Indigenous Negative-Pressure Wound Therapy vs Conventional Dressing for Abdominal Wound Dehiscence in a...

Background and objective The open abdomen and postoperative abdominal wound dehiscence are challenging surgical problems, and negative-pressure wound therapy (NPWT) is the preferred method of temporary abdominal closure. The high cost of commercial NPWT systems frequently limits their accessibility, especially in low- and middle-income countries, prompting the use of indigenous, low-cost alternatives whose comparative performance remains poorly documented. The objective of this study was to compare the effectiveness of an indigenous NPWT (vacuum-assisted closure) system with conventional saline-gauze dressing in the management of postoperative abdominal wound dehiscence. Materials and methods In this prospective, single-center, comparative study conducted at Rajendra Institute of Medical Sciences, Ranchi, India, from January to September 2024, 66 adults (≥18 years) with postoperative abdominal wound dehiscence following midline laparotomy or an open abdomen were managed with either indigenous NPWT (n = 31) or conventional saline-gauze dressing (n = 35). The indigenous system used a locally assembled, autoclaved open-cell foam with a 16-Fr tube and an adhesive polyurethane drape connected to wall suction at 120 mmHg. Outcomes were time to healthy granulation, number of dressing changes, percentage wound-area reduction at one week, rate of granulation-tissue formation, pain (Visual Analog Scale at 24 hours, 48 hours, and seven days), need for additional debridement, and complications. Between-group comparisons were done using the independent t-test or the Mann-Whitney U test for continuous variables, whereas categorical variables were analyzed with the chi-square test or Fisher's exact test. A p-value <0.05 was defined as statistically significant. Results The groups were comparable at baseline in age, sex, and wound area (all p > 0.05). Compared with conventional dressing, indigenous NPWT was associated with a shorter time to healthy granulation (9.84 ± 1.19 vs 16.46 ± 4.20 days; p < 0.001), less frequent dressing changes (2.10 ± 0.30 vs 17.80 ± 4.69; p < 0.001), greater wound-area reduction at one week (54.2% ± 10.3% vs 42.7% ± 14.9%; p < 0.001), and a faster rate of granulation-tissue formation (2.50 ± 0.58 vs 1.00 ± 0.18 cm²/day; p < 0.001). Pain scores were consistently lower in the NPWT group at 24 hours (3.81 ± 0.75 vs 6.03 ± 0.79; p < 0.001) and throughout follow-up. Fewer patients required additional debridement (7/31, 22.6% vs 22/35, 62.9%; p = 0.001). Complications were infrequent (5/66, 7.6%) and did not differ significantly between groups (2/31, 6.5% vs 3/35, 8.6%; p = 1.00). Conclusions Indigenous NPWT was associated with faster granulation and improvement in early wound-healing parameters, fewer dressing changes, greater early wound-area reduction, and less pain than conventional saline-gauze dressing in postoperative abdominal wound dehiscence. As a low-cost, locally assembled alternative, it offers a practical option for resource-limited settings. The nonrandomized, single-center design warrants confirmation in randomized controlled trials.