Dr's using negative pressure devices (vac's) on closed surgical incision

I've just come off wound vac due dehiscence. :)

Plastic surgeon + WOCN discussed this was being used by some docs post op for patients at high risk for dehiscence + ongoing incision drainage --it is different vac from one to close wound, used for up to first 7 days.

Info:

KCI Prevena, the first powered negative pressure wound therapy product, is designed for management of closed surgical incisions.

Clinician instructions

Indication for Use

The Prevenaâ„¢ Incision Management System is intended to manage the environment of surgical incisions that continue to drain following sutured or stapled closure by maintaining a closed environment and removing exudate via the application of negative pressure wound therapy.

Optimum Use Conditions

For maximum benefit the Prevenaâ„¢ IMS should be applied immediately post surgery to clean surgically closed wounds. It is to be continuously applied for a minimum of two days up to a maximum of seven days. It can transition home with the patient; however, all Prevenaâ„¢ Dressing changes should be performed under direct medical supervision.

The Prevenaâ„¢ IMS will not be effective in addressing complications associated with the following:

•ischemia to the incision or incision area

•untreated or inadequately treated infection

•inadequate hemostasis of the incision

•cellulitis of the incision area

The Prevena™ IMS should not be used to treat open or dehisced surgical wounds or on patients who have excessive amounts of exudate from the incision area which may exceed the Prevena™ 45 mL Canister. The V.A.C.® Therapy System should be considered for treatment of these wounds.

The Prevenaâ„¢ IMS should be used with caution in the following patients:

•patients with fragile skin surrounding the incision as they may experience skin or tissue

damage upon removal of the Prevenaâ„¢ Dressing

•patients who are at an increased risk of bleeding from the incision due to anticoagulants or platelet aggregation inhibitors.

CONTRAINDICATION

• sensitivity to silver
  

There are actually vac dressings intended for use with closed incisions- KCI's Prevena comes to mind. A bit more pricey, but at least it can be used as intended.

Negative pressure wound therapy for management of the surgical incision in orthopaedic surgery

A review of evidence and mechanisms for an emerging indication

Abstract

Objectives

The period of post-operative treatment before surgical wounds are completely closed remains a key window, during which one can apply new technologies that can minimise complications. One such technology is the use of negative pressure wound therapy to manage and accelerate healing of the closed incisional wound (incisional NPWT).

Methods

We undertook a literature review of this emerging indication to identify evidence within orthopaedic surgery and other surgical disciplines. Literature that supports our current understanding of the mechanisms of action was also reviewed in detail.

Results

A total of 33 publications were identified, including nine clinical study reports from orthopaedic surgery; four from cardiothoracic surgery and 12 from studies in abdominal, plastic and vascular disciplines. Most papers (26 of 33) had been published within the past three years. Thus far two randomised controlled trials – one in orthopaedic and one in cardiothoracic surgery – show evidence of reduced incidence of wound healing complications after between three and five days of post-operative NPWT of two- and four-fold, respectively. Investigations show that reduction in haematoma and seroma, accelerated wound healing and increased clearance of oedema are significant mechanisms of action.

Conclusions

There is a rapidly emerging literature on the effect of NPWT on the closed incision. Initiated and confirmed first with a randomised controlled trial in orthopaedic trauma surgery, studies in abdominal, plastic and vascular surgery with high rates of complications have been reported recently. The evidence from single-use NPWT devices is accumulating. There are no large randomised studies yet in reconstructive joint replacement.

Cite this article: Bone Joint Res 2013;2:276–84.

Further articles:

Wound vac question/vent

Incisional Negative Pressure Therapy to High-Risk Wounds

Use of Negative Pressure Therapy on Closed Surgical Wounds

Use of an Incision-Line Negative Pressure Wound Therapy Technique to Protect High-Risk Diabetic Foot Wounds, Postoperatively

Smith and Nephew PICO pump

Negative-pressure wound therapy and the emerging role of incisional negative pressure wound therapy as prophylaxis against surgical site infections