Closed Incision Negative Pressure Therapy for Prevention of Groin Wound Complications after Vascular Surgery
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 5, Issue 3
Abstract
The occurance of wound healing complications (WHCs) in the groin after vascular surgery is a serious medical and financial problem. Surgical site infections (SSIs) in the groin are reported with an incidence between 3% and 44%. In up to 6% deep groin infections involve the implanted prosthetic material. Since years case reports and clinical studies report on the effectiveness of the Closed Wound Therapy Incision Negative Pressure (ciNPT) on wound incisions in the groin. The aim of this paper is to review the clinical data of the ciNPT in the treatment of wound incisions in the groin after vascular surgery. Introduction The anatomy of the groin is an important factor in wound healing complications (WHC) after vascular surgery. Due to the presence of lymph vessels and nodes, the proximity to the urogenital organs, as well as its function as a leading access in vascular procedures, postoperatively the groin shows tendency towards wound dehiscence, lymphatic leaks, seroma, hematoma, skin necrosis, tissue infection, and delayed healing [1-7]. Diabetes mellitus, renal insufficiency, overweight, age, malnutrition, operation time and wound length were detected as further risk factors [8]. The incidence of post-surgical site infections (SSIs) in the groin is reported to be between 3% and 44%. Deep groin infections involving the implanted prosthetic material are present in up to 6% [4-11]. SSIs are related to morbidity and correlate with complications such as limb ischemia, extremity loss, massive hemorrhage, systemic sepsis, and septic embolization [1,4,5]. Long hospital stays with high treatment costs are the consequence of SSIs and the accumulation of severe complications [1]. To deal with SSIs many surgical techniques were applied but only systemic antibiotic therapy showed effective treatment results [3-6,12]. Since the development of the Negative Pressure Wound Therapy (NPWT) in the 1990s by Morykwas and Argenta (USA) as well as Fleischmann (Germany), the wound healing process has been enhanced by this method [13,14]. Many case reports and clinical studies reported on the effective use of the NPWT in the treatment of infected wounds as a supplement to surgical debridement and antibiotic therapy; complex open wounds intended for secondary closure; degloving injuries; postoperative sternal wounds; open traumatic injuries; and high-energy trauma wounds [7,14-22]. In the subsequent period successful NPWT was applied on primarily closed wounds with the aim of preventing the wide spectrum of WHC. This new procedure, under the term closed incision negative pressure therapy (ciNPT), has led in abdominal, sternal, traumatic, orthopedic, and plastic surgery incisions to reduction of SSIs since 2010 [23-28]. The success of ciNPT is attributed to its mode of action consisting of protecting the incision from external wound contamination, strengthening the cohesiveness of the wound edges, removing fluids and infectious materials from the wound, decreasing the lateral tension around the incision, and facilitating oxygen saturation and blood microcirculation within the incision area [12,29,30]. At present the Prevena™ Incision Management Therapy System (KCI, an ACELITY Company, San Antonio, Texas, USA) and PICO™ Single Use Negative Pressure Wound Therapy System (Smith&Nephew, London, UK) provide the leading ciNPT systems. Prevena™ consists of a vacuum unit with a battery and a preset negative pressure of -125 mmHg. Additional components are a replaceable exudate collection canister (volume 45 ml), a polyester fabric interface layer with 0.019% silver for the control of bioburden within the dressing, a polyurethane foam bolster, and a polyurethane film with acrylic adhesive. A polyurethane shell encapsulates the foam bolster and interface layer providing a closed system [8] (Figure 1).
Authors and Affiliations
Pleger SP, Fuhrmann L, Elzien M, Böning A, Koshty A
Keywords
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- EP ID EP591729
- DOI 10.26717/BJSTR.2018.05.001203
- Views 161
- Downloads 0
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