January 2018-December 2019).
  • NPWT (PREVENA system) applied intraoperatively and removed 5-7 days postoperatively; standard group received nonadherent and compression dressings.
  • Statistical analysis included Student's t-test and two-sample proportion z-test, with P < .05 considered significant.

Main Results:

  • The NPWT group had a higher incidence of comorbidities like tobacco use (44% vs 13%) and risk factors such as dirty wounds (52% vs 26%).
  • Wound complications were significantly lower in the NPWT group (13%) compared to the standard dressing group (39%; P = .037).
  • No significant differences were observed in perioperative mortality or amputation revision rates between the groups.

Conclusions:

  • Closed incision NPWT may effectively decrease wound complications in vascular patients undergoing major LEAs.
  • This therapy demonstrates potential benefits even in higher-risk patient populations.
  • Consideration of NPWT for major lower extremity amputations is warranted to improve outcomes.