The efficacy of cuff-shaving combined with negative pressure wound therapy in refractory exit-site and tunnel infections: a single center experience

Abstract

Background: Refractory exit-site infections (ESIs) and tunnel infections (TIs) are challenging complications for patients undergoing peritoneal dialysis (PD). This study compared the outcomes of surgical intervention, notably the cuff-shaving (CS) procedure coupled with negative-pressure wound therapy (NPWT), and conservative management strategies for patients with refractory ESI and TI.

Methods: We retrospectively reviewed patients who underwent PD at our center, focusing on the incidence and management of ESI and TI. We evaluated and compared treatment outcomes, including ESI scores, frequency of ESI and/or TI, identification of causative microorganisms, and duration of catheter survival or time until removal.

Results: We identified 97 episodes of catheter-related ESI and/or TI across 71 patients with an incidence rate of 0.15 episodes per patient-year. Of the 23 patients with refractory ESI and/or TI, surgical intervention was performed in 8, while 15 chose conservative management. In the one-month follow-up, patients who underwent CS combined with NPWT showed no complications such as leakage, and their local symptoms resolved completely. The mean PD catheter survival time was significantly longer in the surgical group (29.38 ± 7.25 months) than in the conservative group (7.86 ± 2.13 months). Surgical intervention demonstrated a significantly higher therapeutic efficacy and extended catheter survival.

Conclusions: The combination of CS and NPWT as a surgical approach is crucial for eradicating infectious foci and significantly improving the longevity of PD catheter function. This integrated surgical strategy offers a promising solution for the management of refractory ESI and TI in patients undergoing PD.

Keywords: Negative pressure wound therapy; Peritoneal dialysis catheter; Refractory exit-site infection; Superficial cuff-shaving; Tunnel infection.

Fig. 1

(A) The extent of the tunnel infection (outlined with a blue marker pen), the superficial cuff location (thick black arrow), and redness and swelling of the external orifice with purulent discharge (thin black arrow). (B) A skin incision of about 3–4 cm at the level of the exit-site in the direction of the superficial cuff. (C) Localization of the superficial cuff by blunt dissection and isolation of the superficial cuff from the adipose and tissue. (D) Careful shaving of the cuff using a scalpel and curved forceps until the cuff material was removed. (E) Placement of the high negative pressure drainage tube, and fixation of the high negative pressure drainage bottle with sutures. (F) The remaining shadow of the superficial cuff at the end of the procedure, and removal of the drainage tube through the outside of the incision

Fig. 2

Healed wound one month after superficial cuff-shaving. The original superficial cuff position is indicated by the arrow

Fig. 3

Catheter survival time in the surgical treatment group (blue line) and conservative management group (green line). Kaplan–Meier analysis of catheter survival curve (log-rank test: χ2 = 6.017, p = 0.014)