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Gonzalez MG, Barske ME, Kjellsson KB, Saboda K, Reed HA, Hill MG. Topical negative pressure wound therapy to prevent wound complications following caesarean delivery in high-risk obstetric patients: A randomised controlled trial. Aust N Z J Obstet Gynaecol 2023; 63:516-520. [PMID: 37140175 DOI: 10.1111/ajo.13675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND AND AIMS We investigated whether the use of a prophylactic negative pressure wound therapy (NPWT) system in women undergoing caesarean would decrease wound complications in a high-risk population. MATERIALS AND METHODS A randomised controlled trial was performed. Women with risk factors for wound complications undergoing caesarean delivery were randomised to a standard dressing or NPWT placed over their caesarean wound. We standardised the closure of the subcutaneous fat and skin layers, both with Vicryl. Patients were followed for wound complications for up to 6 weeks after their caesareans. The incidence of wound complications was the primary outcome. The single-use NPWT system, PICO, was provided by Smith and Nephew for use in this trial. The trial was registered on clinicaltrials.gov, # NCT03082664. RESULTS We report here on 154 women randomised to either a standard dressing or to the NPWT. Wound complication rates were equivalent between groups, with 19.4 and 19.7% (P = 0.43) of women with follow-up information available experiencing wound complications. CONCLUSION We found no difference in wound complications in women with risk factors treated with a prophylactic NPWT system or standard wound dressing at the time of caesarean birth.
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Affiliation(s)
- Maritza G Gonzalez
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - M Elisa Barske
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - Kristine B Kjellsson
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - Kathylynn Saboda
- Biostatistics and Bioinformatics shared Service, The University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Heather A Reed
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
| | - Meghan G Hill
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, Arizona, USA
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The Role of the Extracellular Matrix (ECM) in Wound Healing: A Review. Biomimetics (Basel) 2022; 7:biomimetics7030087. [PMID: 35892357 PMCID: PMC9326521 DOI: 10.3390/biomimetics7030087] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 12/27/2022] Open
Abstract
The extracellular matrix (ECM) is a 3-dimensional structure and an essential component in all human tissues. It is comprised of varying proteins, including collagens, elastin, and smaller quantities of structural proteins. Studies have demonstrated the ECM aids in cellular adherence, tissue anchoring, cellular signaling, and recruitment of cells. During times of integumentary injury or damage, either acute or chronic, the ECM is damaged. Through a series of overlapping events called the wound healing phases—hemostasis, inflammation, proliferation, and remodeling—the ECM is synthesized and ideally returned to its native state. This article synthesizes current and historical literature to demonstrate the involvement of the ECM in the varying phases of the wound healing cascade.
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Chetter I, Arundel C, Martin BC, Hewitt C, Fairhurst C, Joshi K, Mott A, Rodgers S, Goncalves PS, Torgerson D, Wilkinson J, Blazeby J, Macefield R, Dixon S, Henderson E, Oswald A, Dumville J, Lee M, Pinkney T, Stubbs N, Wilson L. Negative pressure wound therapy versus usual care for surgical wounds healing by secondary intention (SWHSI-2 trial): study protocol for a pragmatic, multicentre, cross surgical specialty, randomised controlled trial. Trials 2021; 22:739. [PMID: 34696784 PMCID: PMC8543414 DOI: 10.1186/s13063-021-05662-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 09/27/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The majority of surgical wounds are closed (for example with sutures or staples) and so heal by primary intention. Where closure is not possible, or the wound subsequently breaks down, wounds may be left to heal from the bottom up (healing by secondary intention). Surgical wound healing by secondary intention (SWHSI) frequently presents a significant management challenge. Additional treatments are often required during the course of healing, and thus a significant financial burden is associated with treating these wounds. Increasingly, negative pressure wound therapy (NPWT) is used in the management of SWHSI. This wound dressing system provides a negative pressure (vacuum) to the wound, removing fluid into a canister, which is believed to be conducive to wound healing. Despite the increasing use of NPWT, there is limited robust evidence for the effectiveness of this device. A well-designed and conducted randomised controlled trial is now required to ascertain if NPWT is a clinically and cost-effective treatment for SWHSI. METHODS SWHSI-2 is a pragmatic, multi-centre, cross surgical specialty, two arm, parallel group, randomised controlled superiority trial. Adult patients with a SWHSI will be randomised to receive either NPWT or usual care (no NPWT) and will be followed up for 12 months. The primary outcome will be time to healing (defined as full epithelial cover in absence of a scab) in number of days since randomisation. Secondary outcomes will include key clinical events (hospital admission or discharge, treatment status, reoperation, amputation, antibiotic use and death), wound infection, wound pain, health-related quality of life, health utility and resource use. DISCUSSION Given the increasing use of NPWT, despite limited high-quality supporting evidence, the SWHSI-2 Trial will provide robust evidence on the clinical and cost-effectiveness of NPWT in the management of SWHSI. The SWHSI-2 Trial opened to recruitment in May 2019 and is currently recruiting across 20 participating centres. TRIAL REGISTRATION ISRCTN 26277546 . Prospectively registered on 25 March 2019.
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Affiliation(s)
- Ian Chetter
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Catherine Arundel
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK.
| | - Belen Corbacho Martin
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Kalpita Joshi
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Andrew Mott
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Sara Rodgers
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Pedro Saramago Goncalves
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jacqueline Wilkinson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jane Blazeby
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Rhiannon Macefield
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Stephen Dixon
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Eileen Henderson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Angela Oswald
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Jo Dumville
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Matthew Lee
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Thomas Pinkney
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Nikki Stubbs
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
| | - Lyn Wilson
- York Trials Unit, Department of Health Sciences, Faculty of Science, University of York, Lower Ground Floor ARRC Building, York, YO10 5DD, UK
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4
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Gao J, Wang Y, Song J, Li Z, Ren J, Wang P. Negative pressure wound therapy for surgical site infections: A systematic review and meta-analysis. J Adv Nurs 2021; 77:3980-3990. [PMID: 33905552 DOI: 10.1111/jan.14876] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/05/2021] [Accepted: 03/18/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Negative pressure wound therapy is one of the most common treatments for infected wounds. The aim of this meta-analysis was to compare the efficacy of negative pressure wound therapy with conventional treatment methods in the treatment of surgical site infection. DESIGN This study is registered with International Prospective Register of Systematic Reviews. DATA SOURCES The Pubmed, Embase and the Cochrane Central Register of Controlled Trials databases were searched. METHODS The systematic review was searched by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. All trials reporting the use of negative pressure wound therapy for surgical site infection treatment were included regardless of surgery type. The primary outcome measure was wound healing. Secondary outcomes were length of hospital stay, medical costs, adverse events, and reoperation rates. Results are presented with 95% confidence intervals and report estimates as odds ratios. Heterogeneity was determined through the I2 test, with I2 > 50% indicating substantial heterogeneity and p < .10 significance. The search was performed on 10 March 2020. RESULTS We identified 13 eligible trial comparisons, of which 2 were randomized controlled trials and 11 cohort study. Negative pressure wound therapy in surgical site infection (SSI) patients significantly increased wound healing rate, accelerated wound healing time, increased daily wound healing area, reduced hospital stay, and reduced adverse events. However, negative pressure wound therapy was associated with increased medical costs. CONCLUSION Negative pressure wound therapy may be more effective for the treatment of surgical site infection relative to conventional debridement, dressings and other treatments. However, further high-quality randomized controlled trials are needed to determine the most optimal application of negative pressure wound therapy. IMPACT Negative pressure wound therapy is the best treatment strategy for surgical site infection. This study can improve medical practitioners' awareness of negative pressure wound therapy for surgical site infection, promoting the development of relevant randomized controlled trials.
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Affiliation(s)
- Junru Gao
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yunyun Wang
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jingyu Song
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ze Li
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jianan Ren
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.,Lab for Trauma and Surgical Infections, Department of Surgery, Jinling Hospital, Affiliated to Southeast University, Nanjing, China
| | - Peige Wang
- Department of Emergency Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
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5
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Janssen AH, Wegdam JA, de Vries Reilingh TS, Eskes AM, Vermeulen H. Negative pressure wound therapy for patients with hard-to-heal wounds: a systematic review. J Wound Care 2020; 29:206-212. [PMID: 32281512 DOI: 10.12968/jowc.2020.29.4.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Despite the lack of evidence, negative pressure wound therapy (NPWT) is commonly used in patients with hard-to-heal wounds. In our medical centre, one third of patients with abdominal wounds infected postoperatively end this therapy prematurely due to negative experiences and prefer standard wound care. This study was designed to explore the effects of NPWT on quality of life (QoL). METHOD A search from 2000 to 2019 in eight databases was performed to identify qualitative studies of patients treated with NPWT. Studies were selected by two independent reviewers, who appraised the methodological quality, extracted and structured the data and performed content analysis. RESULTS A total of five qualitative studies with good methodological quality, incorporating 51 individual patients, were included. After content analysis, four major themes emerged: reduced freedom of movement caused by an electric device; decreased self-esteem; increased social and professional dependency; and gaining self-control. CONCLUSION NPWT has major effects on the physical, psychological and social domains of QoL. Knowledge of these effects may lead to improved treatment decisions for patients with hard-to-heal wounds regarding use of NPWT or standard wound care.
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Affiliation(s)
| | | | | | - Anne M Eskes
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.,Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Hester Vermeulen
- Scientific Institute for Quality of Healthcare (IQ Healthcare) Radboud University, Nijmegen, the Netherlands
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Sahebally SM, McKevitt K, Stephens I, Fitzpatrick F, Deasy J, Burke JP, McNamara D. Negative Pressure Wound Therapy for Closed Laparotomy Incisions in General and Colorectal Surgery: A Systematic Review and Meta-analysis. JAMA Surg 2018; 153:e183467. [PMID: 30267040 DOI: 10.1001/jamasurg.2018.3467] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Importance Surgical site infections (SSIs) are common after laparotomy wounds and are associated with a significant economic burden. The use of negative pressure wound therapy (NPWT) has recently been broadened to closed surgical incisions. Objective To evaluate the association of prophylactic NPWT with SSI rates in closed laparotomy incisions performed for general and colorectal surgery in elective and emergency settings. Data Sources The PubMed, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar databases were searched without language restrictions for relevant articles from inception until December 2017. The latest search was performed on December 31, 2017. The bibliographies of retrieved studies were further screened for potential additional studies. Study Selection Randomized clinical trials and nonrandomized studies were included. Unpublished reports were excluded, as were studies that examined NPWT (or standard nonpressure) dressings only without a comparator group. Studies that evaluated the use of NPWT in open abdominal incisions were also excluded. Disagreement was resolved by discussion, and if the question remained unsettled, the opinion of the senior author was sought. A total of 198 citations were identified, and 189 were excluded. Data Extraction and Synthesis This meta-analysis was conducted according to PRISMA guidelines. Data were independently extracted by 2 authors. A random-effects model was used for statistical analysis. Main Outcomes and Measures The primary outcome measure was SSI, and secondary outcomes included seroma and wound dehiscence rates. These outcomes were chosen before data collection. Results Nine unique studies (3 randomized trials and 2 prospective and 4 retrospective studies) capturing 1266 unique patients were included. Of these, 1187 patients with 1189 incisions were included in the final analysis (52.3% male among 7 studies reporting data on sex; mean [SD] age, 52 [15] years among 8 studies reporting data on age). Significant clinical and methodologic heterogeneity existed among studies. On random-effects analysis, NPWT was associated with a significantly lower rate of SSI compared with standard dressings (pooled odds ratio [OR], 0.25; 95% CI, 0.12-0.52; P < .001). However, no difference in rates of seroma (pooled OR, 0.38; 95% CI, 0.12-1.23; P = .11) or wound dehiscence (pooled OR, 2.03; 95% CI, 0.61-6.78; P = .25) was found. On sensitivity analysis, focusing solely on colorectal procedures, NPWT significantly reduced SSI rates (pooled OR, 0.16; 95% CI, 0.07-0.36; P < .001). Conclusions and Relevance Application of NPWT on closed laparotomy wounds in general and colorectal surgery is associated with reduced SSI rates but similar rates of seroma and wound dehiscence compared with conventional nonpressure dressings.
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Affiliation(s)
| | - Kevin McKevitt
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Ian Stephens
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - Fidelma Fitzpatrick
- Department of Clinical Microbiology, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Joseph Deasy
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland
| | - John Patrick Burke
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Deborah McNamara
- Department of Colorectal Surgery, Beaumont Hospital, Dublin, Ireland.,Royal College of Surgeons in Ireland, Dublin, Ireland
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7
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Danno K, Matsuda C, Miyazaki S, Komori T, Nakanishi M, Motoori M, Kashiwazaki M, Fujitani K. Efficacy of Negative-Pressure Wound Therapy for Preventing Surgical Site Infections after Surgery for Peritonitis Attributable to Lower-Gastrointestinal Perforation: A Single-Institution Experience. Surg Infect (Larchmt) 2018; 19:711-716. [PMID: 30183559 DOI: 10.1089/sur.2018.134] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND AND PURPOSE For patients at high risk, such as those with lower-gastrointestinal perforations, it is important to establish a preventive method that reduces the incidence of surgical site infections (SSIs) significantly. We applied negative-pressure wound therapy (NPWT) as part of a delayed primary closure approach to prevent SSIs. This study evaluated the value of this technique. METHODS We included prospectively 28 patients undergoing abdominal surgery for peritonitis caused by a lower-gastrointestinal perforation between May 2014 and November 2015. Historical controls comprised retrospective data on 19 patients who had undergone primary suturing for managing peritonitis incisions for a lower-gastrointestinal perforation from January to December 2013. RESULTS We found a significant association between the SSI incidence and the type of incision management (10.7% with NPWT and delayed closure vs. 63.2% with primary suturing; p < 0.001). There was no significant difference between the groups in the length of the hospital stay (22 days for NPWT and delayed closure vs. 27 days for primary suturing; p = 0.45). No severe adverse events were observed related to NPWT. CONCLUSION The use of NPWT and delayed primary closure was an effective measure for preventing SSI in patients undergoing abdominal surgery for peritonitis caused by lower-gastrointestinal perforation.
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Affiliation(s)
- Katsuki Danno
- 1 Department of Gastroenterological Surgery Osaka General Medical Center , Osaka, Japan
| | - Chu Matsuda
- 2 Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine , Suita, Osaka, Japan
| | - Susumu Miyazaki
- 1 Department of Gastroenterological Surgery Osaka General Medical Center , Osaka, Japan
| | - Takamichi Komori
- 1 Department of Gastroenterological Surgery Osaka General Medical Center , Osaka, Japan
| | - Megumi Nakanishi
- 3 Department of Nursing, Osaka General Medical Center , Osaka, Japan
| | - Masaaki Motoori
- 1 Department of Gastroenterological Surgery Osaka General Medical Center , Osaka, Japan
| | - Masaki Kashiwazaki
- 1 Department of Gastroenterological Surgery Osaka General Medical Center , Osaka, Japan
| | - Kazumasa Fujitani
- 1 Department of Gastroenterological Surgery Osaka General Medical Center , Osaka, Japan
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8
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Arundel C, Fairhurst C, Corbacho-Martin B, Buckley H, Clarke E, Cullum N, Dixon S, Dumville J, Firth A, Henderson E, Lamb K, McGinnis E, Oswald A, Saramago Goncalves P, Soares MO, Stubbs N, Chetter I. Pilot feasibility randomized clinical trial of negative-pressure wound therapy versus usual care in patients with surgical wounds healing by secondary intention. BJS Open 2018; 2:99-111. [PMID: 29951633 PMCID: PMC5989956 DOI: 10.1002/bjs5.49] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 12/13/2017] [Indexed: 01/09/2023] Open
Abstract
Background Surgical wounds healing by secondary intention (SWHSI) are increasingly being treated with negative-pressure wound therapy (NPWT) despite a lack of high-quality research evidence regarding its clinical and cost-effectiveness. This pilot feasibility RCT aimed to assess the methods for and feasibility of conducting a future definitive RCT of NPWT for the treatment of SWHSI. Methods Eligible consenting adult patients receiving care at the study sites (2 acute and 1 community) and with a SWHSI appropriate for NPWT or wound dressing treatment were randomized 1 : 1 centrally to receive NPWT or usual care (no NPWT). Participants were followed up every 1-2 weeks for 3 months. Feasibility (recruitment rate, time to intervention delivery) and clinical (time to wound healing) outcomes were assessed. Results A total of 248 participants were screened for eligibility; 40 (16·1 per cent) were randomized, 19 to NPWT and 21 to usual care. Twenty-four of the 40 wounds were located on the foot. Participants received NPWT for a median of 18 (range 0-72) days. Two participants in the NPWT group never received the intervention and 14 received NPWT within 48 h of randomization. Five participants in the usual care group received NPWT during the study. Ten of the 40 wounds were deemed to have healed during the study. Conclusion A full-scale RCT to investigate the clinical and cost-effectiveness of NPWT for SWHSI is feasible. This study identified crucial information on recruitment rates and data collection methods to consider during the design of a definitive RCT. Registration number: ISRCTN12761776 (http://www.iscrtn.com).
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Affiliation(s)
- C Arundel
- York Trials Unit, Department of Health Sciences University of York York UK
| | - C Fairhurst
- York Trials Unit, Department of Health Sciences University of York York UK
| | - B Corbacho-Martin
- York Trials Unit, Department of Health Sciences University of York York UK
| | - H Buckley
- York Trials Unit, Department of Health Sciences University of York York UK
| | - E Clarke
- Academic Vascular Surgical Unit Hull and East Yorkshire Hospitals NHS Trust Hull UK
| | - N Cullum
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK.,Research and Innovation Division, Central Manchester University Hospitals NHS Foundation Trust Manchester Academic Health Science Centre Manchester UK
| | - S Dixon
- Patient and Public Involvement Group Hull UK
| | - J Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health University of Manchester Manchester UK
| | - A Firth
- Academic Vascular Surgical Unit Hull and East Yorkshire Hospitals NHS Trust Hull UK
| | - E Henderson
- Outpatient Services Hull and East Yorkshire Hospitals NHS Trust Hull UK
| | - K Lamb
- Leeds Wound Research Unit Leeds Community Healthcare NHS Trust Leeds UK
| | - E McGinnis
- Department for Tissue Viability Leeds Teaching Hospitals NHS Trust Leeds UK
| | - A Oswald
- Academic Vascular Surgical Unit Hull and East Yorkshire Hospitals NHS Trust Hull UK
| | | | - M O Soares
- Centre for Health Economics University of York York UK
| | - N Stubbs
- Leeds Wound Research Unit Leeds Community Healthcare NHS Trust Leeds UK
| | - I Chetter
- Centre for Health Economics University of York York UK.,Research Office Hull York Medical School Hull UK
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Wu S, Applewhite AJ, Niezgoda J, Snyder R, Shah J, Cullen B, Schultz G, Harrison J, Hill R, Howell M, Speyrer M, Utra H, de Leon J, Lee W, Treadwell T. Oxidized Regenerated Cellulose/Collagen Dressings: Review of Evidence and Recommendations. Adv Skin Wound Care 2017; 30:S1-S18. [PMID: 29049055 PMCID: PMC5704727 DOI: 10.1097/01.asw.0000525951.20270.6c] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Healthcare systems are being challenged to manage increasing numbers of nonhealing wounds. Wound dressings are one of the first lines of defense in wound management, and numerous options exist. The oxidized regenerated cellulose (ORC)/collagen dressing may offer healthcare providers a robust and cost-effective tool for use in a variety of wounds. DESIGN A multidisciplinary panel meeting was convened to discuss the use of ORC/collagen dressings in wound care and provide practice recommendations. A literature search was conducted to provide a brief review of the peer-reviewed studies published between January 2000 and March 2016 to inform the meeting. SETTING A 2-day panel meeting convened in February 2017. PARTICIPANTS Healthcare providers with experience using ORC/collagen dressings. This multidisciplinary panel of 15 experts in wound healing included podiatrists, wound care specialists (doctors, certified wound care nurses, and research scientists), and an orthopedist. RESULTS The literature search identified 58 articles, a majority of which were low levels of evidence (69.3% were level 3 or lower). Panel members identified wound types, such as abrasions, burns, stalled wounds, diabetic foot ulcers, and pressure injuries, where ORC/collagen dressing use could be beneficial. Panel members then provided recommendations and technical pearls for the use of ORC/collagen dressings in practice. Barriers to ORC/collagen dressing use were discussed, and potential resolutions were offered. CONCLUSIONS An ORC/collagen dressing can be a critical tool for clinicians to help manage a variety of wounds. Clinical and economic studies comparing standard-of-care dressings and plain collagen dressings to ORC/collagen dressings are needed.
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Affiliation(s)
- Stephanie Wu
- Stephanie Wu, DPM, MS, is Professor of Surgery, Dr William M. School College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, Center for Lower Extremity Ambulatory Research (CLEAR), North Chicago, Illinois. Andrew J. Applewhite, MD, CSWP, is Medical Director and Physician, Comprehensive Wound Care and Hyperbaric Center at Baylor University Medical Center, Dallas, Texas. Jeffrey Niezgoda, MD, FACHM, MAPWCA, CHWS, is President and Chief Medical Officer of Advancing the Zenith of Healthcare, Milwaukee, Wisconsin. Robert Snyder, DPM, MSc, is Professor and Director of Clinical Research, Barry University School of Podiatric Medicine, North Miami Beach, Florida. Jayesh Shah, MD, is President, South Texas Wound Associated PA, San Antonio, Texas. Breda Cullen, PhD, is R&D Program Director, Systagenix, Gargrave, United Kingdom. Gregory Schultz, PhD, is Professor, University of Florida College of Medicine, Gainesville, Florida. Janis Harrison, BSN, RN, CWOCN, CFCN, is Partner and Chief Clinical Consultant to Harrison WOC Services LLC, Thurston, Nebraska. Rosemary Hill, RN, CWOCN, CETN(C), is Enterostomal Therapist, Lions Gate Hospital, North Vancouver, British Columbia, Canada. Melania Howell, RN, CWOCN, is Wound Care Consultant, Dynamic Wound Care Solutions LLC, Turlock, California. Marcus Speyrer, RN, CWS, is Chief Operating Officer, The Wound Treatment Center LLC, Opelousas General Health System, Opelousas, Louisiana. Howard Utra, BSN, RN, CWCN, is Registered Nurse, Innovated Healing Systems, Tampa, Florida. Jean de Leon, MD, FAPWCA, is Professor, University of Texas Southwestern Medical Center, Dallas, Texas. Wayne Lee, MD, is in private practice, Hill Country Orthopaedic Surgery & Sports Medicine, San Antonio, Texas. Terry Treadwell, MD, is Medical Director, Institute for Advanced Wound Care at Baptist Medical Center, Montgomery, Alabama. ACKNOWLEDGMENTS: The authors thank Ricardo Martinez and Julie M. Robertson (ACELITY) for manuscript preparation and editing. Drs Wu, Applewhite, Niezgoda, Snyder, Shah, Schultz, de Leon, Lee, and Treadwell; Ms Harrison, Hill, and Howell; and Mr Speyrer and Mr Utra are consultants for ACELITY. Dr Cullen is an employee of Systagenix, an ACELITY Company. The panel meeting was sponsored by ACELITY
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Arundel C, Buckley H, Clarke E, Cullum N, Dixon S, Dumville J, Fairhurst C, Firth A, Henderson E, Lamb K, McGinnis E, Oswald A, Goncalves PS, Soares M, Stubbs N, Torgerson D, Chetter I. Negative pressure wound therapy versus usual care for Surgical Wounds Healing by Secondary Intention (SWHSI trial): study protocol for a randomised controlled pilot trial. Trials 2016; 17:535. [PMID: 27821142 PMCID: PMC5100221 DOI: 10.1186/s13063-016-1661-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 10/17/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most incisions following surgery heal by primary intention, with the edges of the wound apposed with sutures or clips. However, some wounds may break open or be left to heal from the bottom up (i.e. healing by secondary intention). Surgical Wounds Healing by Secondary Intention (SWHSI) are often more complex to manage, and require additional treatments during the course of healing. There is significant uncertainty regarding the best treatment for these complex wounds, with limited robust evidence regarding the clinical and cost-effectiveness of different dressings and treatments; one such treatment is Negative Pressure Wound Therapy (NPWT) which is frequently used in the management of SWHSI. Previous randomised controlled trials (RCTs) of NPWT have failed to recruit to time and target, thus we aimed to conduct a pilot RCT to assess the feasibility of conducting a future, full-scale RCT. METHODS This pilot RCT will test the methods and feasibility of recruiting, randomising, and retaining participants into a larger trial of NPWT verses usual care for patients with SWHSI. Participants will be randomised to receive either NPWT or usual care (no NPWT) and will be followed up for 3 months. DISCUSSION This study will provide a full assessment of methods for, and feasibility of, recruiting, randomising, and retaining patients with SWHSI in a trial of NPWT versus usual care. On the basis of this pilot trial, a full trial may be proposed in the future which will provide additional, robust evidence on the clinical and cost-effectiveness of NPWT in the management of SWHSI. TRIAL REGISTRATION Clinical Trial Registry: ISRCTN12761776 , registered on 10 December 2015 - retrospective registration.
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Affiliation(s)
- Catherine Arundel
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK.
| | - Hannah Buckley
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Emma Clarke
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Nicky Cullum
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Stephen Dixon
- Patient and Public Involvement Group Representative, Hull, UK
| | - Jo Dumville
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Caroline Fairhurst
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Anna Firth
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - Karen Lamb
- Leeds Community Healthcare NHS Trust, Leeds, UK
| | | | - Angela Oswald
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | | | - Marta Soares
- Centre for Health Economics, University of York, York, UK
| | | | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Ian Chetter
- Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.,Hull York Medical School, York, UK
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Pañella-Vilamú C, Pereira-Rodríguez JA, Sancho-Insenser J, Grande-Posa L. Intermittent negative-pressure therapy with antibiotic instillation for necrotizing fasciitis of the abdomen and retroperitoneum due to an infected renal hematoma. Cir Esp 2014; 93:199-201. [PMID: 25443148 DOI: 10.1016/j.ciresp.2014.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 08/05/2014] [Accepted: 08/20/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Clara Pañella-Vilamú
- Servicio de Cirugía General y del Aparato Digestivo, Consorci Parc de Salut Mar, Hospital del Mar, Barcelona, España.
| | | | - Joan Sancho-Insenser
- Servicio de Cirugía General y del Aparato Digestivo, Consorci Parc de Salut Mar, Hospital del Mar, Barcelona, España
| | - Luis Grande-Posa
- Servicio de Cirugía General y del Aparato Digestivo, Consorci Parc de Salut Mar, Hospital del Mar, Barcelona, España
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Seidel D, Lefering R, Neugebauer EAM. Treatment of subcutaneous abdominal wound healing impairment after surgery without fascial dehiscence by vacuum assisted closure™ (SAWHI-V.A.C.®-study) versus standard conventional wound therapy: study protocol for a randomized controlled trial. Trials 2013; 14:394. [PMID: 24252551 PMCID: PMC4225503 DOI: 10.1186/1745-6215-14-394] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/31/2013] [Indexed: 11/26/2022] Open
Abstract
Background A decision of the Federal Joint Committee Germany in 2008 stated that negative pressure wound therapy is not accepted as a standard therapy for full reimbursement by the health insurance companies in Germany. This decision is based on the final report of the Institute for Quality and Efficiency in Health Care in 2006, which demonstrated through systematic reviews and meta-analysis of previous study projects, that an insufficient state of evidence regarding the use of negative pressure wound therapy for the treatment of acute and chronic wounds exists. Further studies were therefore indicated. Methods/design The study is designed as a multinational, multicenter, prospective randomized controlled, adaptive design, clinical superiority trial, with blinded photographic analysis of the primary endpoint. Efficacy and effectiveness of negative pressure wound therapy for wounds in both medical sectors (in- and outpatient care) will be evaluated. The trial compares the treatment outcome of the application of a technical medical device which is based on the principle of negative pressure wound therapy (intervention group) and standard conventional wound therapy (control group) in the treatment of subcutaneous abdominal wounds after surgery. The aim of the SAWHI-VAC® study is to compare the clinical, safety and economic results of both treatment arms. Discussion The study project is designed and conducted with the aim of providing solid evidence regarding the efficacy of negative pressure wound therapy. Study results will be provided until the end of 2014 to contribute to the final decision of the Federal Joint Committee Germany regarding the general admission of negative pressure wound therapy as a standard of performance within both medical sectors. Trial registration Clinical Trials.gov NCT01528033 German Clinical Trials Register DRKS00000648
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Affiliation(s)
- Dörthe Seidel
- IFOM - Institute for Research in Operative Medicine, Faculty of Health - School of Medicine, University of Witten/Herdecke, Ostmerheimer Strasse 200, Building 38, 51109, Cologne, Germany.
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Tan A, Gollop ND, Klimach SG, Maruthappu M, Smith SF. Should infected laparotomy wounds be treated with negative pressure wound therapy? Int J Surg 2013; 12:26-9. [PMID: 24246173 DOI: 10.1016/j.ijsu.2013.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/06/2013] [Accepted: 11/02/2013] [Indexed: 10/26/2022]
Abstract
A best evidence topic in surgery was written according to a structured protocol. The question addressed whether there is any benefit in treating infected laparotomy wounds with negative pressure wound therapy (NPWT). Forty-five papers were found using the reported search; of which 4 represented the best evidence to answer the question. The evidence on this subject is limited; there is a single non-randomised controlled trial, 2 prospective cohort studies, and 1 retrospective cohort study discussed in this paper. From the available literature, the use of NPWT in infected laparotomy wounds does reduce the length of hospital stay, the number of dressing changes required and promote faster wound healing.
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Affiliation(s)
- A Tan
- School of Medicine, University of Edinburgh, UK
| | - N D Gollop
- The Norfolk and Norwich University Hospital, Norwich, UK.
| | - S G Klimach
- School of Medicine, University of Sussex, Brighton, UK
| | | | - S F Smith
- School of Medicine, University of Cambridge, UK
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Zwolak P, König MA, Osterhoff G, Wilzeck V, Simmen HP, Jukema GN. Therapy of acute and delayed spinal infections after spinal surgery treated with negative pressure wound therapy in adult patients. Orthop Rev (Pavia) 2013; 5:e30. [PMID: 24416474 PMCID: PMC3883071 DOI: 10.4081/or.2013.e30] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 05/29/2013] [Accepted: 08/20/2013] [Indexed: 11/23/2022] Open
Abstract
We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland) nine patients (three women and six men; mean age 68.6, range 43-87 years) were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30). The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy.
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Affiliation(s)
- Pawel Zwolak
- Department of Trauma Surgery, University Hospital Zurich , Switzerland
| | | | - Georg Osterhoff
- Department of Trauma Surgery, University Hospital Zurich , Switzerland
| | - Verena Wilzeck
- Department of Trauma Surgery, University Hospital Zurich , Switzerland
| | - Hans-Peter Simmen
- Department of Trauma Surgery, University Hospital Zurich , Switzerland
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