Enhanced Closed Incisional Negative Pressure Therapy for Treating Infectious Scars

Abstract

Background: Chronic infectious pathological scars, characterized by mutual reinforcement between infection and pathological scarring, pose challenges in reconstructive surgery. We introduce an enhanced closed incisional negative pressure therapy following a 1-stage surgery to simultaneously eradicate infection and alleviate wound tension.

Methods: A total of 25 patients who underwent chronic infectious pathological scar treatment by using this enhanced closed incisional negative pressure therapy were retrospectively reviewed. The outcomes were evaluated by postoperative recurrence frequency of infection and scarring during a 1-year follow-up, as well as the Patient and Observer Scar Assessment Scale and quality-of-life scores.

Results: After treatment, no serious complications, such as incision dehiscence, occurred. The average wound healing time was 12.68 days. Only 1 patient experienced surgical site scarring. Besides, average infection frequency decreased significantly from 6.40 to 0.00 times per year (P < 0.0001). The Patient and Observer Scar Assessment Scale score decreased from 81.60 to 25.36 (P < 0.0001), whereas the quality-of-life score increased from 2.20 to 4.88 (P < 0.0001).

Conclusions: The enhanced closed incisional negative pressure therapy effectively facilitated infectious wound healing in a 1-stage operation and simultaneously prevented infection and scarring recurrence in long-term follow-up, resulting in satisfactory postoperative outcomes.

Fig. 1.

Schematic drawing of our enhanced ciNPWT. A, A infectious scar wound with abscesses, pus, and sinuses. B, After debridement, the infectious and scarring tissues are removed. C, A fluted drainage tube is placed deep into the wound, with its ends left within the wound and the intermediate portion left outside. The wound is subsequently closed by interrupted sutures. D, A soft open-cell foam is directly placed over the incision, covering the periphery of the incision, and the intermediate portion of the drainage tube is inserted into the foam. E, The foam is sealed with adhesive film. When connected to a negative pressure device, a controlled negative environment forms underneath and above the closed incision, which facilitates the removal of excess fluid and reduces subcutaneous tension. The negative pressure is maintained at a continuous preset pressure of −80 to −100 mmHg.

Fig. 2.

Photographs of a 50-year-old woman with a thoracic infectious pathological scar. A, Preoperative, with arrows indicating the central sinus tract and the ulcers on both sides. B, Two years postoperative.

Fig. 3.

Evaluation of POSAS score. POSAS score was evaluated before surgery and at the 3-, 6-, and 12-month follow-up after surgery; ****P < 0.0001. Repeated measures one-way analysis of variance with post hoc pairwise Tukey test and generalized linear models were applied.

Fig. 4.

QOL scores evaluated before surgery and at the 3-, 6-, and 12-month follow-up after surgery. ****P < 0.0001, and ns indicates no significance. Repeated measures one-way analysis of variance with post hoc pairwise Tukey test and generalized linear models were applied.

Fig. 5.

Photographs of a 52-year-old woman with an umbilical infected hypertrophic scar: preoperative (A), immediately after the suture removal at day 10 (B), 1 month postoperative (C), and 30 months postoperative (D).