title: Evaluation of closed incision management with negative pressure wound therapy (CIM): hematoma/seroma and involvement of the lymphatic system.
abstract: The objective of this porcine study was to evaluate the effect of closed incision management with negative pressure wound therapy (CIM) on hematoma/seroma formation, fluid removal into the CIM canister, and involvement of the lymphatic system. In each swine (n = 8), two sets of ventral contralateral subcutaneous dead spaces with overlying sutured incisions were created. Stable isotope-labeled nanospheres were introduced into each subcutaneous dead space. Each contralateral incision was assigned to CIM (continuous -125 mmHg negative pressure) and control (semipermeable film dressing), respectively. Following 4 days of therapy, hematoma/seroma was weighed, total fluid volume in canisters was measured, five pre-identified lymph nodes were harvested, and five key organs were biopsied. There was 25 ± 8 g (standard error [SE]) (63%) less hematoma/seroma in CIM sites compared to control sites (p = 0.002), without any fluid collection in the CIM canister. In lymph nodes, there were ∼60 μg (∼50%) more 30- and 50-nm nanospheres from CIM sites than from control sites (p = 0.04 and 0.05, respectively). There was significantly greater nanosphere incidence from CIM sites than from control sites in lungs, liver, and spleen (p < 0.05); no nanospheres were detected in kidney biopsies. Thus, in this porcine model, application of CIM significantly decreased hematoma/seroma levels without fluid collection in the canister, which may be explained by increased lymph clearance.
authors.affiliation: Kinetic Concepts, Inc, San Antonio, Texas, USA. kilpadid@kci1.com
authors.forename: Deepak V
authors.initials: DV
authors.lastname: Kilpadi
authors.forename: Mark R
authors.initials: MR
authors.lastname: Cunningham
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D001458:Bandages; D004322:Drainage; D005260:Female; D006406:Hematoma / Q000473:pathology / Q000517:prevention & control*; D007553:Isotope Labeling; D008198:Lymph Nodes / Q000737:chemistry / Q000473:pathology; D054118:Nanospheres / Q000032:analysis; D054843:Negative-Pressure Wound Therapy; D049291:Seroma / Q000473:pathology / Q000517:prevention & control*; D012867:Skin / Q000737:chemistry / Q000473:pathology; D034421:Sus scrofa; D013537:Sutures; D014781:Viscera / Q000737:chemistry / Q000473:pathology