The use of a disposable negative pressure device on acute surgical incisions

Evaluation of the treatment for acute surgical incisions using disposable negative pressure device (NPWT).

The orthopaedic team identified postoperative complications of edema, with high volumes of drainage from lower extremity incisions. These complications prompted prolonged hospitalization for the use of NPWT. Historically, NWPT has been utilized on incision lines based on reported success in the literature to facilitate drainage control and subcutanous wound closure.  This delayed discharge as incisional NPWT is not covered by insurance.  The orthopaedic team requested assistance to provide a solution that facilitates discharge from acute care.

A disposable NWPT device was initiated with twelve patients to determine if the device was effective in incision closure over a seven day life of the device. The devices were applied in the OR. Patients were selected based on risk factors (BMI greater than thirty, obesity, diabetes, smoking, a history of any previous surgical infection, revision, dehiscence or postoperative incisional drainage). Patients were monitored post discharge and data collected through the first month post op.

12 patients completed the trial. 3 had complete closure of incision with no drainage. 2 experienced drainage after the seven day application. The postoperative infection rate was 0 with 0 readmission to acute care. 5 patients did not complete the trial due to drainage beyond the capacity of canister was identified as the reason for premature device removal. 2 patients have pending results.

With a review of new literature, the variables of inclusion of only high risk patients in the trial and the avoidance of Jackson Pratt drains may have contributed to product failure.

Second phase of trial with standard NWPT placed in the OR on high risk patients is being prepared.