N. W. Kugler1, T. Carver1, J. S. Paul1 1Medical College Of Wisconsin,Milwaukee, WI, USA
Introduction: CDC wound classification demonstrates surgical site infection (SSI) occurs in 15-30% of contaminated (class III) and >30% of dirty-infected (class IV) wounds. Several techniques have been utilized to decrease SSI rates in midline laparotomy incisions, however no technique has shown superiority. Evidence suggests incisional negative pressure wound therapy (INPWT) can decrease wound complications but no literature exists regarding INPWT for high-risk laparotomy incisions. We sought to analyze the efficacy of INPWT in the management of high-risk midline laparotomy incisions.
Methods: Retrospective review of adult patients who underwent laparotomy between January 2013 and June 2014 with midline closure utilizing INPWT. Only class III or IV wounds were included. Laparotomy incisions were loosely closed. INPWT set at 125mmHg is placed over oil emulsion impregnated gauze. INPWT is removed after 5 days and the wound left open to air. Records were reviewed for immediate and/or delayed surgical site complications. Primary endpoint was 30-day incisional SSI. Secondary endpoints included other surgical site complications.
Results: One class III and 12 class IV wounds with median of five days INPWT. The class III wound had a small skin dehiscence with no evidence of superficial or deep SSI. Three of 12 patients with a class IV wound developed a superficial SSI. Among class IV wounds, the rate of superficial and deep incisional SSI was 25% and 0% respectively. Overall surgical site complication rate was 41.7%.
Conclusion: INPWT in closure of high-risk midline laparotomy incisions is a safe, effective method of wound closure with equivalent SSI rates to previously described methods.