The Use of Negative Pressure Wound Therapy After Arterial Vascular Reconstructions

BackgroundSurgical site infections following arterial reconstructions with groin dissection are common and potentially preventable. Multiple techniques are currently being used to minimize these complications. Negative pressure therapy has emerged as a potential solution to minimize groin wound complications. We designed a study to evaluate efficacy of a negative pressure therapy (PICO dressing) in reducing groin wound complications after vascular reconstructions.MethodsA retrospective single center comparative analysis of vascular reconstructions involving common femoral artery dissection was performed between July 2021 and March 2022. Patients were divided into two groups: patients who received negative pressure wound therapy using the PICO device, and those who received standard wound care (non-PICO). Patient demographics, comorbidities, vascular history, and postoperative complications were recorded and compared. The wound complications were graded as minor: seroma, hematoma, and skin dehiscence, and major involving deeper than subcutaneous dehiscence and graft explantation. Statistical significance for the mean values of two groups was determined using a two-sample t test. Z-scores were calculated for population proportions to determine P values.ResultsA total of 43 groin dissections in 37 patients were identified during the study period and analyzed. There were 18 and 25 groin dissection in PICO and non-PICO groups, respectively. The baseline characteristics were similar between the groups with statistically higher body mass index values (26.8 ± 4.5 vs 23.7 ± 3.8; P = .038) in PICO group (Table). There were comparable numbers of redo groin, open and endovascular procedures between the groups. The incidence of minor wound complications was higher in non-PICO group (20% vs 0%; P = .04; Table).ConclusionsTableComparative analysis of negative pressure wound therapy (PICO) and standard dressing application after arterial vascular reconstructionsPICONon-PICOP valueNumber of groin incisions18 (41.9%)25 (58.1%)Number of patients15 (40.5%)22 (59.5%)Demographics Age, years, mean (SD)67.3 (7.4)70.2 (11.2).349 Female, n (%)3 (20%)6 (27.3%).61 Body mass index, kg/m2, mean (SD)26.8 (4.5)23.7 (3.8).038Comorbidities Diabetes7 (46.7%)7 (31.8%).36 End-stage renal disease0 (0%)0 (0%) Coronary artery disease4 (26.7%)7 (31.8%).72 Congestive heart failure2 (13.3%)0 (0%).078 Chronic obstructive pulmonary disease3 (20%)3 (13.6%).6 Smoking (former/current)12 (80%)19 (86.4%).6 Antiplatelet use12 (80%)6 (27.3%).002 Anticoagulation use6 (40%)7 (31.8%).61 Ambulatory statusIndependent12 (80%)16 (72.7%).61Assistive device2 (13.3%)6 (27.3%).31Unknown1 (6.7%)0 (0%).21Interventions Prior endovascular procedures, mean (SD)1.13 (2.02)0.59 (0.94).347 Prior open procedures, mean (SD)0.4 (0.71)0.36 (0.57).857 Redo surgery4 (26.7%)3 (12%).37 Follow-up time, days, mean (SD)63.1 (46.9)60.1 (48.43).852Complications Wound dehiscence0 (0%)5 (20%).04 Explantation of hardware0 (0%)0 (0%)SD, Standard deviation.Boldface entries indicate statistical significance. Open table in a new tab BackgroundSurgical site infections following arterial reconstructions with groin dissection are common and potentially preventable. Multiple techniques are currently being used to minimize these complications. Negative pressure therapy has emerged as a potential solution to minimize groin wound complications. We designed a study to evaluate efficacy of a negative pressure therapy (PICO dressing) in reducing groin wound complications after vascular reconstructions. Surgical site infections following arterial reconstructions with groin dissection are common and potentially preventable. Multiple techniques are currently being used to minimize these complications. Negative pressure therapy has emerged as a potential solution to minimize groin wound complications. We designed a study to evaluate efficacy of a negative pressure therapy (PICO dressing) in reducing groin wound complications after vascular reconstructions. MethodsA retrospective single center comparative analysis of vascular reconstructions involving common femoral artery dissection was performed between July 2021 and March 2022. Patients were divided into two groups: patients who received negative pressure wound therapy using the PICO device, and those who received standard wound care (non-PICO). Patient demographics, comorbidities, vascular history, and postoperative complications were recorded and compared. The wound complications were graded as minor: seroma, hematoma, and skin dehiscence, and major involving deeper than subcutaneous dehiscence and graft explantation. Statistical significance for the mean values of two groups was determined using a two-sample t test. Z-scores were calculated for population proportions to determine P values. A retrospective single center comparative analysis of vascular reconstructions involving common femoral artery dissection was performed between July 2021 and March 2022. Patients were divided into two groups: patients who received negative pressure wound therapy using the PICO device, and those who received standard wound care (non-PICO). Patient demographics, comorbidities, vascular history, and postoperative complications were recorded and compared. The wound complications were graded as minor: seroma, hematoma, and skin dehiscence, and major involving deeper than subcutaneous dehiscence and graft explantation. Statistical significance for the mean values of two groups was determined using a two-sample t test. Z-scores were calculated for population proportions to determine P values. ResultsA total of 43 groin dissections in 37 patients were identified during the study period and analyzed. There were 18 and 25 groin dissection in PICO and non-PICO groups, respectively. The baseline characteristics were similar between the groups with statistically higher body mass index values (26.8 ± 4.5 vs 23.7 ± 3.8; P = .038) in PICO group (Table). There were comparable numbers of redo groin, open and endovascular procedures between the groups. The incidence of minor wound complications was higher in non-PICO group (20% vs 0%; P = .04; Table). A total of 43 groin dissections in 37 patients were identified during the study period and analyzed. There were 18 and 25 groin dissection in PICO and non-PICO groups, respectively. The baseline characteristics were similar between the groups with statistically higher body mass index values (26.8 ± 4.5 vs 23.7 ± 3.8; P = .038) in PICO group (Table). There were comparable numbers of redo groin, open and endovascular procedures between the groups. The incidence of minor wound complications was higher in non-PICO group (20% vs 0%; P = .04; Table). ConclusionsTableComparative analysis of negative pressure wound therapy (PICO) and standard dressing application after arterial vascular reconstructionsPICONon-PICOP valueNumber of groin incisions18 (41.9%)25 (58.1%)Number of patients15 (40.5%)22 (59.5%)Demographics Age, years, mean (SD)67.3 (7.4)70.2 (11.2).349 Female, n (%)3 (20%)6 (27.3%).61 Body mass index, kg/m2, mean (SD)26.8 (4.5)23.7 (3.8).038Comorbidities Diabetes7 (46.7%)7 (31.8%).36 End-stage renal disease0 (0%)0 (0%) Coronary artery disease4 (26.7%)7 (31.8%).72 Congestive heart failure2 (13.3%)0 (0%).078 Chronic obstructive pulmonary disease3 (20%)3 (13.6%).6 Smoking (former/current)12 (80%)19 (86.4%).6 Antiplatelet use12 (80%)6 (27.3%).002 Anticoagulation use6 (40%)7 (31.8%).61 Ambulatory statusIndependent12 (80%)16 (72.7%).61Assistive device2 (13.3%)6 (27.3%).31Unknown1 (6.7%)0 (0%).21Interventions Prior endovascular procedures, mean (SD)1.13 (2.02)0.59 (0.94).347 Prior open procedures, mean (SD)0.4 (0.71)0.36 (0.57).857 Redo surgery4 (26.7%)3 (12%).37 Follow-up time, days, mean (SD)63.1 (46.9)60.1 (48.43).852Complications Wound dehiscence0 (0%)5 (20%).04 Explantation of hardware0 (0%)0 (0%)SD, Standard deviation.Boldface entries indicate statistical significance. Open table in a new tab SD, Standard deviation. Boldface entries indicate statistical significance.