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Negative Pressure Dressing Versus Conventional Passive Dressing in Pilonidal Surgery: A Randomized Controlled Trial
Nicholas Ensor1, Sarah Martin2, Annette Chang1
1Department of Paediatric Surgery, Urology & Surgical Simulation, Monash Children's Hospital, Melbourne, Australia.
The Journal of Surgical Research
|October 11, 2024
Summary
Negative pressure wound therapy (NPWT) did not reduce surgical wound dehiscence (SWD) rates in pilonidal sinus disease (PSD) excisions. This study suggests NPWT is not a routine preventative measure for PSD surgical wounds.
Area of Science:
- Surgical innovation and wound healing research.
- Clinical trial methodology in surgical outcomes.
Background:
- Pilonidal sinus disease (PSD) surgery has high complication rates, including surgical wound dehiscence (SWD), reaching up to 44%.
- Negative pressure wound therapy (NPWT) is a potential intervention to mitigate SWD in high-risk surgical wounds.
Purpose of the Study:
- To evaluate the efficacy of NPWT compared to conventional passive (CP) dressings in reducing SWD rates after PSD excision with off-midline primary closure.
- To assess the impact of NPWT on patient quality of life and return to normal activities post-PSD surgery.
Main Methods:
- A prospective, crossover randomized controlled trial involving 50 patients (12-40 years) with PSD.
- Participants were randomized to receive either NPWT (SNAP) or CP (Primapore or Opsite) dressings.
- Follow-up included regular wound assessments and a 2-month postoperative online survey for quality of life outcomes.
Main Results:
- The overall dehiscence rate was 42% (21/50), with 48% in the NPWT group and 36% in the CP group (P=0.6).
- No significant differences were observed in deep SWD rates, duration to wound healing, or time to return to school/work, sitting normally, or physical activity between the groups.
- SWD was associated with increased excision dimensions in the NPWT group only (P=0.03).
Conclusions:
- NPWT did not demonstrate improved outcomes in terms of surgical wound dehiscence or quality of life for PSD excisions with off-midline primary closure.
- The findings do not support the routine use of NPWT as a preventative measure for these specific surgical procedures.
- Further research may be warranted, but current evidence suggests limited benefit in this patient population.
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