Closed Incision Negative Pressure Therapy: Review of the Literature

Closed Incision Negative Pressure Therapy Versus Standard of Care Over Closed Abdominal Incisions in the Reduction of Surgical Site Complications: A Systematic Review and Meta-Analysis of Comparative Studies

Background

Surgical site complications (SSCs) pose a significant risk to patients, potentially leading to severe consequences or even loss of life. While previous research has shown that closed incision negative pressure therapy (ciNPT) can reduce wound complications in various surgical fields, its effectiveness in abdominal incisions remains uncertain. To address this gap, a systematic review and meta-analysis were conducted to assess the impact of ciNPT on postsurgical outcomes and health care utilization in patients undergoing open abdominal surgeries.

Methods

A systematic literature search using PubMed, EMBASE, and QUOSA was performed for publications written in English, comparing ciNPT with standard of care dressings for patients undergoing abdominal surgical procedures between January 2005 and August 2021. Characteristics of study participants, surgical procedures, dressings used, duration of treatment, postsurgical outcomes, and follow-up data were extracted. Meta-analyses were performed using random-effects models. Dichotomous outcomes were summarized using risk ratios and continuous outcomes were assessed using mean differences.

Results

The literature search identified 22 studies for inclusion in the analysis. Significant reductions in relative risk (RR) of SSC (RR: 0.568, P = .003), surgical site infection (SSI) (RR: 0.512, P < .001), superficial SSI (RR: 0.373, P < .001), deep SSI (RR: 0.368, P =.033), and dehiscence (RR: 0.581, P = .042) were associated with ciNPT use. ciNPT use was also associated with a reduced risk of readmission and a 2.6-day reduction in hospital length of stay (P < .001).

Conclusions

These findings indicate that use of ciNPT in patients undergoing open abdominal procedures can help reduce SSCs and associated hospital length of stay as well as readmissions.A previous version of this abstract was presented at the 2023 Conference of the European Wound Management Association (EWMA) in Milan, Italy and posted online at the site listed below. EWMA permits abstracts to be republished with the complete manuscript. https://journals.cambridgemedia.com.au/application/files/9116/8920/7316/JWM_Abstracts_LR.pdf.

Closed Incision Negative Pressure Therapy vs Standard of Care Dressing in Breast Surgery: A Systematic Review

The implementation of closed incision negative pressure therapy (CINPT) is widely seen in many surgical subspecialties including orthopaedics, vascular surgery, and abdominal surgery. However, research on its use in breast surgery is still in its infancy. We conducted a systematic review on the use of CINPT vs standard of care dressings (SOC) in wound management of post-operative breast surgery. A literature search was conducted on PubMed, MedLine, and Google Scholar for studies that compared CINPT against SOC. Seven studies were included in this systematic review. The results of our systematic review have shown that CINPT has a positive outcome in reducing post-operative wound complication rates as compared to SOC dressings (commonly Steri-Strips and waterproof dressings), which was 1-8% vs 1-30% in CINPT and SOC, respectively. Furthermore, CINPT has the potential to confer additional cost-savings of up to USD218 per patient for a health institution with regards to reduced complications rates that might have required extended management. The use of CINPT in breast surgery remains highly promising. It has many advantages over SOC, including better wound outcomes and added cost savings. Further studies are required to delineate the potential benefits in different sub-sets of patients.

Clinical Applications and Benefits of Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management: A Novel Approach for Comorbid Wounds

The principle of negative pressure technique dates back to the earliest civilizations; during the Roman era, the technique of using dome-shaped cupping glasses was used to create the suction needed to promote healing. This technique was used throughout the 19th century. In 1821, a British physician named Dr. Francis Fox invented the "glass leech" technique. Thereafter in 1952, an innovative approach was introduced to the treatment of serious, complex wounds through the use of sub-atmospheric or negative pressure known as "negative pressure wound therapy" (NPWT). Later, the "vacuum-assisted closure", or VAC therapy system founded by Dr. Louis Argenta in 1990 revolutionized the advanced wound care market, and still remains the most clinically proven alternative for the treatment of complex, hard-to-heal wounds. These therapies utilize a foam dressing that is conformed to the wound bed. When sealed and placed under negative (vacuum) pressure, the system creates a unique wound-healing environment that has been shown to promote the wound-healing process, reduce edema, prepare the wound bed for closure, promote the formation of granulation tissue and remove infectious materials. The negative pressure therapy system addresses patient quality of life through an easy-to-use system designed to assist surgeons in the management and treatment of comorbid wounds, and open abdomen and other wound complications to help achieve primary fascial closure. Comorbidities can be defined as a concurrence of multiple chronic diseases in the same patient. Closed-incision negative pressure therapy (CINPT) has revolutionized the way in which caregivers treat the most serious, complex wounds or comorbid wounds. Wound healing can be achieved by the host's innate and adaptive immune defence mechanisms as in an uninfected simple surgical incision through the skin or by combination of the host's defence mechanisms and therapeutic modalities. It has been confirmed in some clinical researches that growth factors exert amazing effects on wound-healing promotion and skin function restoration without any obvious side effects. In this review, we have hypothesized a novel modality, focusing on the treatment of wound complications secondary to comorbidity by a combination of negative pressure therapy followed by a positive pressure infusion with growth factor concentrates.