What Are The Indications for Closed Incision Negative Pressure Therapy and Do We Adhere to Them in Practice?
Sina Foroutanjazi1,2,*, Michael Jonczyk1,3, Lilian Chen1, Abhishek Chatterjee1 1Tufts Medical Center, Department of Surgery, 800 Washington Street, Boston, MA 02111; achatterjee1.org (A.C.) 2 Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA; sina.foroutanjazi.edu (S.F.) 3Department of Clinical and Translational Science, Tufts University Sackler Graduate School, 136 Harrison Ave #813, Boston, MA 02111, USA * Correspondence: sina.foroutanjazi.edu
Background:
Decreasing wound complications is particularly challenging in patients with obesity, diabetes mellitus, vasculopathies, smoking history, and steroid use. Surgical site infections, wound dehiscence, hematomas, and seromas define wound complications. More recently, Closed Incision Negative Pressure Therapy (CINPT) has shown promise in reducing wound complications. The FDA indications for using CINPT are nonspecific, as they recommend utilizing them in "high-risk patients" and "to maintain a closed environment [to] remove exudate". We performed a literature review looking for indications for the use of CINPT and subsequently reviewed the ACS-NSQIP database to demonstrate adherence to such indications.
Methods:
A standard literature review of the PubMed and Google Scholar was performed using the following keywords: "negative pressure therapy", "wound vac", "comorbidities", "closed incision", "indications". We reviewed selected articles to determine the clinical indications for CINPT and then analyzed the ACS-NSQIP database to determine if clinical practice adhered to literature indication guidelines for the use of CINPT.
Results:
The literature review of 32 articles showed that the most recommended indications for using CINPT were DM (56.25%), chronic conditions such as CHF, CVD, CKD, COPD (53.13%), BMI >30 (43.75%), and smoking status (31.25%). ACS-NSQIP data suggested CINPT is more frequently used in patients with DM (22.7%), BMI>30 (47.1%), hypertension (58%), ASA class III or over (81.2%), suggesting adherence to literature guidelines.
Conclusion:
The major evidence-based indications for using CINPT, as shown in the literature review and confirmed with the ACS-NSQIP data, are DM, BMI>30, and history of smoking.
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