Prophylactic negative pressure wound therapy at cesarean: Are we there yet?

Abstract

Prophylactic negative pressure wound therapy (NPWT) has emerged as a promising intervention in patients at high risk for surgical site infection (SSI). One such group is obese gravidae, a growing population worldwide who are at high risk for both cesarean delivery and SSI. Although the precise mechanism by which NPWT aids incisional wound healing is unclear, experimental evidence suggests that it reduces bacterial contamination, edema, and exudate, increases microvascular blood flow, promotes formation of granulation tissue and reduces lateral tensile and shear stress. Data on NPWT after cesarean have hitherto been limited to retrospective cohort and small pilot randomized trials (RCT). Whereas some studies demonstrated benefit in reducing SSI and other wound complications, they were limited by small sample sizes, selection bias and confounding.