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Influence of negative-pressure therapy and conventional dressings on incisional wounds following abdominal wall reconstruction: a comparative study.
Alexandra Condé-Green, MD, Thomas L. Chung, MD, Luther Holton, III, MD, Helen G. Hui-Chou, MD, Yue Zhu, MD, Howard Wang, BS, Hamid R. Zahiri, DO, Devinder P. Singh, MD.
University of Maryland Medical Center, Baltimore, MD, USA.

BACKGROUND: The benefits of negative-pressure wound therapy (NPWT) are well described in the management of complex, open abdominal wounds. Improvements in surgical techniques have allowed us to achieve primary closure in a high percentage of large abdominal hernia repairs. However, postoperative wound complications remain common. The aim of our study was to investigate the effects of incisional NPWT following primary closure of the abdominal wall and to compare the outcomes of patients treated postoperatively with NPWT versus conventional gauze dressings.
METHODS: We performed a retrospective chart review of patients having undergone abdominal wall reconstruction with the components separation technique and the use of porcine acellular dermal matrix, from September 2008 to May 2011. This population of patients had primary closure of their incisions and were treated in the immediate postoperative period with either incisional NPWT or conventional dry gauze dressings. Patient information collected included history of abdominal procedures, smoking status and body mass index. Postoperative complications were analyzed using chi-square exact test and logistic regression analysis.
RESULTS: Datas from 56 patients were included in this study. Group I included 23 patients treated with incisional NPWT and Group II included 33 patients who had conventional dry gauze dressings placed on their closed incisions. The rates of overall wound complications in Groups I and II were respectively 22% and 63.6%, (p=0.020). The rates of skin dehiscence were respectively 9% and 39%, (p=0.014). Both postoperative outcomes achieved statistical significance. Rates of infection, skin and fat necrosis, seroma and hernia recurrence were respectively 4%, 9%, 0% and 4% for group I and 6%, 18%, 12%, 9% for group II.
CONCLUSIONS: This study suggests that the use of NPWT on closed incisions of patients having undergone ventral hernia repair, significantly improves the rates of postoperative wound complications and skin dehiscence when compared to those who had conventional dry gauze dressings placed on their closed wounds. Prospective, randomized, controlled sutides are needed to further characterize the potential benefits of this therapy on wound healing after abdominal wall reconstruction.


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