Efficacy of Negative Pressure Wound Therapy on Management of Surgical Site Infections: A Systematic Review of Randomized Clinical Trials
DOI:
https://doi.org/10.56570/jimgs.v3i2.179Keywords:
Negative pressure wound therapy, Vacuum-assisted wound therapy, Vacuum-Assisted Closure (VAC), Wound care techniques, Advanced wound care, Postoperative CareAbstract
Surgical site infections (SSIs) are common postoperative complications that typically develop within 30 days of surgery. Negative Pressure Wound Therapy (NPWT) has gained prominence because of its potential to reduce dressing changes and enhance wound care outcomes. This systematic review evaluated the efficacy of NPWT in managing SSIs based on evidence from randomised controlled trials (RCTs). A systematic review was conducted, adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were sourced from Google Scholar, PubMed, and PMC using specific search terms related to NPWT and SSIs. Articles were evaluated for quality using the Cochrane appraisal to ensure a comprehensive and bias-free review. Our literature review provided us with 18,199 articles, and upon removing duplicates and irrelevant articles, 409 papers remained, which were then screened based on title, abstract, and full-length texts. Finally, 16 articles were considered; two were unavailable, four failed the critical appraisal, and two needed to meet the criteria for further evaluation. Consequently, eight studies, all of which were randomised controlled trials with a total of 1,196 patients, remained. This study involved adult males and females who underwent negative pressure wound therapy for various arthroplasties and diabetic foot ulcers. NPWT was compared to traditional dressings, and the outcomes measured were infections, epithelialisation time, hospital stay, blisters, seromas, wound complications, and amputations, with significance set at p < 0.05. NPWT showed significant benefits over traditional dressings, including reduced SSIs and fewer dressing changes. This offers a promising approach to enhancing wound management. However, given the limited research available, further research is needed to provide conclusive evidence across all surgical types and patient populations.References
Arad M, Goli R, Ebrahimzade M, Lorzini M, Abdali M, Sepehrnia N. Ending surgical site infection by negative pressure wound therapy (NPWT): A case report. Int J Surg Case Rep. 2022;94:107080. Doi:10.1016/j.ijscr.2022.107080
Lenet T, Gilbert RWD, Abou-Khalil J, Balaa FK, Martel G, Brind'Amour A, et al. The impact of prophylactic negative pressure wound therapy on surgical site infections in pancreatic resection: A systematic review and meta-analysis. HPB (Oxf). 2022;24(12):2035-44. Doi:10.1016/j.hpb.2022.08.010
Scalise A, Calamita R, Tartaglione C, et al. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of incisional negative pressure wound therapy. A systematic review of the literature. Int Wound J. 2016;13(6):1260-81. Doi:10.1111/iwj.12492
Sinha S. Management of post-surgical wounds in general practice. Aust J Gen Pract. 2019;48(8):596-9. doi:10.31128/AJGP-04-19-4921
Dumville JC, Owens GL, Crosbie EJ, Peinemann F, Liu Z. Negative pressure wound therapy for treating surgical wounds healing by secondary intention. Cochrane Database Syst Rev. 2015;4:CD011278. doi:10.1002/14651858.CD011278.pub2
Robert N. Negative pressure wound therapy in orthopaedic surgery. Orthop Traumatol Surg Res. 2017;103(1S):S99-103. doi:10.1016/j.otsr.2016.04.018
Svensson-Björk R, Hasselmann J, Asciutto G, et al. Negative pressure wound therapy for the prevention of surgical site infections using fascia closure after EVAR: A randomized trial. World J Surg. 2022;46(11):3111-20. doi:10.1007/s00268-022-06740-5
Lee K, Murphy PB, Ingves MV, et al. Randomized clinical trial of negative pressure wound therapy for high-risk groin wounds in lower extremity revascularization. J Vasc Surg. 2017;66(6):1814-9. Doi:10.1016/j.jvs.2017.06.084
Monsen C, Acosta S, Mani K, Wann-Hansson C. A randomized study of NPWT closure versus alginate dressings in peri-vascular groin infections: quality of life, pain, and cost. J Wound Care. 2015;24(6):254-6. Doi:10.12968/jowc.2015.24.6.252
Pachowsky M, Gusinde J, Klein A, et al. Negative pressure wound therapy to prevent seromas and treat surgical incisions after total hip arthroplasty. Int Orthop. 2012;36(4):719-22. doi:10.1007/s00264-011-1321-8
Mody GN, Nirmal IA, Duraisamy S, Perakath B. A blinded, prospective, randomized controlled trial of topical negative pressure wound closure in India. Ostomy Wound Manage. 2008;54(6):36-46.
Chau WW, Lo KC, Lau LC, Ong MT, Ho KK. Single-use negative pressure wound therapy (NPWT) system in the management of knee arthroplasty. BMC Musculoskelet Disord. 2023;24:186. doi:10.1186/s12891-023-06470-2
Karlakki SL, Hamad AK, Whittall C, Graham NM, Banerjee RD, Kuiper JH. Incisional negative pressure wound therapy dressings (iNPWTd) in routine primary hip and knee arthroplasties: A randomised controlled trial. Bone Joint Res. 2016;5(8):328-37. doi:10.1302/2046-3758.58.BJR-2016-0022.R1
Blume PA, Walters J, Payne W, Ayala J, Lantis J. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: A multicenter randomized controlled trial. Diabetes Care. 2008;31(4):631-6. doi:10.2337/dc07-2196
Benrashid E, Youngwirth LM, Guest K, Cox MW, Shortell CK, Dillavou ED. Negative pressure wound therapy reduces surgical site infections. J Vasc Surg. 2020;71(3):896-904. doi:10.1016/j.jvs.2019.05.066
