The Implementation of Incisional Negative Pressure Therapy in Trauma Laparotomies Leads to Fewer Open Wounds at Discharge

Abstract

Background: Surgical site infections (SSIs) tend to be higher in emergent trauma cases. To combat this increased risk, the skin is often left open and allowed to heal by secondary intention. We sought to investigate the effect of the implementation of incisional negative pressure wound therapy (iNPWT) in trauma laparotomies. Methods: A single-institution retrospective chart review was performed of trauma patients receiving an emergent exploratory laparotomy between 2015 and 2022. Patients with class II and III wounds were included. The primary outcome was open wound at discharge between the pre-iNPWT and post-iNPWT implementation. The secondary outcome was development of superficial SSI in closed wounds. Results: 260 patients, 111 pre-iNPWT and 149 post-iNPWT implementation, were included. The proportion of patients who were discharged with an open wound in the pre-iNPWT group was 52.3% vs 18.8% in the post-iNPWT group, P = <.001. The proportion of patients with closed wounds who developed a superficial SSI in the pre-iNPWT group was 12.1%, 8 of 66, vs 5.9%, 8 of 135, in the post-iNPWT group, P = .13. The proportion of patients with closed class III wounds who developed a superficial SSI was 14.0%, 7 of 50, vs 5.0%, 6 of 119, in the post-iNPWT group, P = .046. Conclusion: Our study identified a decrease in the number of patients who were discharged with an open wound after the implementation of iNPWT without an increase in SSIs. A decrease in SSIs in class III wounds closed with iNPWT was also observed.

Keywords: surgical infection; trauma; wound healing.