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Dunson B, Kogan S, Grosser JA, Davidson A, Llull R. Influence of Closed-incision Negative Pressure Wound Therapy on Abdominal Site Complications in Autologous Breast Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5326. [PMID: 37817928 PMCID: PMC10561809 DOI: 10.1097/gox.0000000000005326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 08/24/2023] [Indexed: 10/12/2023]
Abstract
Background Closed-incision negative pressure wound therapy (ciNPWT) has shown promise in reducing surgical wound complications. Among its numerous benefits, it allows for exudate management and tension offloading from wound edges. The purpose of this systematic review and meta-analysis was to assess the efficacy of prophylactic ciNPWT versus conventional dressings on abdominal donor site complications in microsurgical breast reconstruction (MR). Methods A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines in January 2023. PubMed and Embase were searched to identify all relevant studies. Data collected included rates of total wound complications, wound dehiscence, infection, seroma, and length of hospital stay. Results A total of 202 articles were screened, and eight studies (1009 patients) met the inclusion criteria. Use of ciNPWT was associated with a significantly lower rate of wound dehiscence (OR, 0.53; 95% confidence interval, 0.33-0.85; P = 0.0085, I2 = 0%). There was no significant difference in the rate of total wound complications [odds ratio (OR), 0.63; 95% CI, 0.35-1.14; P = 0.12, I2 = 69%], donor site infection (OR, 0.91; 95% CI, 0.42-1.50; P = 0.47, I2 = 13%), seroma (OR, 0.74; 95% CI, 0.22-2.49; P = 0.63, I2 = 57%), or length of hospital stay (SMD, 0.089; 95% CI, -0.13-0.35; P = 0.37, I2 = 29%). Conclusions Although exudate management by ciNPWT fails to reduce surgical site infection, seroma formation, and overall length of stay, ciNPWT tension offloading properties seem to be associated with lower rates of wound dehiscence when compared with conventional dressings in abdominal-based autologous breast reconstruction.
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Affiliation(s)
- Blake Dunson
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, N.C
| | - Samuel Kogan
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, N.C
| | - Joshua A. Grosser
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, N.C
| | - Amelia Davidson
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, N.C
| | - Ramon Llull
- From the Department of Plastic and Reconstructive Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, N.C
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Huang W, Wei ZQ, Qiu YH, Tang G, Sun H. Effects of wound infection on prognosis after laparoscopic abdominoperineal resection of rectal cancer. Front Oncol 2023; 12:1036241. [PMID: 36686786 PMCID: PMC9846744 DOI: 10.3389/fonc.2022.1036241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Background In two facilities in Chongqing, this research sought to retrospectively evaluate the effects of perineal wound infection on survival after laparoscopic abdominoperineal resection (LAPR) of rectal cancer. Methods To obtain clinical information on patients who underwent LAPR between January 2013 and December 2021, we performed a multicenter cohort study. A total of 473 patients were enrolled: 314 in the non-infection group and 159 in the group with perineal infection. The general data, perioperative conditions, and tumor outcomes between groups were analyzed. The infection rates, recurrence rates, and survival rates of the two centers were compared. Results The age, height, weight, body mass index (BMI), preoperative complications, preoperative treatment, and intraoperative conditions of patients in the LAPR infection group were not statistically different from those in the non-infection group. The percentage of men, typical postoperative hospital stay, length of initial postoperative therapy, and recurrence and metastasis rates were all considerably higher in the infection group than those in the non-infection group. Wound infection was an independent factor affecting tumor recurrence and metastasis after LAPR as well as an independent factor shortening patient survival time according to multivariate analysis. The incidence of wound infection, the rate of recurrence, and the rate of mortality did not vary significantly across sites. Conclusion Wound infection after LAPR increases the mean postoperative hospital stay, prolongs the time to first postoperative treatment, and decreases the disease-free survival (DFS) and overall survival (OS). Therefore, decreasing the rate of LAPR wound infection is expected to shorten the postoperative hospital stay and prolong the patient DFS and OS. Patients with postoperative infection may require intensive adjuvant therapy.
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Affiliation(s)
- Wang Huang
- Department of Gastrointestinal Surgery, Chongqing University Cancer Hospital, Chongqing, China
| | - Zheng-qiang Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yu-hao Qiu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Gang Tang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hao Sun
- Department of Gastrointestinal Surgery, Chongqing University Cancer Hospital, Chongqing, China,*Correspondence: Hao Sun,
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3
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Mori GA, Tiernan JP. Management of Perineal Wounds Following Pelvic Surgery. Clin Colon Rectal Surg 2022; 35:212-220. [PMID: 35966381 PMCID: PMC9374536 DOI: 10.1055/s-0042-1742414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Despite advancements in understanding and technique, there remain significant challenges in the management of a complex perineal wound following pelvic surgery. Complications including wound sepsis, fistulation, persistent sinus, and herniation produce additional morbidity and health care costs. This article details the methods of optimizing patient and operative factors to mitigate this risk, alongside strategies to deal with sequelae of wound failure.
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Affiliation(s)
- George A Mori
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, United Kingdom
| | - Jim P Tiernan
- John Goligher Colorectal Unit, St James's University Hospital, Leeds, United Kingdom
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Martí MTC, Fernandez-Gonzalez S, Martí MD, Pla MJ, Barahona M, Ponce J. Prophylactic incisional negative pressure wound therapy for gynaecologic malignancies. Int Wound J 2021; 19:272-277. [PMID: 34268886 PMCID: PMC8762569 DOI: 10.1111/iwj.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/16/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022] Open
Abstract
Wound complications are an important cause of postoperative morbidity among patients with gynaecologic malignancies. We evaluated whether the placement of closed-incisional negative pressure therapy (ciNPT) at the time of laparotomy for gynaecologic cancer surgery reduced wound complication rates. A retrospective cohort study with primary wound closure performed by a gynaecologic oncologist was carried out. We evaluated two cohorts of patients who underwent surgery in 2017 with standard closure and patients who underwent surgery in 2019 with the placement of prophylactic ciNPT. Postoperative outcomes were examined. A total of 143 patients were included, 85 (59.4%) vs 58 (40.6%) with standard closure and ciNPT, respectively. The total complication rate in our sample was 38.71%. The rate of surgical complications in patients treated with ciNPT was 6.9% compared with 31.8% (P = .000) in patients treated with standard closure. In the analysis of complications, a significant reduction in infections (17.1%), seromas (15.4%), and wound dehiscence (17.1%) were observed when ciNPT was applied. The median hospital stay was 8 vs 6 days in the standard closure vs ciNPT groups (P = .048). The use of the prophylactic ciNPT following a laparotomy may decrease wound complications and hospital stays in oncological patients. ciNPT could be considered as part of clinical practice in patients at high risk of wound complications, such as patients with gynaecological malignancies.
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Affiliation(s)
| | | | | | - Maria Jesus Pla
- Department of Gynecology, Multidisciplinary Breast Cancer Unit, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Marc Barahona
- Department of Gynecology, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Jordi Ponce
- Department of Gynecology, Hospital Universitari Bellvitge, Barcelona, Spain
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5
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Han Z, Yang C, Wang Q, Wang M, Li X, Zhang C. Continuous Negative Pressure Drainage with Intermittent Irrigation Leaded to a Risk Reduction of Perineal Surgical Site Infection Following Laparoscopic Extralevator Abdominoperineal Excision for Low Rectal Cancer. Ther Clin Risk Manag 2021; 17:357-364. [PMID: 33911871 PMCID: PMC8075358 DOI: 10.2147/tcrm.s306896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/08/2021] [Indexed: 12/28/2022] Open
Abstract
Purpose High rate of perineal surgical site infection (SSI) is the most common complication following abdominoperineal resection (APR), especially for extralevator abdominoperineal excision (ELAPE). The purpose of this study was to investigate the effect of continuous negative pressure drainage combined with intermittent irrigation (CNPDCII) in the presacral space on the perineal SSI following laparoscopic ELAPE for low rectal cancer. Patients and Methods The clinical data of 99 patients with low rectal cancer who underwent laparoscopic ELAPE surgery were retrospectively analyzed. Among the 99 patients, 46 patients received CNPDCII and 53 patients received conventional drainage in the presacral space after ELAPE. Self-made irrigation drainage tube: took a silicone drainage tube, cut 3 side holes at every 2cm intervals at the front end, and fixed a flexible tube of an intravenous needle at the front end of the silicone drainage tube. The conventional drainage tube or self-made irrigation drainage tube was placed in the presacral space and poked out from the inside of the ischial tuberosity. The incidence of SSI and other perioperative indicators between the two groups was compared within 30 days after surgery. Results There was no statistical difference in clinicopathological features between the two groups of patients (p>0.05). A statistically lower rate of SSI was found in CNPDCII group (17.4%, 8/46) than the conventional drainage group (35.8%, 19/53). The drainage tube retention time (7.8±1.2 d VS 9.4±1.6 d) and the postoperative hospital stay (9.7±1.4 d VS 11.9±2.3 d) in CNPDCII group were significantly shortened than the conventional drainage group. There was no statistical difference in operating theatre time and intraoperative blood loss between the two groups. Multivariate analysis confirmed that CNPDCII was an independent protective factor for SSI after ELAPE. Conclusion CNPDCII can effectively reduce the incidence of SSI following laparoscopic ELAPE, which is simple, safe and effective.
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Affiliation(s)
- Zhongbo Han
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Chunxia Yang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Qingfeng Wang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Meng Wang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Xi Li
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
| | - Chao Zhang
- Department of Gastrointestinal Surgery, Zibo Central Hospital, Shandong University, Zibo, Shandong, People's Republic of China
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6
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Inoue M, Uchida K, Matsushita K, Koike Y, Toiyama Y. Incisional negative pressure wound therapy for perineal wound in Crohn's disease. Pediatr Int 2021; 63:475-477. [PMID: 33675280 DOI: 10.1111/ped.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/08/2020] [Accepted: 08/07/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Mikihiro Inoue
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Keiichi Uchida
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Kohei Matsushita
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuhki Koike
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Tsu, Mie, Japan
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7
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Zaheer Ahmad N, Abbas MH, Al-Naimi NMAB, Parvaiz A. Meta-analysis of biological mesh reconstruction versus primary perineal closure after abdominoperineal excision of rectal cancer. Int J Colorectal Dis 2021; 36:477-492. [PMID: 33392663 DOI: 10.1007/s00384-020-03827-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Extralevator abdominoperineal excision (ELAPE) of rectal cancer has been proposed to achieve better oncological outcomes. The resultant wide perineal wound, however, presents a challenge for primary closure and subsequent wound healing. This meta-analysis compared the outcomes of primary perineal closure with those of biological mesh reconstruction. METHODS The Medline and Embase search was performed for the publications comparing primary perineal closure to biological mesh reconstruction. Early perineal wound complications (seroma, infection, dehiscence) and late perineal wound complications (perineal hernia, chronic pain, and chronic sinus) were analyzed as primary endpoints. Intraoperative blood loss, operation time, and hospital stay were compared as secondary endpoints. RESULTS There was no significant difference in the overall early wound complications after primary closure or biological mesh reconstruction (odds ratio (OR) of 0.575 with 95% confidence interval (CI) of 0.241 to 1.373 and a P value of 0.213). The incidence of perineal hernia after 1 year was significantly high after primary closure of the perineal wounds (OR of 0.400 with 95% CI of 0.240 to 0.665 and a P value of 0.001). No significant differences were observed among other early and late perineal wound complications. The operation time and hospital stay were shorter after primary perineal closure (p 0.001). CONCLUSION A lower incidence of perineal hernia and comparable early perineal wound complications after biological mesh reconstruction show a relative superiority over primary closure. More randomized studies are required before a routine biological mesh reconstruction can be recommended for closure of perineal wounds after ELAPE.
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Affiliation(s)
- Nasir Zaheer Ahmad
- Department of Surgery, University Hospital Limerick, St Nessan's Rd, Dooradoyle, Co., Limerick, V94 F858, Republic of Ireland.
| | - Muhammad Hasan Abbas
- Department of Surgery, Russells Hall Hospital NHS Trust, Pensnett Rd, West Midlands, Dudley, DY1 2HQ, UK
| | | | - Amjad Parvaiz
- Faculty of Health Sciences, University of Portsmouth, Portsmouth, UK.,Colorectal Department, Poole NHS Trust Poole UK, Poole, UK
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8
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Murphy C, Stephens I, OꞌFlanagan G, OꞌByrne L, Reynolds IS, Ajmal N, O'Sullivan JB, OꞌNeill B, Deasy J, Burke JP, McNamara DA. A comparison of oncological outcomes after abdominoperineal excision before and after the implementation of a selective perineal flap closure program. J Surg Oncol 2020; 123:614-621. [PMID: 33238062 DOI: 10.1002/jso.26309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 10/12/2020] [Accepted: 11/08/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Abdominoperineal excision (APE) is the operation chosen when a patient has low rectal cancer unamenable to sphincter preserving surgery. Perineal flap reconstruction is associated with less wound morbidity but little is known about oncological outcomes. The objective was to compare outcomes in patients undergoing APE before and after the introduction of a program that utilized flap reconstruction of the perineum. METHODS A retrospective review of a prospectively maintained database was performed. Patients who underwent APE followed by primary closure or flap reconstruction between 1998 and 2018 were selected. The cohorts were divided according to the implementation of the flap reconstruction program in July 2009. Clinicopathological data, recurrence and survival were compared between the cohorts. RESULTS One hundred and forty nine patients underwent APE for rectal adenocarcinoma between 1998 and 2018. There were 57 patients in the pre-flap era and 92 in the post-flap era. Forty-six patients underwent flap reconstruction in the latter cohort (50%). More patients in the post-flap era underwent neoadjuvant chemoradiotherapy (85.9% vs. 63.2%; p < .01). Margin positivity rates decreased from 21.1% in the pre-flap era to 10.9% in the post-flap era (p = .10) and there was an associated improvement in incidence and time to local recurrence (p = .03). CONCLUSION The use of perineal flap reconstruction is associated with a longer median time to local recurrence. Perineal flap reconstruction may contribute to reduced margin positivity.
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Affiliation(s)
- Claudine Murphy
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Ian Stephens
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Grace OꞌFlanagan
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - Lisa OꞌByrne
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Ian S Reynolds
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Department of Physiology and Medical Physics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Nadeem Ajmal
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - John Barry O'Sullivan
- Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland
| | - Brian OꞌNeill
- Department of Radiation Oncology, Beaumont Hospital, Dublin, Ireland
| | - Joseph Deasy
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - John P Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Deborah A McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Department of Surgery, Royal College of Surgeons in Ireland, Dublin, Ireland
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Kaneko T, Funahashi K, Ushigome M, Kagami S, Goto M, Koda T, Kurihara A. Incisional negative pressure wound therapy to reduce perineal wound infection after abdominoperineal resection. Int Wound J 2020; 18:103-111. [PMID: 33236842 PMCID: PMC7948915 DOI: 10.1111/iwj.13499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 01/03/2023] Open
Abstract
We explored the effects of incisional negative pressure wound therapy in perineal wound infections after abdominoperineal resection. We retrospectively evaluated 146 patients who underwent abdominal perineal resection from December 2004 to December 2019 and compared conventional gauze dressing (controls) with incisional negative pressure wound therapy. We compared patients' characteristics, surgical factors, and perineal infection rates between groups, and patients' characteristics, surgical factors, and negative pressure therapy use between perineal infection vs non-infection groups, as well as the risk factors for perineal infections. In the negative pressure therapy group, compared with controls, the number of men, smoking prevalence, blood transfusion, drainage via the perineal wound, and intraoperative blood loss were significantly lower (p < 0.05, p < 0.05, p < 0.05, p < 0.001, p < 0.01, respectively), and operation time was significantly longer (p < 0.05). Infections were significantly less common in the negative pressure group (p < 0.05). In the univariate analysis, the infection-positive group had significantly higher laparoscopic surgery (p < 0.01) and negative pressure wound therapy-free rates (p < 0.01), and significantly more intraoperative blood loss (p < 0.05). Multivariate analysis using these three factors and preoperative radiotherapy showed that incisional negative pressure wound therapy-free status was a risk factor for infection. Incisional negative pressure wound therapy was beneficial in managing perineal wound infections after abdominoperineal resection.
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Affiliation(s)
- Tomoaki Kaneko
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Kimihiko Funahashi
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Mitstunori Ushigome
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Satoru Kagami
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Mayu Goto
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Takamaru Koda
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Akiharu Kurihara
- Department of Gastroenterological Surgery, Toho University Omori Medical Center, Tokyo, Japan
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10
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The safety and efficacy of using negative pressure incisional wound VACs in pediatric and neonatal patients. J Pediatr Surg 2020; 55:1470-1474. [PMID: 31839369 DOI: 10.1016/j.jpedsurg.2019.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 09/06/2019] [Accepted: 10/08/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Surgical site infection (SSI) rates are an important surgical quality metric. Decreased SSI rates have been demonstrated using negative pressure incisional wound vac device (NPIWV) dressings in adults but have not been studied in children. MATERIALS AND METHODS A retrospective review of patients treated with NPIWV at our institution between February 2016 and February 2018 was performed. NPIWV dressings were applied by previously described techniques. Using the same CPT codes from our study patients, we queried the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) data between January 2014 and January 2016 to identify preimplementation controls (PIC). NPIWV patients were compared to historical controls to assess safety and efficacy of SSI prevention. RESULTS There were 32 patients managed with NPIWV, and 65 patients in the PIC group. There were no NPIWV-associated complications. There was a trend toward reduced incidence of SSI in NPIWV patients, with 1 SSI in 32 cases (3.1%) versus 7 SSIs in the 65 historical control patients (10.8%) (p = 0.22). CONCLUSIONS Our study shows that NPIWV dressings can be used safely in pediatric and neonatal patients undergoing surgery, with a trend toward decreased SSI rates. These findings should be confirmed in a larger, prospective trial. TYPE OF STUDY Retrospective comparative study. LEVEL OF EVIDENCE Level III.
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11
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Gologorsky R, Arora S, Dua A. Negative-Pressure Wound Therapy to Reduce Wound Complications after Abdominoperineal Resection. Perm J 2020; 24:19.173. [PMID: 32069209 DOI: 10.7812/tpp/19.173] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Abdominoperineal resection is associated with a high rate of wound complications. A high degree of wound tension, a common contributor to wound breakdown and complications, may be mitigated by incisional negative-pressure wound therapy (NPWT). Although NPWT has been shown to reduce complications associated with open and complex wounds, there is a paucity of data regarding its prophylactic use for incisional wounds. OBJECTIVE To determine the effect of NPWT use on surgical wound complications of abdominoperineal resection for malignancy. METHODS We performed a systematic review by querying the PubMed database for studies from 1990 to 2019 and included English-language studies that used incisional NPWT for closed wounds from abdominoperineal resection in malignancy cases. RESULTS Five studies with a total of 76 patients were included. Their findings showed reduced rates of surgical site complications with the use of incisional NPWT. Another 2 studies describing the use of prophylactic NPWT to expedite secondary closure of the surgical wound followed by incisional wound therapy were separately categorized and included 8 patients, none of whom experienced wound wound complications. DISCUSSION Additional, prospective research is needed to confirm the benefit of prophylactic incisional NPWT.
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Affiliation(s)
- Rebecca Gologorsky
- Department of Surgery, University of California San Francisco-East Bay, Oakland
| | | | - Anahita Dua
- Department of Surgery, Massachusetts General Hospital, Boston
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12
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Closed Incisional Negative Pressure Wound Therapy Sponge Width and Tension Off-Loading. Ann Plast Surg 2020; 85:295-298. [DOI: 10.1097/sap.0000000000002217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
BACKGROUND Reconstruction of the pelvic floor defect caused by extralevator abdominoperineal excision poses a challenge for the surgeon. OBJECTIVE The aim of this study was to analyze the long-term perineal wound complications in patients undergoing conventional primary closure versus biological mesh-assisted repair after extralevator abdominoperineal excision. DESIGN This was a single-institution retrospective observational study. SETTINGS The study was conducted at a tertiary academic medical center. PATIENTS Patients with low advanced rectal cancer undergoing extralevator abdominoperineal excision from August 2008 to December 2016 (N = 228) were included. INTERVENTIONS All of the patients received extralevator abdominoperineal excision operation. MAIN OUTCOME MEASURES The primary outcome measure was perineal wound complications after the operation. RESULTS Of the 228 patients who underwent extralevator abdominoperineal excision, 174 received biological mesh repair and 54 received primary closure. Preoperative radiotherapy was administered to 89 patients (51.1%) in the biological mesh group and 20 patients (37.0%) in the primary closure group. The biological mesh group had significantly lower rates of perineal wound infection (11.5% vs 22.2%; p = 0.047), perineal hernia (3.4% vs 13.0%; p = 0.022), wound dehiscence (0.6% vs 5.6%; p = 0.042), and total perineal wound complications (14.9% vs 35.2%; p = 0.001) compared with the primary closure group. Multivariable logistic regression analysis showed preoperative radiotherapy (p < 0.001), conventional primary closure (p < 0.001), and intraoperative bowel perforation (p= 0.001) to be significantly associated with perineal procedure-related complications. LIMITATIONS This was a single-center retrospective study. CONCLUSIONS Although perineal wound repair with biological mesh prolongs the operative time of perineal portion, the perineal drainage retention time, and the length of hospital stay, it may reduce perineal procedure-related complications and improve wound healing. Preoperative radiotherapy and intraoperative bowel perforation appear to be independent predictors of perineal complications. See Video Abstract at http://links.lww.com/DCR/B42. COMPLICACIONES DE LA HERIDA PERINEAL DESPUÉS DE LA EXCISIÓN ABDOMINOPERINEAL EXTRA-ELEVADORA EN CASO DE CÁNCER DE RECTO BAJO: La reconstrucción del defecto en el suelo pélvico, resultado de una resección abdominoperineal extra-elevadora plantea un desafío para el cirujano.El analisis de las complicaciones de la herida perineal a largo plazo en pacientes sometidos a un cierre primario convencional versus una reparación asistida por malla biológica después de una resección abdominoperineal extra-elevadora.Estudio retrospectivo observacional en una sola institución.Investigación realizada en un centro médico académico terciario.Se incluyeron los pacientes con cáncer rectal bajo avanzado que se sometieron a una resección abdominoperineal extra-elevadora desde agosto de 2008 hasta diciembre de 2016 (n= 228).Todos aquellos pacientes que fueron sometidos a una resección abdominoperineal extra-elevadora.Todas las complicaciones de la herida perineal en el postoperatorio.De los 228 pacientes que se sometieron a una resección abdominoperineal extra-elevadora, 174 fueron reparados con una malla biológica y 54 se beneficiaron de un cierre primario. La radioterapia preoperatoria se administró a 89 (51,1%) pacientes en el grupo de malla biológica y 20 (37,0%) pacientes en el grupo de cierre primario. El grupo de malla biológica tuvo tasas significativamente más bajas de infección de la herida perineal (11.5% vs. 22.2%; p = 0.047), hernia perineal (3.4% vs. 13.0%; p = 0.022), dehiscencia de la herida (0.6% vs. 5.6%; p = 0,042) y complicaciones perineales de la herida (14,9% frente a 35,2%; p = 0,001) en comparación con el grupo de cierre primario. El análisis de regresión logística multivariable mostró que la radioterapia preoperatoria (p <0.001), el cierre primario convencional (p <0.001) y la perforación intestinal intra-operatoria (p = 0.001) se asociaron significativamente como complicaciones relacionadas con el procedimiento perineal.Estudio retrospectivo de centro único.Aunque la reparación de la herida perineal con malla biológica prolonga el tiempo perineal de la operación, la presencia y duración del drenaje perineal y la hospitalización pueden reducir las complicaciones relacionadas con el procedimiento perineal y mejorar la cicatrización de la herida. La radioterapia preoperatoria y la perforación intestinal intra-operatorias parecen ser predictores independientes de complicaciones perineales. Vea el Resumen del Video en http://links.lww.com/DCR/B42.
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14
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Ito E, Yoshida M, Ohdaira H, Kitajima M, Suzuki Y. Case series of in situ pelvic floor reconstruction combining levator ani suture and negative pressure wound therapy for abdominoperineal resection. Ann Med Surg (Lond) 2019; 43:64-67. [PMID: 31198553 PMCID: PMC6556482 DOI: 10.1016/j.amsu.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/18/2019] [Accepted: 05/27/2019] [Indexed: 11/27/2022] Open
Abstract
Background Abdominoperineal resection (APR) is a standard surgical technique for low rectum cancer with a low recurrence rate. There are some problems associated with APR such as perineal hernia and perineal surgical site infection. Recently, the prophylactic efficacy of negative pressure wound therapy (NPWT) for surgical site infection has been reported. Herein, we analyzed the efficacy of in situ pelvic floor reconstruction combining levator ani suture and NPWT after APR for perineal hernia and perineal surgical site infection. Methods We analyzed six patients treated by laparoscopic APR with NPWT combined with levator ani suture retrospectively. The primary endpoints were surgical site infection within 30 days and perineal hernia within 1 year after surgery. The day following surgery, we performed NPWT for the perineal wound using the VAC® abdominal wound management system (KCI, San Antonio, TX, USA). Results There were four male and two female patients ranging in age from 69 to 86 years (mean: 76 years). The mean NPTW duration was 17 days (13–20 days). The length of the postoperative hospital stay was 14–22 days (median: 18 days). There was no patient with surgical site infection within 30 days or with perineal hernia within 1 year after surgery. Conclusion We experienced the in situ pelvic floor reconstruction combining levator ani suture and NPWT after laparoscopic APR for perineal hernia and perineal surgical site infection. This combination treatment was safe and may be effective for preventing surgical site infection and perineal hernia. Although APR has some unresolved problems such as perineal hernia and perineal surgical site infection. NPWT decreased perineal wound infection after APR but not reduced deep wound infection rates. Our procedure was able to reconstruct without foreign materials and provided sufficient separation from internal organs to perform safe NPWT. The in situ pelvic floor reconstruction combining levator ani suture and NPWT after laparoscopic APR was safe and may be effective for preventing surgical site infection and perineal hernia.
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Affiliation(s)
- Eisaku Ito
- Department of Surgery, International University of Health and Welfare Hospital, Japan
| | - Masashi Yoshida
- Department of Surgery, International University of Health and Welfare Hospital, Japan
| | - Hironori Ohdaira
- Department of Surgery, International University of Health and Welfare Hospital, Japan
| | - Masaki Kitajima
- Department of Surgery, International University of Health and Welfare Hospital, Japan
| | - Yutaka Suzuki
- Department of Surgery, International University of Health and Welfare Hospital, Japan
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15
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Cahill C, Fowler A, Williams LJ. The application of incisional negative pressure wound therapy for perineal wounds: A systematic review. Int Wound J 2018; 15:740-748. [PMID: 29863305 DOI: 10.1111/iwj.12921] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/12/2018] [Accepted: 02/19/2018] [Indexed: 12/31/2022] Open
Abstract
Impaired perineal wound healing is a major source of morbidity after abdominoperineal resection. Incisional negative pressure wound therapy can improve healing, prevent infections, and decrease the frequency of dehiscence. Our objective was to summarise existing evidence on the use of incisional negative pressure wound therapy on perineal wounds after abdominoperineal resection and to determine the effect on perineal wound complications. Electronic databases were searched in January 2017. Studies describing the use of incisional negative pressure wound therapy on primarily closed perineal wounds after abdominoperineal resection were included. Of the 278 identified articles, 5 were retrieved for inclusion in the systematic review (n = 169 patients). A significant decrease in perineal wound complications when using incisional negative pressure wound therapy was demonstrated, with surgical site infection rates as low as 9% (vs 41% in control groups). The major limitation of this systematic review was a small number of retrieved studies with small patient populations, high heterogeneity, and methodological issues. This review suggests that incisional negative pressure wound therapy decreases perineal wound complications after abdominoperineal resection. Further prospective trials with larger patient populations would be needed to confirm this association and delineate which patients might benefit most from the intervention.
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Affiliation(s)
- Caitlin Cahill
- Section of Colorectal and Minimally Invasive Surgery, Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Amanda Fowler
- Section of Colorectal and Minimally Invasive Surgery, Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lara J Williams
- Section of Colorectal and Minimally Invasive Surgery, Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada
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