International Delphi Study on Wound Closure and Incision Management in Joint Arthroplasty Part 2: Total Hip Arthroplasty.

BACKGROUND: This modified Delphi study aimed to develop a consensus on optimal wound closure and incision management strategies for total hip arthroplasty (THA). Given the critical nature of wound care and incision management in influencing patient outcomes, this study sought to synthesize evidence-based best practices for wound care in THA procedures. METHODS: An international panel of 20 orthopedic surgeons from Europe, Canada, and the United States evaluated a targeted literature review of 18 statements (14 specific to THA and 4 related to both THA and total knee arthroplasty). There were 3 rounds of anonymous voting per topic using a modified 5-point Likert scale with a predetermined consensus threshold of ≥ 75% agreement necessary for a statement to be accepted. RESULTS: After 3 rounds of voting, consensus was achieved for all 18 statements. Notable recommendations for THA wound management included (1) the use of barbed sutures over non-barbed sutures (shorter closing times and overall cost savings); (2) the use of subcuticular sutures over skin staples (lower risk of superficial infections and higher patient preferences, but longer closing times); (3) the use of mesh-adhesives over silver-impregnated dressings (lower rate of wound complications); (4) for at-risk patients, the use of negative pressure wound therapy over other dressings (lower wound complications and reoperations, as well as fewer dressing changes); and (5) the use of triclosan-coated sutures (lower risk of surgical site infection) over standard sutures. CONCLUSIONS: Through a structured modified Delphi approach, a panel of 20 orthopedic surgeons reached consensus on all 18 statements pertaining to wound closure and incision management in THA. This study provides a foundational framework for establishing evidence-based best practices, aiming to reduce variability in patient outcomes and to enhance the overall quality of care in THA procedures.

Closed incision negative pressure therapy: international multidisciplinary consensus recommendations.

Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words 'prevention', 'negative pressure wound therapy (NPWT)', 'active incisional management', 'incisional vacuum therapy', 'incisional NPWT', 'incisional wound VAC', 'closed incisional NPWT', 'wound infection', and 'SSIs' identified peer-reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m2 ); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high-risk procedure or a procedure that would have highly morbid consequences if an SSI occurred.

Prevention of Sternal Wound Infections by use of a Surgical Incision Management System: First Reported Australian Case Series.

BACKGROUND: Sternal wound infections are considered a costly and potentially devastating consequence of the median sternotomy in cardiothoracic surgery. Surgical incision management employs the technique of applying a closed, negative pressure vacuum dressing to a closed wound. Several studies have demonstrated a reduction in sternal wound infections using this system. METHODS: A retrospective audit of cases receiving surgical incision management demonstrated a statistically significant reduction in sternal wound infections against a predicted rate. RESULTS: Of the 62 patients identified, only one was complicated by a sternal wound infection with the greatest reduction seen in the high-risk infection group. CONCLUSIONS: Although smaller in size, the results compared well to trials conducted in larger European and US centres. Although not advocating surgical incision management for routine use, it should be considered on patients considered high-risk for sternal wound infection, such as diabetics, the elderly and the obese.

The impact of surgical site occurrences and the role of closed incision negative pressure therapy.

Surgical site occurrences are observed in up to 60% of inpatient surgical procedures in industrialised countries. The most relevant postoperative complication is surgical site infection (SSI) because of its impact on patient outcomes and enormous treatment costs. Literature reviews ('SSI', 'deep sternal wound infections' (DSWI), 'closed incision negative pressure wound therapy' (ciNPT) were performed by electronically searching MEDLINE (PubMed) and subsequently using a 'snowball' method of continued searches of the references in the identified publications. Search criteria included publications in all languages, various study types and publication in a peer-reviewed journal. The SSI literature search identified 1325, the DSWI search 590 and the ciNPT search 103 publications that fulfilled the search criteria. Patient-related SSI risk factors (diabetes mellitus, obesity, smoking, hypertension, female gender) and operation-related SSI risk factors (re-exploration, emergency operations, prolonged ventilation, prolonged operation duration) exist. We found that patient- and operation-related SSI risk factors were often different for each speciality and/or operative procedure. Based on the evidence, we found that high-risk incisions (sternotomy and incisions in extremities after high-energy open trauma) are principally recommended for ciNPT use. In 'lower'-risk incisions, the addition of patient-related or operation-related risk factors justifies the application of ciNPT.

Prologue: transformational healing solutions.

In recent years, the provision of wound care for patients has dramatically improved through the development of new therapeutic options, allowing for a wide range of wound care therapy choices. In June 2014, an educational International Surgical Wound Forum (ISWF) was held to present current options in wound care to a multidisciplinary group of healthcare providers. Topics included negative pressure wound therapy with instillation and dwell time (NPWTi-d), surgical incision management (SIM), use of NPWT in the management of the open abdomen, epidermal skin harvesting, and advanced wound dressings. This supplement provides in-depth discussion of some of the topics covered at the 2014 ISWF.

Incisional negative pressure wound therapy for high-risk wounds.

With an ageing population and a growing number of people with obesity and/or undergoing advanced cancer therapies, there is an increasing risk of surgical site complications including surgical site infections (SSIs). Postoperative shifting of large mobilised tissue flaps, such as in abdominoplasties, remains a dreaded complication, particularly following massive weight loss. Besides negative implications for the patient, surgical site complications result in an economic burden due to prolonged and repeated wound treatments. Preventative tools to reduce SSIs are needed. In selected patients at high risk of SSI and/or wound breakdown, use of incisional NPWT has been shown to actively manage clean, closed surgical incisions. This article contains a review of scientific and clinical research relevant to incisional NPWT use over surgical incisions, with particular emphasis on the common problem of wound breakdown and SSI following body-contouring surgery in post-bariatric patients. Although there are a growing number of studies describing use of incisional NPWT in a variety of applications, including vascular, cardiac and orthopaedic, a literature search revealed few studies regarding incisional NPWT use post body-contouring surgery. In a clinical study of seroma formation, less seroma and haematoma formation was reported in post-bariatric patients who received incisional NPWT, versus the control, following body-contouring surgery. In another study of widely applied external NPWT wound dressings over the ventral and lateral trunk following post-bariatric abdominal dermolipectomy, results showed a significant reduction in exudate formation, earlier drain removal, and decreased length of hospitalisation, compared with conventional treatment. Additional controlled studies are needed to validate the clinical impact of incisional NPWT following body-contouring surgery, and to determine proper recommendations for its use.

The use of a surgical incision management system on vascular surgery incisions: a pilot study.

Health care-associated infections in hospitals, including surgical site infections, contribute significantly to morbidity as well as mortality. Surgical incision management (SIM) using negative pressure wound therapy (Prevena™ Incision Management System, Kinetic Concepts, Inc., San Antonio, TX, USA) is designed to cover and protect closed surgical incisions from external factors including infectious sources and local trauma, while negative pressure removes fluid and infectious material from the surgical incision. A prospective case-control study assessed wound complications in patients undergoing vascular bypass procedures, where both femoral areas were incised to gain access to the femoral arteries. SIM was placed on one femoral area while a standard postoperative wound dressing was placed on the contralateral femoral area. Eight patients were included in this pilot study. All of them required bilateral femoral artery access. During the follow-up period patients were monitored for wound complications. All wound complications requiring surgical intervention were considered significant. No significant wound complications occurred in wounds treated with SIM, compared with three significant complications in control wounds. These preliminary data would suggest a potential reduction in wound complications and no observed increase in haemorrhage in high-risk patients with severe co-morbidities undergoing vascular surgery.

Effect of surgical incision management on wound infections in a poststernotomy patient population.

Skin breakdown and infiltration of skin flora are key causative elements in poststernotomy wound infections. We hypothesised that surgical incision management (SIM) using negative pressure wound therapy over closed surgical incisions for 6-7 days would reduce wound infections in a comprehensive poststernotomy patient population. 'All comers' undergoing median sternotomy at our institution were analysed prospectively from 1 September to 15 October 2013 (study group, n = 237) and retrospectively from January 2008 to December 2009 (historical control group, n = 3508). The study group had SIM (Prevena™ Therapy) placed immediately after skin suturing and applied at -125 mmHg for 6-7 days, whereas control group received conventional sterile wound tape dressings. Primary endpoint was wound infection within 30 days. Study group had a significantly lower infection rate than control group: 1·3% (3 patients) versus 3·4% (119 patients), respectively (P < 0·05; odds ratio 2·74). In the study group, when the foam dressing was removed after 6-7 days, the incision was primarily closed in 234 of 237 patients (98·7%). SIM over clean, closed incisions for the first 6-7 postoperative days significantly reduced the incidence of wound infection after median sternotomy. Based on these data SIM may be cost-effective in patients undergoing cardiac surgery.

Meta-Analysis Comparing Outcomes of Two Different Closed Incision Negative Pressure Systems in Breast Surgery and Implications to Cost of Care.

Background: Surgical site complication (SSC) rates in breast surgery have been reported between 2.25% and 53%. Use of incision management may help reduce the risk of SSCs. The potential of 2 closed incision negative pressure therapy (ciNPT) systems to mitigate surgical site complications (SSC) and surgical site infections (SSI) in breast surgery were assessed. Methods: A systematic literature review for breast surgery studies was conducted comparing ciNPT use against standard of care (SOC). SSC, SSI, and dehiscence rates were examined. SSCs were defined as all surgical site complications including SSI, dehiscence, seroma, hematoma, and necrosis. Risk ratios and random effects models were used to assess the effect of ciNPT with multilayer absorbent dressing (ciNPT-MLA) and ciNPT with foam dressing (ciNPT-F) compared with SOC. Results: Eight articles were included in the meta-analysis. No significant differences in SSC rates (P = .307) or SSI rates (P = .453) between ciNPT-MLA and SOC were observed. ciNPT-MLA use was associated with a reduction in dehiscence compared with SOC (RR = 0.499, 95% CI = 0.303, 0.822; P = .006). A significant reduction in SSC rates (RR = 0.498, 95% CI = 0.271, 0.917; P = .025) was observed with ciNPT-F use. Similarly, dehiscence rate reduction was associated with ciNPT-F use (RR = 0.349, 95% CI= 0.168, 0.725; P = .005). A trend towards reduction of SSI rates with ciNPT-F use compared with SOC was also noted (P = .053). Conclusions: Compared with SOC, ciNPT-MLA significantly reduced rates of dehiscence, while ciNPT-F use resulted in significantly reduced SSC and dehiscence rates with a trend toward reducing SSI.

Prospective evaluation of a closed-incision negative pressure wound therapy system in kidney transplantation and its association with wound complications.

Introduction: Wound complications can cause considerable morbidity in kidney transplantation. Closed-incision negative pressure wound therapy (ciNPWT) systems have been efficacious in reducing wound complications across surgical specialties. The aims of this study were to evaluate the use of ciNPWT, Prevena™, in kidney transplant recipients and to determine any association with wound complications. Material and methods: A single-center, prospective observational cohort study was performed in 2018. A total of 30 consecutive kidney transplant recipients deemed at high risk for wound complications received ciNPWT, and the results were compared to those of a historical cohort of subjects who received conventional dressings. Analysis for recipients with obesity and propensity score matching were performed. Results: In total, 127 subjects were included in the analysis. Of these, 30 received a ciNPWT dressing and were compared with 97 subjects from a non-study historical control group who had conventional dressing. The overall wound complication rate was 21.3% (27/127). There was no reduction in the rate of wound complications with ciNPWT when compared with conventional dressing [23.3% (7/30) and 20.6% (20/97), respectively, p = 0.75]. In the obese subset (BMI ≥30 kg/m2), there was no significant reduction in wound complications [31.1% (5/16) and 36.8% (7/19), respectively, p = 0.73]. Propensity score matching yielded 26 matched pairs with equivalent rates of wound complications (23.1%, 6/26). Conclusion: This is the first reported cohort study evaluating the use of ciNPWT in kidney transplantation. While ciNPWT is safe and well tolerated, it is not associated with a statistically significant reduction in wound complications when compared to conventional dressing. The findings from this study will be used to inform future studies associated with ciNPWT in kidney transplantation.

Different Surgeon, Different Closure: Lack of Consensus on Appropriate Closure Technique for Various Case Scenarios.

Background: Many techniques for closure of surgical incisions are available to the surgeon, but there is minimal guidance regarding which technique(s) should be utilized at the conclusion of surgery and under what circumstances. Hypothesis: Management of incisions at the conclusion of surgery lacks consensus and varies among individual surgeons. Methods: The Surgical Infection Society membership was surveyed on the management of incisions at the conclusion of surgery. Several case scenarios were provided to test the influences of operation type, intra-operative contamination, and hemodynamic stability on incision management (e.g., close fascia or skin, use of incision/wound vacuum-assisted closure [VAC] device). Responses by two-thirds of participants were required to achieve consensus. Data analysis by χ2 test and logistic regression, a = 0.05. Response heterogeneity was quantified by the Shannon index (SI). Results: Among 78 respondents, consensus was achieved for elective splenectomy (91% close skin/dry dressing). Open appendectomy and left colectomy/end-colostomy had the greatest heterogeneity (SI, 1.68 and 1.63, respectively). During trauma laparotomy, the majority used damage control for hemodynamic instability (53%-67%) but not for hemodynamically stable patients (0%-1.3%; p < 0.001). Additional consensus was achieved for close skin/dry dressing for hemodynamically stable trauma splenectomy patients (87%) and fascia open/wound VAC for hemodynamically unstable colon resection/anastomosis (67%). Fecal diversion for rectal injury and colon resection/anastomosis (both when hemodynamically stable) had high heterogeneity (SI, 1.56 and 1.48, respectively). In penetrating trauma, sentiment was for more use of wet-to-dry dressings and incision/wound VAC with increased contamination in hemodynamically stable patients. Conclusions: Damage control was favored in hemodynamically unstable trauma patients, with use of wet-to-dry dressings and incision/wound VAC with spillage after penetrating trauma. However, most scenarios did not achieve consensus. High variability of practices regarding incision management at the conclusion of surgery was confirmed. Prospective studies and evidence-based guidance are needed to guide decision making at end-operation.

Development and validation of a point-of-care clinical risk score to predict surgical site infection following open spinal fusion.

Background: Surgical site infection (SSI) after open spine surgery increases healthcare costs and patient morbidity. Predictive analytics using large databases can be used to develop prediction tools to aid surgeons in identifying high-risk patients and strategies for optimization. The purpose of this study was to develop and validate an SSI risk-assessment score for patients undergoing open spine surgery. Methods: The Premier Healthcare Database of adult open spine surgery patients (n = 157,664; 2,650 SSIs) was used to create an SSI risk scoring system using mixed effects logistic regression modeling. Full and reduced multilevel logistic regression models were developed using patient, surgery or facility predictors. The full model used 38 predictors and the reduced used 16 predictors. The resulting risk score was the sum of points assigned to 16 predictors. Results: The reduced model showed good discriminatory capability (C-statistic = 0.75) and good fit of the model ([Pearson Chi-square/DF] = 0.90, CAIC=25,517) compared to the full model (C-statistic = 0.75, [Pearson Chi-square/DF] =0.90, CAIC=25,578). The risk scoring system, based on the reduced model, included the following: female (5 points), hypertension (4), blood disorder (8), peripheral vascular disease (9), chronic pulmonary disease (6), rheumatic disease (16), obesity (12), nicotine dependence (5), Charlson Comorbidity Index (2 per point), revision surgery (14), number of ICD-10 procedures (1 per procedure), operative time (1 per hour), and emergency/urgent surgery (12). A final risk score as the sum of the points for each surgery was validated using a 1,000-surgery random hold-out (independent from the study cohort) sample (C-statistic = 0.77). Conclusions: The resulting SSI risk score composed of readily obtainable clinical information could serve as a strong prediction tool for SSI in preoperative settings when open spine surgery is considered.

Assessment of Silver Levels in a Closed-Incision Negative Pressure Therapy Dressing: In Vitro and In Vivo Study.

Objective: In recent years, reticulated open-cell foam-based closed-incision negative pressure therapy (ROCF-ciNPT) has shown effectiveness in management of various postoperative incisions. These dressings consist of a skin interface layer that absorbs fluid from the skin surface and reduces the potential for microbial colonization within the dressing by means of ionic silver. This study examines the ability of silver to reduce the bioburden within the dressing as well as the localized effect due to potential silver mobility. Approach: Ability of silver to reduce bioburden within the ROCF-ciNPT dressing was assessed using Staphylococcus aureus, Pseudomonas aeruginosa, and Candida spp. Furthermore, silver mobility was assessed using an in vitro skin model to study the zone of inhibition along with released silver quantification. Using a porcine model, diffusion of silver into blood and tissue was studied using emission spectrometry and histology. Results: Microbial growth in the ROCF-ciNPT dressing was significantly reduced (∼2.7-4.9 log reduction) compared to a silver-free negative control. No zone of inhibition was observed for microbial colonies for up to 7 days with minimal localized silver release (<5.5 ppm release). In vivo studies demonstrated no measurable concentration (<0.2 µg/g) of silver in the blood, urine, feces, kidney, and liver tissue biopsy. Innovation: This study provides an important insight into silver concentration and mobility within the ROCF-ciNPT dressing, given emerging concerns associated with potential silver cytotoxicity. Conclusion: These results indicate the concentration of silver (0.019% silver by weight) in the ROCF-ciNPT dressings has been adequate to reduce bioburden within the skin interface layer, while severely limiting the amount of silver leaching out.

Negative pressure wound therapy (NPWT) on closed incisions to prevent surgical site infection in high-risk patients in hepatopancreatobiliary surgery: study protocol for a randomized controlled trial-the NP-SSI trial.

BACKGROUND: Incisional surgical site infections (iSSI) in hepatopancreatobiliary (HPB) surgery usually lead to prolonged hospital stays, consume valuable resources, and impact on patients' outcome. Prophylactic closed incision negative pressure wound therapy (ciNPWT) to decrease wound complications has become available. Owing to an increasing number of studies, evidence for superiority in many indication areas has accumulated; however, in general surgery, there are a few data and those have shown contradictory results. METHODS: In this monocentric, prospective, randomized, controlled, two-armed study, the influence of ciNPWT on incisional surgical site infection rates after HPB operations will be investigated. A total of 222 patients will be randomized 1:1 to an interventional group (7-day treatment with ciNPWT) or a control group (treated with gauze dressing). The primary parameter to evaluate efficacy is the rate of incisional SSIs within 30 days after surgery. Additionally, several clinically relevant secondary outcomes will be assessed. DISCUSSION: A reduction in the rate of incisional SSIs would not only lead to a significant cost reduction and shorter postoperative length of stay, but may also improve postoperative quality of life for patients. While earlier publications have shown advantages for ciNPWT, recent studies did not confirm a positive effect regarding iSSI rate. Even if iSSI rate is not reduced, findings obtained from the secondary endpoints may be of clinical relevance, such as reduction of wound complication rates. TRIAL REGISTRATION: This trial has been registered in the German Clinical Trials Register, DRKS 00015136 . Registered on 19 February 2019 and has been approved by the local ethics committee of the University of Regensburg: 18-1225-101.

[Application of interrupted suture at exercise position in total knee arthroplasty].

Objective: To investigate the effectiveness of interrupted suture under exercise position in total knee arthroplasty (TKA). Methods: Eighty-four patients with osteoarthritis who were treated with TKA between July 2015 and July 2016 were enrolled in the study. All patients were randomly divided into control group and observation group with 42 cases in each group. There was no significant difference in gender, age, side, body mass index, and osteoarthritis grading between 2 groups ( P>0.05). The incisions were interrupted sutured at the knee flexion position in control group and at the exercise position in observation group. Preoperative and postoperative treatments of 2 groups were same. The incision length, suture time, total tramadol usage, intraoperative blood loss, stitches removal time, hospitalization time, incidence of postoperative complication, the incision healing score (HWES), and satisfaction score of incisional self evaluation (Liktert score) were recorded and compared between 2 groups. The visual analogue scale (VAS) score was used to evaluate the incision pain at pre- and post-operation. The hospital for special surgery (HSS) score and range of motion (ROM) were also used to assess the knee function. Results: There was no significant difference in incision length, incidence of postoperative complication, HWES score, stitching time, and hospitalization time between 2 groups ( P>0.05). The suture time, intraoperative blood loss, and Likter score were significantly lower in control group than those in observation group ( P<0.05), but the total tramadol usage was significantly higher in control group than that in observation group ( P<0.05). All patients were followed up. The follow-up time ranged from 12 to 24 months (mean, 14.7 months) in control group and from 12 to 23 months (mean, 15.3 months) in observation group. There was no significant difference in VAS scores between 2 groups before operation, before going to bed at the 1st day, and after suture removal ( P>0.05). The VAS score of observation group after flexion and extension exercises at the 1st day was significantly lower than that of control group ( P<0.05). There was no significant difference in HSS score and ROM between 2 groups before operation and at 12 months after operation ( P>0.05). The HSS score and ROM in observation group at discharge and at 1, 3, and 6 months after operation were superior to those in control group ( P<0.05). Conclusion: Compared with interrupted suture at flexion knee position, the application of interrupted suture at exercise positon in TKA had the advantages of less postoperative pain and good incision healing, and can get satisfactory early joint function recovery. But significant difference in the long-term effectiveness of the two methods was not found.

Incisional Negative Pressure Wound Therapy for Surgical Site Infection Prophylaxis in the Post-Antibiotic Era.

Background: With the prospect of antibiotic failure in the post-antibiotic era, strategies that prevent surgical site infection (SSI) are increasingly important. Current literature suggests that incisional Negative Pressure Wound Therapy (iNWPT) is a promising intervention. Methods: Based on published literature regarding iNPWT, its mechanisms of action, and clinical results, a narrative summary was built, including both the experimental as well as the clinical literature. Results: The experimental literature indicates that iNPWT provides a barrier against external contamination before re-epithelialization, increases blood flow and lymphatic clearance, and reduces edema. Meta-analyses of randomized studies indicate that iNWPT is effective in reducing SSI. We did not identify studies that assessed bacterial clearance during iNPWT in contaminated surgical sites, nor did we identify clinical studies that specified they omitted concomitant antibiotic prophylaxis. Conclusions: Moderate quality evidence indicates that iNWPT reduces SSI, although data without the concomitant use of antibiotic prophylaxis are lacking. The iNPWT is likely effective as a result of its barrier function and optimization of the surgical site micro-environment. For now, iNPWT is recommended for incorporation in SSI prevention bundles. The iNPWT as a substitute for antibiotic prophylaxis is not recommended currently. Further reduction of SSI by iNPWT will lessen the need for therapeutic use of antibiotic agents.

Leaving the Skin Incision Open May Not Be as Beneficial as We Have Been Taught.

BACKGROUND: Currently, various methods of skin closures are used in contaminated and dirty abdominal wounds without solid, evidence-based guidance. This study investigates whether closure methods affect surgical site infection (SSI) and other incisional complications. We hypothesize that open management of the skin would have the lowest complications, including SSI. PATIENTS AND METHODS: Patients age ≥18 who underwent trauma laparotomy (TL) or damage control laparotomy (DCL) from 2008-2013 and had class III/IV wounds were included. Demographic, injury, treatment, and outcome variables were compared based on skin closure methods: Primary closure, intermittently stapled with wicks, or open management. Subgroup analyses for TL, DCL, and high-risk patients with stomach, colon, or rectal injuries were performed. Bivariable and multivariable logistic regression (MLR) analyses were performed to identify risk factors for superficial/deep SSI and surgical incision complications. RESULTS: A total of 348 patients were included. The median age was 47 years; 14% were female; 21% had blunt injuries. Overall SSI was highest for open incisions (p < 0.05), but there was no difference in superficial/deep SSI. Primary closures healed a median of 20 days, compared with 68 and 71 days for the intermittently stapled and open groups, respectively (p < 0.001). Primary closure in TL and high-risk patients also had the lowest SSI rates (all p < 0.05), but there were no differences in superficial/deep SSI in any subgroup. In TL patients, diabetes mellitus and colon injuries were independently associated with the development of superficial/deep SSI and surgical incision complications; however, skin closure method was not. CONCLUSION: In class III and IV wounds, primary closure was associated with the lowest SSI, shortest length of stay and healing time. Method of skin closure, however, did not have an independent effect on the development of superficial/deep SSI or surgical incision complications. These suggest that primary skin closure in contaminated and dirty abdominal wounds may be performed more safely than commonly perceived.

Effect of a new incision management system (PREVENA®) on wound healing after endophlebectomy of the common femoral vein: a case series.

BACKGROUND: New endovascular techniques facilitate treatment of complex deep vein obstructions in cases of post-thrombotic syndrome. In a relevant number of these patients, endophlebectomy including the implantation of an arteriovenous fistula between the common femoral artery and the femoral vein is indispensable in order to establish a good inflow. These procedures display a high risk of wound complications. Despite conservative efforts to prevent these postoperative complications, wound healing problems occur in more than 20 % of cases. The present case report is the first description of wound dressing using a PREVENA® incision management system in cases of endophlebectomy. CASE PRESENTATION: A single center's experience with the incision management system PREVENA®, which was used after endophlebectomy and venous stenting in complex hybrid procedures in three white men aged 46 years, 53 years, and 61 years is the subject of this case report. Although the surgical procedures were performed under therapeutical anticoagulation and took a couple of hours, no wound complications occurred. CONCLUSIONS: These encouraging results underline a potential benefit of the incision management system PREVENA® in cases of complex venous recanalization including endophlebectomy of the femoral vein as well as the implantation of an arteriovenous fistula.

Can post-sternotomy mediastinitis be prevented by a closed incision management system?

Post-sternotomy mediastinitis is a serious complication after cardiothoracic surgery and contribute significantly to post-operative morbidity, mortality, and healthcare costs. Negative pressure wound therapy is today's golden standard for post-sternotomy mediastinitis treatment. A systematic literature search was conducted at PubMed until October 2012 to analyse whether vacuum-assisted closure technique prevents mediastinitis after clean surgical incisions closure. Today's studies showed reduction of post-sternotomy mediastinitis including a beneficial socio-economic impact. Current studies, however included only high-risk patients, hence furthermore, larger randomised controlled trials are warranted to clarify the benefit for using surgical incision vacuum management systems in the general patient population undergoing sternotomy and clarify risk factor interaction.