Open vs Closed Negative Pressure Wound Therapy for Contaminated and Dirty Surgical Wounds: A Prospective Randomized Comparison
| Autor: | Stephen W. Abernathy, Justin L. Regner, Harry T. Papaconstantinou, Stanley Kurek, Randall W. Smith, Travis Isbell, Anthony Manning, Richard C. Frazee, Claire L. Isbell |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Abdominal Wound Closure Techniques medicine.medical_treatment Surgical Wound law.invention 03 medical and health sciences symbols.namesake 0302 clinical medicine Randomized controlled trial law Negative-pressure wound therapy Surgical Wound Dehiscence medicine Humans Surgical Wound Infection 030212 general & internal medicine Prospective Studies Prospective cohort study Fisher's exact test Wound Healing integumentary system business.industry Surgical wound Middle Aged medicine.disease Surgery 030220 oncology & carcinogenesis Seroma symbols Female Wound healing business Negative-Pressure Wound Therapy |
| Zdroj: | Journal of the American College of Surgeons. 226(4) |
| ISSN: | 1879-1190 |
| Popis: | Background A new proprietary negative pressure wound device has been developed to apply negative pressure therapy to closed wounds (closed-NPWT). We postulated that closed-NPWT management of contaminated and dirty wounds would lead to faster wound healing and no significant difference in wound complications. Study Design An IRB approved, prospective randomized trial was performed. Patients were consented preoperatively, but not entered nor assigned treatment until intraoperative findings were known. Patients were randomly assigned to either open-NPWT or a wound closed with skin staples and external closed-NPWT. Primary outcome was time to complete wound healing, defined as complete epithelization of the wound. Secondary outcomes were wound complications including wound infection, seroma, and dehiscence. Statistical analysis was performed using chi-square test, Fisher exact test, t -test, and Wilcoxon Rank-Sum test with significance of p Results Twenty-five closed-NPWT and 24 open-NPWT patients were analyzed. There were no significant differences in sex, mean age, BMI, smoking history, steroid use, comorbidities, or indication for surgery in the 2 groups. One patient in the open-NPWT group and 2 patients in the closed-NPWT group developed a wound infection (p = 1.0). Four open-NPWT and 3 closed-NPWT patients died from complications unrelated to the wound. Wound healing occurred at a median of 48 days (range 6 to 126 days) for the open-NPWT group vs a median of 7 days (range 6 to 12 days) for the closed-NPWT group (p Conclusions Wound healing was significantly faster in contaminated and dirty wounds when managed with closed-NPWT. There was no difference in wound complications between the 2 treatment groups. This approach shows promise for closed management of contaminated and dirty wounds and warrants additional prospective studies with larger patient groups. |
| Databáze: | OpenAIRE |
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