title: A preliminary study of the effect of closed incision management with negative pressure wound therapy over high-risk incisions.
abstract: BACKGROUND
  Certain postoperative wounds are recognised to be associated with more complications than others and may be termed high-risk. Wound healing can be particularly challenging following high-energy trauma where wound necrosis and infection rates are high. Surgical incision for joint arthrodesis can also be considered high-risk as it requires extensive and invasive surgery and postoperative distal limb swelling and wound dehiscence are common. Recent human literature has investigated the use of negative pressure wound therapy (NPWT) over high-risk closed surgical incisions and beneficial effects have been noted including decreased drainage, decreased dehiscence and decreased infection rates. In a randomised, controlled study twenty cases undergoing distal limb high-energy fracture stabilisation or arthrodesis were randomised to NPWT or control groups. All cases had a modified Robert-Jones dressing applied for 72 h postoperatively and NPWT was applied for 24 h in the NPWT group. Morphometric assessment of limb circumference was performed at six sites preoperatively, 24 and 72 h postoperatively. Wound discharge was assessed at 24 and 72 h. Postoperative analgesia protocol was standardised and a Glasgow Composite Measure Pain Score (GCPS) carried out at 24, 48 and 72 h. Complications were noted and differences between groups were assessed.
  
  
  RESULTS
  Percentage change in limb circumference between preoperative and 24 and 72 h postoperative measurements was significantly less at all sites for the NPWT group with exception of the joint proximal to the surgical site and the centre of the operated bone at 72 h. Median discharge score was lower in the NPWT group than the control group at 24 h. No significant differences in GCPS or complication rates were noted.
  
  
  CONCLUSIONS
  Digital swelling and wound discharge were reduced when NPWT was employed for closed incision management. Larger studies are required to evaluate whether this will result in reduced discomfort and complication rates postoperatively.
authors.affiliation: Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, 736 Wilson Road, East Lansing, MI, 48824, USA. kperry@cvm.msu.edu.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Perry
authors.affiliation: Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK. lrutherford@rvc.ac.uk.
authors.forename: Lynda
authors.initials: L
authors.lastname: Rutherford
authors.affiliation: Department of Clinical Science and Services, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK. dsajik@rvc.ac.uk.
authors.forename: David M R
authors.initials: DM
authors.lastname: Sajik
authors.affiliation: Department of Production and Population Health, The Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, UK. mbruce@rvc.ac.uk.
authors.forename: Mieghan
authors.initials: M
authors.lastname: Bruce
mesh_terms: D000818:Animals; D002371:Cat Diseases / Q000517:prevention & control*; D002415:Cats; D004283:Dog Diseases / Q000517:prevention & control*; D004285:Dogs; D005260:Female; D005592:Fracture Fixation / Q000662:veterinary; D008297:Male; D054843:Negative-Pressure Wound Therapy / Q000662:veterinary*; D011183:Postoperative Complications / Q000517:prevention & control*; D013529:Surgical Wound Dehiscence / Q000517:prevention & control / Q000662:veterinary*; D013530:Surgical Wound Infection / Q000517:prevention & control / Q000662:veterinary*; D014947:Wounds and Injuries / Q000601:surgery