Negative pressure-wound therapy (NPWT) is an effective option for subcutaneous abdominal wound healing impairment (SAWHI) after surgery, although it’s tied to more complications than conventional therapy, researchers say.
The multinational study showed that with NPWT, “wound healing was achieved faster and more often than with conventional wound treatment (CWT), but NPWT caused more device- and wound-related adverse events,” Dorthe Seidel of the University of Witten/Herdecke in Koln, Germany, told Reuters Health on behalf of the SAWHI study group.
“The most frequently documented wound-related adverse events were periwound macerations and local infections with signs of inflammation,” she said. “Macerated wound margins are mainly avoidable with adequate protection.”
As reported in JAMA Surgery, the study included 507 patients with SAWHI randomized to NPWT or CWT. The median age was 66 and about 56% were men.
The mean time to wound closure was significantly shorter with NPWT (36.1 days) compared with CWT (39.1 days). In addition, the wound closure rate within 42 days was significantly higher with NPWT (35.9%) than with CWT (21.5%).
However, after excluding participants with unauthorized treatment changes (NPWT, 22; CWT, 50), the risk for wound-related AEs was higher in the NPWT arm (risk ratio, 1.51).
Further, 23 adverse events related to the NPWT device (9.6%) occurred, including battery defects, continuous nonidentifiable alarms, and canister blockage, among others.
Seidel said, “The use of innovative technical medical devices in wound healing has benefits for both patients and users. Medical devices are safe to use if applied correctly and continuously monitored. Adequate protective and countermeasures in the event of unavoidable adverse events are mandatory.”
“A technical medical device will never replace the expertise and experience of doctors and nurses,” she concluded.
Dr. Rohit Soans, Medical Director of Bariatric Surgery at Temple University Hospital in Philadelphia commented by email, “For some time, we have known the benefit of (the NPWT) approach and it has been widely accepted even without level-one data (i.e., evidence from at least one randomized trial). This paper provides the level-one data that has been missing in the surgical literature.”
“The caveats for NPWT are only really two major issues – infection and cost,” he told Reuters Health. “Infected wounds are best not treated with NPWT until the infection is under control. NPWT does have specialized foam dressing as well as a vacuum device that add cost to the therapy.”
“We have had many instances where patients do not get approval for NPWT and have to use CWT,” he noted. “Interestingly, the lack of level-one evidence is often cited in the denial letters we get so this study may help solve some of the issue.”
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