PräVAC Study: Epidermal Vacuum Dressing Reduces Wound Complications Post-Inguinal Lymphadenectomy

Overview

The PräVAC prospective randomized trial evaluated epidermal vacuum-assisted closure (VAC) versus conventional wound care (CONV) after inguinal lymphadenectomy in penile cancer patients. Epidermal VAC significantly reduced wound complications such as lymphorrhea, lymphocele formation, and lymphedema, confirming prior retrospective findings.

Background

Penile cancer is a rare but aggressive malignancy with a high risk of inguinal lymph node metastasis, necessitating surgical lymph node staging or dissection. Inguinal lymphadenectomy, while life-saving, is associated with high morbidity including prolonged lymph secretion, lymphocele, and wound dehiscence in 25–70% of patients. These complications contribute to underutilization of guideline-recommended surgery. Epidermal vacuum wound dressings apply negative pressure to closed wounds, potentially stabilizing the wound and reducing lymphatic leakage. Prior retrospective data suggested epidermal VAC reduces wound complications compared to conventional care.

Data Highlights

Key Findings

• Epidermal vacuum dressing significantly reduced lymphocele formation from 62% to 20% compared to conventional care.
• Persistent lymphorrhea incidence decreased from 45% with conventional care to 7% with VAC treatment.
• Lymphedema of the lower extremity was completely prevented in the VAC group (0%) versus 46% in conventional care.
• Reintervention rates were lower with VAC (7%) compared to conventional care (23%), though not statistically significant.
• The study design randomized treatment sides within the same patient to control for patient-specific confounders.
• VAC dressings were applied for 7–8 days postoperatively, while conventional pressure dressings were removed after 24 hours.

Clinical Implications

Epidermal vacuum-assisted closure after inguinal lymphadenectomy in penile cancer patients can substantially reduce wound-related complications, potentially improving patient outcomes and adherence to guideline-recommended surgery. Incorporating VAC dressings may decrease lymphatic leakage and the need for reinterventions, enhancing postoperative recovery and patient satisfaction.

Conclusion

The PräVAC trial confirms that epidermal vacuum wound dressing is an effective intervention to reduce wound complications following inguinal lymphadenectomy in penile cancer patients, supporting its integration into standard postoperative care.

References

1. Hakenberg et al. 2024 -- Outcomes of the PräVAC Study: Reducing Wound Complications After Inguinal Lymph Node Dissection in Penile Cancer Patients Through Epidermal Vacuum-Assisted Closure