Current View on Prophylactic Negative Pressure Wound Therapy in Practice from Surgeons' Perspective
The journal Updates in Surgery recently published the results of a survey on prophylactic negative-pressure wound therapy (pNPWT) conducted among Swiss surgeons. The survey results show how often this therapy is used, in what situations it is typically applied, and what could make negative-pressure wound therapy more attractive in the future.
Introduction
Prophylactic negative-pressure wound therapy (pNPWT) involves applying negative pressure to a postoperative wound with the aim of reducing the incidence of surgical site infections and laparotomy wound dehiscence. Although this therapeutic approach is recommended by the UK's National Institute for Health and Care Excellence (NICE) and its efficacy is supported by meta-analyses, it is not a widely used method. Reasons may include a lack of long-term data from randomized clinical trials and the cost of the therapy.
An international medical team conducted a survey on the use of pNPWT in the Swiss healthcare system. The survey included a hundred surgeons specializing in abdominal surgery, who have been in the field on average for over 16 years.
Perceived Efficacy of pNPWT in Practice
A total of 70% of respondents confirmed active use of prophylactic negative-pressure wound therapy, 26% had never used it, and 3% of surgeons had discontinued its use, citing insufficient therapeutic effect, particularly regarding the incidence of surgical site infections. In contrast, 85.7% of respondents considered prophylactic negative-pressure wound therapy to be an effective way of preventing these infections. The effect of pNPWT on laparotomy wound dehiscence was noted by 58.6% of surgeons, while 20% reported its effectiveness in incisional hernia. A small portion of surgeons (4.3%) confirmed a beneficial impact on scar appearance. Nearly 6% of surgeons observed no effect of pNPWT in any of the mentioned aspects.
The survey authors address the topic of pNPWT's efficacy, questioning whether the observed lack of effectiveness in some cases might be related to a combination of various unfavorable circumstances or whether pNPWT might be less effective in patients with fewer risk factors for complicated wound healing or in more complex application areas.
Indications and Extent of Method Use
Regarding specific uses of pNPWT, most respondents (90%) who employ this therapy apply it in midline laparotomy, followed by stomas (30%), perineal wounds (28.6%), Pfannenstiel incisions (23.7%), inguinal incisions (22.9%), subcostal incisions (18.6%), McBurney incisions (4.3%), and other incisions (25.7%).
The survey also looked into the frequency of pNPWT use. Results indicate that 68.6% of surgeons use pNPWT in less than 10% of their patients. 14% of respondents use negative pressure therapy in 10–25% of patients, 8.6% use it in 25–50% of patients, and the remaining 2.9% of surgeons use prophylactic negative-pressure therapy in 75–100% of patients.
Limiting Factors and Room for Improvement
Respondents identified the primary limiting factors in using pNPWT to be the therapy's financial cost, application difficulties in specific areas such as the perineum or close proximity to drains and stomas, and the limited mobility of patients using pNPWT. These insights suggest various proposals for improving this therapy – better sealing, reusability of the system, better adaptability in the perineal area, smaller device size, better financial accessibility, and the ability to monitor the wound through the dressing.
Summary and Conclusion
The survey authors concluded that prophylactic negative-pressure wound therapy is a widely used method in the Swiss healthcare system, particularly in patients undergoing midline laparotomy. However, most surveyed surgeons apply it to a small portion of patients and have several practical reservations and suggestions for improvement. According to the survey authors, broader implementation of pNPWT in surgical practice requires quality, long-term studies that would also contribute to better specification of patients benefiting from this type of wound therapy and a more precise assessment of the method's effectiveness.
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Source: Roos E., Douissard J., Abbassi Z. et al. Prophylactic negative-pressure wound therapy for prevention of surgical site infection in abdominal surgery: a nationwide cross-sectional survey. Updates Surg 2021 Oct; 73 (5): 1983-1988, doi: 10.1007/s13304-021-01017-3.
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