Healing Surgical Wounds with Negative Pressure Wound Therapy Through Primary Closure

In this study, the authors (Gill Norman, Chunhu Shi, En Lin Goh, Elizabeth Ma Murphy, Adam Reid , Laura Chiverton, Monica Stankiewicz, Jo C Dumville) assess the effects of negative pressure wound therapy (NPWT) for preventing surgical site infections (SSI) in wounds healing through primary closure, and to assess the cost-effectiveness of NPWT in wounds healing through primary closure. This study (Negative Pressure Wound Therapy for Surgical Wounds Healing by Primary Closure) was published on April 26, 2022, with the Cochrane Database of Systematic Reviews.

The authors of this review looked at existing evidence for the effectiveness of NPWT on postoperative wound healing by primary closure. They assessed the effects of NPWT for preventing SSI in wound healing through primary closure.

The method of research started in January 2021, where the authors searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL, and other clinical trials registries and references of included studies. The authors included trials that allocated participants to treatments randomly and compared NPWT with any other type of wound dressing or different brands of NPWT.

In total, 62 randomized controlled trials (RCTs) consisted of 13,340 participants, and 6 economic study, which evaluated NPWT in a wide range of surgeries, including orthopedic, obstetric, vascular, and other general procedures. The results find that there is low-certainty evidence showing there may be a reduced risk of death after surgery for people treated with NPWT (0.84%) compared with standard dressings (1.17%), but the authors postulate there is uncertainty around this as confidence intervals including risk of benefits and harm (risk ratio [RR] = 0.78; 95% CI, 0.63–0.85; I2 = 0%).1 There is moderate-certainty evidence that NPWT probably results in fewer SSIs (8.7% of participants) than treatment with standard dressings (11.75%) after surgery (RR = 0.73; 95% CI 0.63 to 0.85; I2 = 29%). There is moderate-certainty evidence that there is probably little or no difference in dehiscence between people treated with NPWT (6.62%) and those treated with standard dressing (6.97%), although there is imprecision around the estimate that includes risks of benefit and harm (RR = 0.97; 95% CI, 0.82–1.16; I2 = 4%). There may be a reduced risk of seroma for people treated with NPWT, but this is imprecise (RR = 0.82; 95% CI, 0.65–1.05; I2 = 0%; 15 trials; 5436 participants). For skin blisters, there is low-certainty evidence that individuals treated with NPWT may be more likely to develop skin blisters compared with those treated with standard dressing (RR = 3.55; 95% CI, 1.43–8.77; I2 = 74%; 11 trials; 5015 participants).

Cost-effectiveness: In the 6 economic studies the authors reviewed, they assessed the cost-effectiveness of NPWT compared with standard care. They considered NPWT in 5 different surgical indications: caesarean sections in women who are obese; surgery for lower limb fracture; knee/hip arthroplasty; coronary artery bypass grafts; and vascular surgery with inguinal incisions.

The authors stated in their conclusion that people with primary closure of their surgical wound and who were treated prophylactically with NPWT following a surgery “probably experience fewer SSIs than people treated with standard dressings but there is probably no difference in wound dehiscence (moderate-certainty evidence).” They think there may be a reduced risk of death after surgery for people treated with NPWT compared with standard dressings but there is uncertainty around this because confidence intervals include risk of benefit and harm (low-certainty evidence). 

To read the full study and full results list, click here.

—Cat Urbanski, Associate Digital Editor

Reference

1. Norman G, Shi C, Goh EL, et al. Negative pressure wound therapy for surgical wounds healing by primary closure. Cochrane Database Syst Rev. 2022;4(4):CD009261. doi:10.1002/14651858.CD009261.pub7