Effect of Negative Pressure Incision Care Dressing on wound infection
rate in Colorectal Surgery: A Prospective Non Randomized Trial
SM Zaidi, WM Chaudhry, HA Khokhar, H Majeed, SA Khan.
Our Lady Of Lourdes Hospital Drogheda, Ireland.
INTRODUCTION
 Since its introduction, Negative Pressure Wound
Therapy (NPWT) traditionally, has been used
mainly to deal with chronic wounds.
 Mechanism of action of NPWT includes protection
of wound bed (1), splinting of soft tissues (1),
reduction of edema, increasing perfusion of wound
(2) and enhancing granulation tissue.
 Application of Negative Pressure Incision Care
Therapy (NPICT) to prevent wound complications is
a new concept.
 NPICT has also been used successfully in acute
wounds of Orthopaedics (3, 4), Gynecological and
Cardiothoracic surgery patients to reduce wound
infection rates in high risk surgical patients.
 There is no data about the use of NPICT in General 7 days later after removal of NPWT.
(NB: this patient had malnutrition with perforation of malignancy and
surgical patients with acute wounds, considered to
associated abscesses formation.)
have high risk of developing wound complications
secondary to their co-morbid conditions.
RESULTS
 Mean age in NPICT group was 66.46 sd 8.999
AIMS
(range 45-89) and in control group it was 65.58 sd
8.799 (range 46-87).
 Aim of this study was to assess the use of NPICT in
 Male to female ratio was 1:1.06(NPICT) and
prevention of wound infection and dehiscence, in
1:1.04(Non-NPICT)
general surgical patients, who have risk factors and
 In 06(%) patients therapy failed because of
considered to be high risk of developing such
technical failure of vacuum application.
complications.
 There were 42.02% patients with High BMI (>35) in
NPICT group and 33.03% in control group
(p=0.1442).
METHODS
 Patients with malignancy were 40.57% in NPWT
group and 36.6% in control group (p=0.3522).
 A total of 317 patients underwent Laparotomy in a
 Emergency surgery was done in 30.43% of cases in
colorectal unit of a regional hospital by a single
NPICT group and 26.78% cases in control group.
surgeon and his team  Fisher exact test was used to calculate p value.
 between October 2010 to June 2013 .
 Risk factors and their relative frequencies in two
 104 (32.1%) patients were excluded on the basis of
groups are shown in table (Fig 1).
other complications affecting LOS.  3 patients (4.2%) in NPICT group and 29 patients
 Out of 213 patients included, 71 (33.3%) patients (20.4%) in Non-NPICT group developed wound
received NPICT, while 142 (66.6%) patients complications [p <0.001, RR=0.68(0.57-0.79),
received regular dressings (Non-NPICT group).
OR=0.14(0.033-0.6362)]
 NPICT was applied in Operation Theater,  The LOS increased from 9 ± 3.22 days in the
immediately after skin closure in conventional way NPICT group and 14 ±  4.31 days for Non-NPICT
and left in place for 7 days
group.
 Study endpoints were rate of 30-day wound
 Complete healing of wounds occurred by
infection rate and LOS. 31.1 ± 8.22 days in NPICT group.
Risk Factors NPWT Control
BMI > 35 42.02 % 33.03 %
Malignancy 40.57 % 36.60 %
Emergency Surgery 30.43 % 26.78 %
Atherosclerosis 26.08 % 17.85 %
Smoker 8.69 % 16.07 %
Diabetes Mellitus 7.24 % 10.71 %
NPWT immediately after application Fig. 1: Risk factors and their relative frequencies. (BMI=Body
Mass Index)
DISCUSSION
 NPWT has been widely used since its introduction
in 1971 but there has been little written regarding
the potential application of NPWT in closed
incisions to prevent wound complications.
 Timmers et al have demonstrated increase blood
flow, after application of NPWT on healthy skins of
volunteers(2), augmenting the efficacy on wound
healing.
 Stannard et al have shown the effect of NPWT in
reducing wound hematoma formation in high energy
trauma patients involving lower limbs (3).
 Stannard et al have also shown the decrease
incidence of seroma formation after lower limb
fracture surgery (4).
 Kilpadi et al have shown reduced seroma formation
in animal models (5).
 NPWT may also diminish the risk of wound
contamination, since these dressings are applied in
sterile environment (6).
 With use of NPICT, there is 78% decrease in
hospital stay and 76% decrease in cost with acute
and chronic wounds (7).
 Another perceived advantage of NPWT is splinting
of incisions. There is reduction of lateral tension and
lines of tension are normalised, similar to pre-
incision levels after application of NPWT (8).
 Also, NPWT application may keep the deep fat
layer in close contact, resulting in decrease shear
stress (8) thus decreasing rate of dehiscence and
scarring and better cosmesis.
 Kaplan et al showed faster recovery of patients who
suffered severe trauma with soft tissue defects, if a
NPWT device was applied early (9).
 This study is the first of its kind, involving general
surgical patients.
 Selection of patients, considered to be high risk of
wound complications was based on established risk
factors.
CONCLUSION
 Use of Negative Pressure Incision care therapy
(NPICT) significantlty reduces risk of wound
infections in high risk colorectal surgical patients
thus reducing patients stay and cost. Randomised
studies are needed to verify our findings.
REFERENCES
P value
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