![]() In clinical application, intermittent mode has shown an increased potential for pain due to repeated wound filler contraction and expansion ( 33). Though preclinical studies show higher granulation under intermittent and variable pressures, continuous delivery is the established normal setting in clinical practice ( 33). Pressure modes can be changed between continuous, intermittent, and variable delivery. Pressures can also be lowered if the patient experiences pain or excessive amount of blood is seen in the canister despite hemostasis. However, it is recommended to avoid using higher NPWT pressures in wounds with compromised vascularity or risk of ischemia ( 9). Bridge modification enables the suction pad to be placed outside weight-bearing area of the foot allowing patients to wear protective shoes and offloading gear while on NPWT. Higher pressures can be used when there is high exudate and wound fluids ( 32) or in instances such as application of a bridge NPWT dressing. In clinical practice, 125 mmHg is the normal setting though levels can vary between 50 and 150 mmHg depending on the wound type ( 31). In vitro studies showed that at subatmospheric pressures of 125 mmHg, there is a fourfold increase in blood flow ( 4). The NPWT pump delivers the desired negative pressure to the entire system. Pressure setting: what pressure level and whether Although underlying wound deformation by foam and gauze are different, studies show no differences in the time to complete healing between the two filler types ( 30). Similar to white foam, gauze is also useful in wounds where post-debridement soft tissue structures such as tendons and bone are exposed. Gauze is alternate filler and is useful for irregular wounds because of its conformability and ease of application ( 27). silver) impregnated foam is also available to provide antibacterial cover during NPWT ( 28, 29). It is also beneficial for use on exposed tendons and bones. Its higher tensile strength and less adherent properties are typically indicated for use in tunnels and shallow undermining. The polyvinyl ‘white’ foam is hydrophilic or moisture retaining. Foam-induced scarring further aids in wound contracture and size reduction. This foam results in thick and rapid granulation ( 27) and is ideal for wounds with large defects after radical debridement. ![]() The conventional ‘black’ PU foam is hydrophobic or water repelling and enables the dressing to conform to the wound bed providing the foam–tissue interface. Commonly used fillers in diabetic wounds are polyurethane (PU), polyvinyl alcohol foam, and saline-moistened gauze. Wound filler characteristics determine most of the effects of NPWT on the wound bed. International Wound Journal published by Inc and John Wiley & Sons Ltd.Wound filler type: black foam, white foam, or gauze? Existing evidence suggests that ciNPWT has a positive impact on patients undergoing spinal fusion surgery, as it significantly reduces the incidence of postoperative surgical site wound infections however, it does not result in a shorter hospital stay for patients.Ĭlosed incision meta negative-pressure wound therapy spine surgery wound infection. The meta-analysis results revealed that ciNPWT significantly reduced the incidence of SSIs in patients undergoing spinal fusion surgery (OR, 0.39 95% CI: 0.22-0.67, p = 0.0007) however, it did not lead to a reduction in hospital stay duration (SMD: -0.48, 95% CI: -0.98 to 0.01, p = 0.06). In total, eight articles involving 1198 patients, including 391 in the experimental group and 807 in the control group, were included. RevMan 14.0 and STATA 17.0 were employed for meta-analysis of the extracted data. Meta-analyses were performed using the odds ratios (ORs) and standardised mean differences (SMDs) as effect variables. The literature screening and data extraction were performed by two researchers based on predefined inclusion and exclusion criteria, followed by a quality assessment of the included studies. Relevant studies pertaining to the application of ciNPWT in spinal surgery were retrieved through searches of the PubMed, Embase, MEDLINE and Cochrane Library databases, spanning from their inception to May 2023. The present meta-analysis was conducted to comprehensively assess the impact of closed-incision negative-pressure wound therapy (ciNPWT) on the incidence of surgical site infections (SSIs) in patients undergoing spinal fusion surgery, thereby aiming to provide evidence-based support for the prevention of postoperative wound infections during spinal surgery.
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