The Prophylactic Use of Negative Pressure Wound Therapy in Contaminated Wounds: A Prospective Cohort Study Conducted in ASU Hospitals

Abstract Background Contaminated wound and its complications cause increased patient morbidity, and it associated with delayed healing and increasing health care coast. Negative pressure wound therapy (NPWT) is frequently used for both chronic and acute open wounds, and studies have shown that it can speed up wound healing by encouraging the formation of granulation tissue, increasing perfusion, and enabling epithelialization and contraction. The introduction of NPWT to closed surgical incisions was motivated by improved results on open wounds. In high-risk patients, the use of NPWT in the early postoperative period lowers wound dehiscence and surgical site infections (SSIs). It minimizes hematoma and seroma rates by reducing wound edema and enhancing local perfusion and lymphatic flow. With better perfusion and oxygenation, wounds heal more quickly. Objective To evaluate the prophylactic use of negative pressure wound therapy as a technique for management and control of the contaminated wounds. Methods A prospective cohort study conducted at Ain Shams University Hospitals within a period of 6 months, 60 Patients with contaminated wounds immediately in postoperative period were included. And they are divided into two groups control group and study group each of them included 30 cases. Results 50% of the study group with application of NPWT immediately postoperative showed no discharge and no evidence of SSI, 20% showed minimal signs of inflammation in form of serous discharge and about 30% of them showed purulent discharge, erythema and evidence of SSI. In the control group with traditional gauze dressing about 46.7% showed purulent discharge and evidence of SSI. As regard muscle weakness and wound dehiscence, about 40% of the study group with NPWT showed muscle weakness and evidence of dehiscence and 46.7% of the control group with the traditional dressing showed muscle weakness and dehiscence. And as regard cosmetic appearance about 76% of the study group with NPWT showed good cosmetic appearance with average fine line scar or scar less than.5 cm in width. If take the consideration of satisfaction about the wound appearance About 56.7% of the cases showed parents' satisfaction, while 43.3% of control group showed parents' satisfaction. Conclusion Our study showed significant results in role of NPWT in reduction of SSI as 50% of the study group with application of NPWT immediately postoperative showed no evidence of SSI, 20% showed minimal signs of inflammation in form of serous discharge and about 30% of them showed purulent discharge, erythema and evidence of SSI. In the control group with traditional gauze dressing, about 46.7% showed purulent discharge and evidence of SSI. And as regard the muscle weakness and wound dehiscence, there is no significant difference in the use of NPWT or traditional gauze dressing as about 40% of the study group with NPWT showed muscle weakness and evidence of dehiscence and 46.7% of the control group with the traditional dressing showed muscle weakness and dehiscence. SO, the prophylactic use of NPWT in contaminated wound is effective in reducing the SSI, but there is no effect on muscle weakness and wound dehiscence.