Comparison of surgical site infection between negative pressure wound therapy and standard dressing on closed midline incisions in Class 3 and 4 abdominal surgical wounds: A Randomized control trial

Despite peri-operative preventive measures to minimize the risk of SSI, such as hand hygiene of the surgical team, antibiotic prophylaxis, skin preparation, and sterile drapes and gowns SSI remains a challenging problem to surgeons and patients worldwide.SSIs prolong hospitalization, increase the risk of morbidity and mortality and need for repeat surgery thereby increasing healthcare costs and form a major burden on the health infrastructure.

Prophylactic negative pressure wound therapy (pNPWT) uses a closed, sealed device that is packed with porous foam or gauze dressing and sealed with an occlusive drape and continuous negative pressure rates of between-50 to -125 mm Hg maintained by connecting suction tubes to the dressing .It enhances wound healing by reducing dead space, oedema and exudates , hastening granulation tissue formation, decreasing bacterial burden, providing a moist wound healing environment and increasing blood circulation by angiogenesis.

WHO panel guidelines suggest the use of negative pressure wound therapy (NPWT) in adult patients on primarily closed surgical incisions in high-risk wounds, for the purpose of the prevention of SSI.

Justification:While there has been extensive research on the beneficial effects of negative pressure wound therapy on open wounds such as diabetic foot and non-healing ulcers, there are few studies which evaluated the effects of negative pressure wound therapy on closed midline incisions in patients undergoing laparotomy with grossly contaminated abdominal surgeries

Standard dressing involves use of dry sterile gauge pieces. WHO panel suggests against using any type of advanced dressings over a standard dressing on primarily closed surgical wounds for the purpose of preventing SSI.

Although the use of NPWT has conventionally been researched in open wounds, their use on closed laparotomy wounds has been found to be associated with a significant reduction in SSI rates.This will lead to a reduction in the overall economic burden and complications following laparotomy by decreasing length of hospital stay and reducing the number of readmissions and need for re-exploration