Initial Experience Using Disposable Negative Pressure Wound Therapy for Closed Incisions Following Outpatient Wound Reconstruction

Wound reconstruction surgeries are at high risk for failure. Outpatient wound reconstruction (OWR) describes these procedures performed in the outpatient setting under local anesthesia. The use of closed incision negative pressure therapy (ciNPT) has been shown to protect the incision and help minimize the risk of postoperative complications. To date, this has not been readily adopted in the outpatient setting. The authors report their initial experience with 3 cases of OWR with ciNPT used by the application of disposable negative pressure wound therapy (dNPWT) to the closed, postsurgical incision. The results of these 3 cases were favorable. While more data are needed, the authors believe the use of dNPWT with OWR will help optimize surgical outcomes and serve as an alternative to surgery with acute hospitalization.

Previous literature has provided data supporting the use of closed incision negative pressure therapy (ciNPT), which has been shown to protect the incision environment and minimize edema, for the management of closed incisions in patients with a high risk of developing complications.¹ Therefore, wound reconstruction surgical procedures, which are at high risk for failure, may benefit from ciNPT. Historically, wound reconstruction procedures and the application of ciNPT have been performed in an acute hospital setting.

The objective of this study was to describe the authors’ early experiences with 3 cases of wound reconstruction surgeries performed in an outpatient setting under local anesthesia, followed by the application of disposable negative pressure wound therapy (dNPWT) to the closed postsurgical incision.

In this study, 3 patients underwent outpatient wound reconstruction (OWR) surgery at a physician-office-based wound facility in Arizona. Following OWR surgery, each incision was closed using sutures, and dNPWT (SNAP Therapy System; 3M + KCI) was then applied at -125 mm Hg over the closed incisions for 5 to 7 days. Procedures were performed under local anesthesia, and patients were given postoperative oral antibiotics and pain medication when necessary. 

Three patients were assessed and treated in this study. One patient was a 36-year-old male with a medical history of chronic pain who presented with a nonhealing surgical wound of the left ankle (Figure 1). Another patient was a 42-year-old female, who was otherwise healthy, and presented with a nonhealing abdominal wound following a gunshot injury (Figure 2). The third patient was a 62-year-old woman with comorbidities (ie, obesity, diabetes, and hypertension) presented with a nonhealing surgical wound following patellar fracture repair (Figure 3). Procedures included surgical reconstruction of nonhealing wounds followed by flap closure. Importantly, all incisions healed without postoperative complications. Furthermore, there was 100% patient satisfaction due to the avoidance of further hospitalization and general anesthesia, as well as definitive closure.

The use of electrically powered ciNPT (PREVENA Therapy; 3M + KCI) to help manage closed incisions following the surgical correction of wide pathological scars was first reported in 2015.² Following the first report, a retrospective, comparative study showed patients treated with electrically powered ciNPT over the closed postsurgical incisions after revision hip or knee surgeries developed significantly fewer surgical site complications (P = .024) and fewer surgical site infections (P = .045) than patients treated with antimicrobial dressings.³ In these studies,^2,3 electrically powered ciNPT was first applied in an acute care setting and was continued either in the hospital or at home following patient discharge. In contrast, to the authors’ knowledge, this study was the first to report the use of mechanically powered dNPWT to help manage closed incisions following OWR surgeries, which yielded favorable outcomes. 

This study was extremely limited in that it was a retrospective description of only 3 cases. The small sample size along with the lack of a comparative group prevented the results from being generalized to a wider population. In addition, the results of such a small sample size and the retrospective nature of the findings could be accounted for by a selection bias on the part of the clinician. Nonetheless, these cases support further examination of the effectiveness of dNPWT on closed incisions following OWR surgeries. 

While further research is needed, these 3 cases support OWR as a new model of care. It will serve as an alternative to inpatient surgical wound reconstruction, avoiding hospitalization and the need for general anesthesia. The use of dNPWT following OWR surgeries may further support successful postoperative outcomes, which is paramount. Readily available dNPWT units may allow increased utilization of OWR procedures. 

Note: The authors thank Johnny Short, PhD (3M + KCI) for providing medical writing support for this manuscript.

Authors: Michael N. Desvigne, MD, FACS, CWS, FACCWS; Michael L. Berman, DO, CWSP, FACCWS, FAPWH; D. Scott Villanueva, PA-C; Kristina Fawcett, NP-C, CWS; Jessica Aragon, RN, BSN; Ashley L. Wardman, LPN; and Jay Moya, MA

Affiliation: Valley Wound Care Specialists, Glendale, AZ

Correspondence: Michael N. Desvigne, MD, FACS, CWS, FACCWS, Valley Wound Care Specialists, 6320 W Union Hills Drive Building A, Suite 140, Glendale, AZ 85308; mdesvigne@desvignemd.com

Disclosure: Dr. Desvigne is a consultant for 3M + KCI. Manuscript preparation assistance was provided by 3M + KCI. These data were presented at the Symposium on Advanced Wound Care Fall in November 2018.