Prophylactic Negative Pressure Wound Therapy in Major Complex Abdominal Wall Reconstruction

Overview

This retrospective study evaluated the impact of prophylactic negative pressure wound therapy (pNPWT) on wound complications in patients undergoing major complex abdominal wall reconstruction (CAWR). The use of pNPWT was associated with a reduction in the incidence of superficial and deep wound infections compared to standard care. Secondary wound complications and re-intervention rates were also assessed to determine the overall benefit of pNPWT in this high-risk surgical population.

Background

Patients undergoing major complex abdominal wall repair are at high risk for wound complications due to factors such as contamination, use of mesh and flaps, and suboptimal physical and nutritional status. Surgical site infections (SSI) in this population range from 29% to 66%, leading to increased morbidity, mortality, and healthcare costs. Prophylactic negative pressure wound therapy (pNPWT) has emerged as a potential method to reduce wound complications by applying negative pressure to closed incisions, promoting wound healing and protecting against microbial contamination. However, evidence on its effectiveness in CAWR remains conflicting.

Data Highlights

The study compared two 14-month periods before and after the introduction of pNPWT in January 2014 at a tertiary university hospital. Data were collected from adult patients undergoing elective midline open CAWR by a single experienced surgeon. Primary outcomes included incidence of superficial and deep wound infections classified by CDC criteria. Secondary outcomes included other wound complications such as seroma, hematoma, necrosis, wound dehiscence, anastomotic leakage, intra-abdominal abscesses, enterocutaneous fistulas, interventions, emergency visits, readmissions, and 30-day mortality.

Key Findings

• pNPWT was implemented as a standard procedure starting January 2014 for patients undergoing major CAWR.
• Primary outcome showed a reduction in superficial and deep wound infections in the pNPWT group compared to the control group.
• Wound infections were further categorized into incisional wound infections and subcutaneous abscesses, with pNPWT showing benefit in reducing these complications.
• Secondary wound complications such as seroma, hematoma, skin or fat necrosis, and wound dehiscence requiring prolonged NPWT were monitored, with trends favoring pNPWT.
• Postoperative interventions including radiologic drainage and reoperations were recorded, with pNPWT potentially reducing the need for such interventions.
• No formal consent was required due to the retrospective nature of the study, and data were collected from a single surgeon’s consecutive cases to minimize selection bias.

Clinical Implications

The findings suggest that prophylactic negative pressure wound therapy may reduce the incidence of wound infections and other complications in patients undergoing complex abdominal wall reconstruction. Incorporating pNPWT into standard postoperative care protocols could improve patient outcomes by decreasing morbidity associated with surgical site infections. Clinicians should consider patient risk factors and operative characteristics when deciding on the use of pNPWT.

Conclusion

Prophylactic negative pressure wound therapy appears to be an effective strategy to reduce wound infections and complications in major complex abdominal wall reconstruction. Further prospective studies could solidify its role in improving surgical outcomes in this high-risk population.

References

1. Slater 2014 -- Criteria of major complex abdominal wall surgery
2. CDC SSI criteria -- Surgical Site Infection Classification