Outcomes of Reconstructive Surgery Using Vacuum-Assisted Closure in Patients With Complex Wounds

This study aimed to assess the results of reconstructive surgery with vacuum-assisted closure (VAC) therapy in patients with complex wounds. The sample included 60 patients with a mean age of 53.03 years. The sample was ethnically diverse, with significant representation from various regions, including Khyber Pakhtunkhwa (KPK), Punjab, Sindh, Balochistan, Gilgit-Baltistan, and Kohistan. The most common comorbidities were obesity (26.7%), diabetes (25.0%), and cardiovascular disease (13.3%). Patients had varied wound types, including diabetic ulcers (26.7%) and pressure ulcers (23.3%) in the lower extremities, constituting 25.0%. VAC therapy was given to 53.3% of the patients with different parameters varying from continuous to intermittent mode with pressure between 50-149 mmHg. Pre- and post-operative laboratory results showed raised inflammatory markers and poor nutritional status, which are strongly related to delayed wound healing. The most common complications were infection (21.7%) and hemorrhage (15.0%). The type of surgical site was significantly associated with the complications. Surgical outcomes ranged from fully healed wounds to 23.3% to partially healed wounds and 28.3% of reopened wounds. While VAC therapy proves beneficial, comorbidities, as well as wound characteristics, play important roles in determining a greater degree of success. More research must be conducted to optimize VAC therapy protocols for more complex wounds.

Prophylactic Negative Pressure Wound Therapy in Reducing Surgical Site Infections: An Evidence-Based Literature Review

Background

Surgical site infections (SSIs) are a frequent postoperative complication that nurses commonly need to provide asepsis-specific meticulous care for. The application of a closed-incisional negative pressure wound therapy (iNPWT) device is regarded as a novel technique that aims to lower the risk of external wound contamination.

Aim

The purpose of this review was to evaluate the effectiveness of iNPWT on high-risk closed laparotomy incisions with the aim to inform nursing practitioners and physicians engaged in multieffort wound care practices. Nursing professionals play a crucial role in mitigating the incidence of SSIs, from the time of application, through ongoing assessment tissue condition, and ensuring asepsis, thereby enhancing patient care and safety.

The Research Question

Is prophylactic negative pressure wound therapy effective in reducing the incidence of (closed) surgical site wound infections postlaparotomy?

PICO Elements

The population studied included patients undergoing laparotomy surgery. The intervention under review included the application of iNPWT, compared to the use of standard gauze dressing. The expected outcome was SSI reduction.

Methods and Results

A systematized literature search was conducted using various databases to identify published studies that address the PICO question. The PRISMA checklist and Critical Appraisal Skills Programme tools allowed to exclude irrelevant articles and to critically appraise the evidence, respectively. Eleven key articles were retrieved including four RCTs and seven systematic reviews and meta-analysis. The results indicated an overall positive association between iNPWT and a reduction in SSI in laparotomy surgeries when compared to standard dressings.

Linking Evidence to Action

Data across most studies reviewed support the benefits with the use of iNPWT as a preventive strategy to lower the rates of SSI, with some claiming no difference. Although heterogeneity in the studies precludes a definite conclusion, nurses may make a more informed decision when navigating the demands of SSI prevention targeted nursing care.

A Novel Approach to Negative Pressure Wound Therapy: Use of High Suction Capillary Device to Improve Wound Healing

INTRODUCTION

Negative Pressure Wound Therapy (NPWT) is a procedure used for nonhealing wounds. In NPWT, a special sealed dressing of large cell foam (>400 µm) or gauze is connected to a pump. Most commonly, negative pressures between -10 and -125 millimeters of mercury (mm Hg) are used. The mechanism of healing is unknown but maybe attributable to removal of the exudate and bacteria, and the stimulation of tissue repair through microdeformation. Reticulated foams with micron-size open cells, Capillary Suction Devices (CSD; 100 to 5 µm) exert capillary suction between 10 and 70 mm of Hg with a multilayered foam dressing.

MATERIALS AND METHODS

Yorkshire pigs received 5 surgical excision wounds, 3 cm2, on each side of the back. The wounds were covered with a NPWT dressing (110 mm Hg negative pressure by a pump), CSD with capillary suctions of 30 mm Hg (CSD-30) and 70 mm Hg (CSD-70), and a conventional gauze dressing. The wounds were measured on day 2, and then every 4-5 days thereafter; the total fluid collected by the various dressing over time.

RESULTS

By post-wound day 20, the wounds treated with CSD-70 and NPWT were 100% closed while the wounds treated with CSD-30 and gauze were 65% and 45%, respectively. This indicated comparable wound closure efficacies for CSD-70 and NPWT. The average total fluid uptake measured in grams dry weight were similar for CSD-70 and NPWT, 36 and 38 g, respectively, while the values were 24 g for CSD-30 and 12 g for gauze. However, the maximum fluid uptake observed at day 2 indicated that CSD-70 and CSD 30, 24 and 14 g, respectively, were superior to NPWT and gauze 12 and 7 g, respectively.

CONCLUSION

This data indicate comparable wound closure efficacies for CSD-70 and NPWT. It is felt that CSD is an effective, safe, and lower cost alternative to vacuum-assisted NPWT.