Outcomes of Vacuum-Assisted and Conventional Wound Management in Pediatric Abdominal Surgery: A Retrospective Study
Vaibhav Pandey1, Shashi Prakash Mishra2, Marripati Bhanumurthy Kaushik1
1Department of Pediatric Surgery, IMS-BHU, Varanasi, Uttar Pradesh 221005, India.
Insights
Vacuum-assisted closure (VAC) and wound manager systems effectively treat complex pediatric abdominal wounds, reducing reoperations. These advanced wound care methods improve healing and outcomes in resource-limited settings.
Area of Science:
- Pediatric Surgery
- Wound Management
- Medical Technology
Background:
- Complicated pediatric abdominal wounds, especially enterocutaneous fistulae, pose challenges in resource-limited settings.
- Vacuum-assisted closure (VAC) therapy, proven in adults, has limited pediatric application.
Purpose of the Study:
- To compare vacuum-assisted closure (VAC) and conventional wound management for pediatric abdominal wounds.
- To evaluate outcomes in a resource-constrained environment.
Main Methods:
- Retrospective observational study of 43 pediatric patients (0-18 years) with complicated abdominal wounds.
- Comparison between traditional wound closure (n=19) and VAC/wound manager systems (n=24).
Main Results:
- VAC therapy showed earlier granulation (6 vs. 10 days) and better epithelialization (80% vs. 40%).
- Zero re-explorations in the VAC/wound manager group versus three in the traditional group (p=0.0011).
- 20% spontaneous closure of enterocutaneous fistulas with VAC therapy.
Conclusions:
- VAC and wound manager systems are effective for complex pediatric abdominal wounds.
- These systems reduce reoperation rates and improve wound healing.
- Adoption in low-resource settings can enhance pediatric surgical care.
Background:
Complicated abdominal wounds following pediatric laparotomy, particularly in cases of enterocutaneous fistulae, trauma, or re-exploration, present significant management challenges, especially in resource-limited settings. Despite evidence supporting vacuum-assisted closure (VAC) therapy in adults, its use in pediatric populations remains limited.
Aim:
This study aimed to evaluate and compare the outcomes of vacuum-assisted and conventional wound management techniques in pediatric abdominal surgery within a resource-constrained environment.
Methods:
A retrospective observational study was conducted at a tertiary pediatric surgical centre in Northern India from January 2016 to December 2024. A total of 43 children (0-18 years) with complicated postoperative abdominal wounds were included. Patients were divided into two groups: Group 1 (n = 19) underwent traditional wound closure, while Group 2 (n = 24) received wound management using VAC therapy or simple wound manager systems. Primary outcomes were time to wound healing and incidence of wound-related complications. Secondary outcomes included hospital stay, re-exploration, and spontaneous fistula closure.
Results:
The wound manager group showed a slightly longer median healing time (15 vs. 12 days) but had zero re-explorations compared to three cases in the traditional group (p = 0.0011). VAC therapy led to earlier granulation (median 6 vs. 10 days), greater complete epithelialization (80 % vs. 40 %, p = 0.04), and spontaneous closure in 20 % of enterocutaneous fistulas. Four patients continued VAC therapy at home without complications.
Conclusion:
VAC and simple wound manager systems are effective in managing complex pediatric abdominal wounds, reducing the need for reoperation and enhancing healing outcomes. Their adoption in low-resource settings could significantly improve pediatric surgical care.
