Micro-power negative pressure wound technique reduces risk of incision infection following loop ileostomy closure

Abstract

Background: Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer. Incisional surgical site infection (SSI) is a common complication after ileostomy closure.

Aim: To evaluate the efficacy and safety of the micro-power negative pressure wound technique (MPNPWT) in preventing incisional SSI.

Methods: This was a prospective, randomized controlled clinical trial conducted at a single center. A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021. Patients were randomly allocated into an MPNPWT group and a control group. The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing. The surgical outcomes were compared between the MPNPWT (n = 50) and control (n = 51) groups. Risk factors for incisional SSI were identified using logistic regression.

Results: There were no differences in baseline characteristics between the MPNPWT (n = 50) and control groups (n = 51). The incisional SSI rate was significantly higher in the control group than in the MPNPWT group (15.7% vs 2.0%, P = 0.031). However, MPNPWT did not affect other surgical outcomes, including intra-abdominal complications, operative time, and blood loss. Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups (P = 0.069 and 0.843, respectively). None of the patients experienced adverse effects of MPNPWT, including skin allergy, dermatitis, and pain. MPNPWT also helped heal the infected incision. Our study indicated that MPNPWT was an independent protective factor [odds ratio (OR) = 0.005, P = 0.025)] and diabetes was a risk factor (OR = 26.575, P= 0.029) for incisional SSI.

Conclusion: MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.

Keywords: Ileostomy closure; Incisional surgical site infection; Infection prevention; Micro-power negative pressure technique; Postoperative incision.

Figure 1

Composition and working principle of micro-power negative pressure wound technique. A: The wound dressing is made of a special polyvinyl alcohol foam material. The material covers the wound and is sealed by a medical transparent film. In this way, it becomes a three-layer dressing containing a medical film layer, liquid locking layer, and micro-power vacuum and pumping effect layer; B: When exudates are absorbed into the liquid locking layer, the dressing expands, and the medical film layer is elevated. Then the closed space becomes larger and forms a local micro-power vacuum, which exerts negative pressure attraction on the wound and its deep soft tissue.

Figure 2

Incision equipped with micro-power negative pressure wound dressing. A: During the surgery, the incision was intermittently sutured with 2-0 Prolene with a 10-12 mm needle spacing in the micro-power negative pressure wound technique group; B: Then the micro-power negative pressure wound dressing was equipped immediately; C: When exudates were absorbed, they appeared on the the material’s surface, and the dressing expanded; D: A clean and dry incision was obtained after removing the material in 72 h.

Figure 3

Consort diagram.