Is Prevena a better choice for patients with pressure ulcers after reconstruction?
Shih-Wei Yang, Chung-Yu Lai, Wang Lin Yin, Kuo-Feng Hsu, Yu-Tse Weng, Yuan-Sheng TzengObjective:
Prevena (3M KCI, US) is a new incisional negative pressure wound therapy system (iNPWT) for closed surgical incision management. The surgical management of pressure ulcers (PUs) remains challenging. A high rate of recurrence and overall complications have been reported. This study analysed the clinical efficacy of the iNPWT system in patients with PUs.
Method:
In this retrospective study, patients with stage 3 or 4 PUs who were surgically managed by a single plastic surgeon specialising in PUs at Tri-Service General Hospital, Taiwan, between January 2011 and June 2022 were reviewed. The primary outcomes assessed were: wound healing complications; dressing change frequency; and length of hospital stay. Patients were divided into two groups: those receiving the iNPWT system (iNPWT group) and those not receiving the iNPWT system (non-iNPWT group).
Results:
A total of 187 patients were included (n=161 non-iNPWT group; n=26 iNPWT group). The rate of poor outcomes (defined as partial dehiscence or inadequate wound healing that required a secondary debridement followed by primary closure or additional flap reconstruction) was 19.2% (n=5) in the iNPWT group compared to 31.1% (n=50) in the non-iNPWT group. A lower number of dressing changes was noted in the iNPWT group (p<0.001). Male sex and multiple debridement procedures (≥2 times) were significantly associated with poor outcomes, with odds ratios of 2.10 (p=0.032) and 3.72 (p=0.009), respectively. A higher albumin level (>3.0g/dl) was significantly associated with better outcomes (p=0.009).
Conclusion:
A lower poor outcome rate of wound healing was noted in the iNPWT group. Otherwise, the use of the iNPWT system reduced the number of dressing changes, which potentially reduces the caregiving burden and improves patient comfort. The Prevena system may be a more effective choice for patients with PUs after reconstruction.