title: Closed incision negative pressure therapy: international multidisciplinary consensus recommendations.
abstract: Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words 'prevention', 'negative pressure wound therapy (NPWT)', 'active incisional management', 'incisional vacuum therapy', 'incisional NPWT', 'incisional wound VAC', 'closed incisional NPWT', 'wound infection', and 'SSIs' identified peer-reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m2); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high-risk procedure or a procedure that would have highly morbid consequences if an SSI occurred.
authors.affiliation: Department of Traumatology and Orthopaedic, Septic and Reconstructive Surgery, Research and Treatment Center for Complex Combat Injuries, Wound Centre Berlin, Bundeswehr Hospital Berlin, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Willy
authors.affiliation: Division of Orthopaedic Traumatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
authors.forename: Animesh
authors.initials: A
authors.lastname: Agarwal
authors.affiliation: Vascular/Endovascular/Limb Preservation Surgery Service, Madigan Army Medical Center, Tacoma, WA, USA.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Andersen
authors.affiliation: Plastic, Reconstructive, Microvascular and Aesthetic Surgery, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giorgio De
authors.initials: G
authors.lastname: Santis
authors.affiliation: Plastic Surgery, PeaceHealth Medical Group, Vancouver, WA, USA.
authors.forename: Allen
authors.initials: A
authors.lastname: Gabriel
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Onnen
authors.initials: O
authors.lastname: Grauhan
authors.affiliation: Surgery, Suburban Surgical Associates, St. Louis, MO, USA.
authors.forename: Omar M
authors.initials: OM
authors.lastname: Guerra
authors.affiliation: Division of Medical Sciences, University of Oxford, Oxford, UK.
authors.forename: Benjamin A
authors.initials: BA
authors.lastname: Lipsky
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Mahmoud B
authors.initials: MB
authors.lastname: Malas
authors.affiliation: Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
authors.forename: Lars L
authors.initials: LL
authors.lastname: Mathiesen
authors.affiliation: Division of Plastic Surgery, Anne Arundel Medical Center, Annapolis, MD, USA.
authors.forename: Devinder P
authors.initials: DP
authors.lastname: Singh
authors.affiliation: TriStar CV Surgery, Centennial Heart and Vascular Center, Nashville, TN, USA.
authors.forename: V Sreenath
authors.initials: VS
authors.lastname: Reddy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy / Q000379:methods* / Q000592:standards*; D017410:Practice Guidelines as Topic; D000072836:Surgical Wound / Q000382:microbiology*; D013530:Surgical Wound Infection / Q000188:drug therapy* / Q000382:microbiology*
chemical_list: D000890:Anti-Infective Agents
keywords: Consensus recommendation; Negative pressure therapy; Surgical incision management; Surgical site infection