Michael Sugrue presented the state-of-the-art use of Negative Pressure Wound Therapy (NPWT) in open wounds, making an extensive review of the literature and sharing his clinical experience, particularly on the use of NPWT in the Open Abdomen. Prof. Sugrue reminded how, in the US, approximately 500,000 surgical site infections (SSI) occur per annum, 40-60% of which are considered preventable1. A SSI has been proven to affect long-term survival2, so the surgeons have to consider a multi-factorial strategy, including a precise timing of antibiotic administration, good bowel and skin preparation, double gloving, careful fascial closure technique, and the appropriate use of NPWT, in order to achieve better outcomes. Evidence-based recommendations for the treatment variables of Negative Pressure Wound Therapy3, the use of NPWT in chronic wounds4, in traumatic wounds and reconstructive surgery5, and most recently in open abdominal wounds6 have been published, and are now available in the public domain, but the awareness of this therapeutic option is still relatively limited. In the management of the OA, one of the most important improvements, so far, is the combination of NPWT with a mesh-mediated traction, which has been proven to achieve a reduced lateralisation and an increased closure rate7.
1. Najjar PA, Smink DS Prophylactic Antibiotics and Prevention of Surgical Site Infections.Surg Clin North Am. 2015 Apr;95(2):269-283. doi: 10.1016/j.suc.2014.11.006. Epub 2015 Jan 10.
2. Artinyan A, Orcutt ST, Anaya DA, Richardson P, et al. Infectious post-operative complications decrease long-term survival in patients undergoing curative surgery for colorectal cancer. Ann Surg. 2015. 261; (3):497-505.
3. Birke-Sorenson H, Malmsjo M, Rome P, Hudson D et al., (2011) Evidence-based recommendations for negative pressure wound therapy: Treatment variables (pressure levels, wound filler and contact layer) Steps towards an international consensus. JPRAS 64, s1-s16.
4. Vig S, Dowsett C, Berg L, Caravaggi C. Evidence-based recommendations for negative pressure wound therapy in chronic wounds: Steps towards an international consensus. Journal of Tissue Viability. 2011 20; s1-s18.
5. Krug E, Berg L, Lee C, Hudson D, et al.., Evidence-based recommendations for negative pressure wound therapy in traumatic wounds and reconstructive surgery: Steps towards an international consensus. Injury. 2011 42; s1 – s12.
6. Bruhin A, Ferreira F, Chariker M, Smith, J, et al., Systematic Review and Evidence Based Recommendations for the use of Negative Pressure Wound Therapy in the Open Abdomen. International Journal of Surgery. 2014. 12; (10):1105–1114.
7. Acosta S, Bjarnason T, Petersson U, Pålsson B, et al., Multicentre prospective study of fascial closure rate after open abdomen with vacuum and mesh-mediated fascial traction. BJS. 2011. 98; 5:735–743.