The Use of the Prevena™ Incision Management System on Post-Surgical Cesarean Section Incisions

A Prospective, Randomized, Evaluation of the Prevena™ Incision Management System on Closed Incisions in Obese Subjects Undergoing Cesarean Section Surgery

The purpose of this study is to compare the post-surgical standard-of-care dressing to the Prevena™ Incision Management System in women undergoing Cesarean section surgery.

Study Overview

• Status: Completed
• Conditions: Surgical Wound Infection; Surgical Site Infection; Post-operative Complications
• Intervention / Treatment: Device: Standard-of-care Dressing; Device: Prevena™ Incision Management System (PIMS)

Detailed Description

This is a randomized, open-label, single-center, Phase IV, comparative interventional study looking at the effect of the Prevena™ Incision Management System (PIMS) on Cesarean section Subjects compared to a control arm treated with a standard-of-care surgical incision dressing. The prospective, post-marketing clinical study described in this protocol will assess the effectiveness and functional performance of PIMS on closed incisions. Clinical outcomes of interest for this study are defined as Surgical Site Occurrences (SSOs) that include unanticipated local inflammatory response, prolonged drainage, fluid collection, dehiscence, and surgical site infection (SSI). This investigation will compare these outcomes to a control group consisting of Subjects screened for the same inclusion and exclusion criteria but treated with a standard-of-care surgical incision dressing.

• Study Type: Interventional
• Enrollment (Actual): 92
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • North Carolina
    • Durham, North Carolina, United States, 27705
      • Duke University Medical Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

Description

Inclusion Criteria:

The Subject:

1. is a female aged ≥ 18 years
2. is able to provide her own informed consent
3. will undergo a Cesarean section procedure using a subcuticular skin closure technique within the next 42 days
4. will require a surgical incision able to be covered completely by the PIMS skin interface
5. has a BMI ≥ 35 kg/m2 as determined during the Screening Period up to 42 days pre-surgery

6. is preoperatively assessed to undergo a procedure with a CDC Wound Classification of:

   1. Class I (Clean): An uninfected operative wound in which no inflammation is encountered and the respiratory, alimentary, genital, or uninfected urinary tract is not entered

      - OR -

   2. Class II (Clean Contaminated): An operative wound in which the respiratory, alimentary, genital, or uninfected urinary tract are entered under controlled conditions and without unusual contamination
7. is willing and able to return for all scheduled and required study visits
8. is not concurrently enrolled in another clinical intervention trial which may impact maternal health or the surgical site

Exclusion Criteria:

The Subject:

1. is ASA Class P4, P5, or P6 (Appendix F - American Society of Anesthesiologists (ASA) Physical Status Classification System)
2. has a systemic bacterial or fungal infection at the time of surgery
3. has a remote-site skin infection at the time of surgery
4. has a life expectancy of < 12 months

5. is preoperatively assessed to undergo a procedure with a CDC Wound Classification of:

   1. Class III (Contaminated): Open, fresh, accidental wounds, and/or major breaks in sterile technique or gross spillage from the gastrointestinal tract

      - OR -

   2. Class IV (Dirty-Infected): Old traumatic wounds with retained devitalized tissue and those that involve existing clinical infection or perforated viscera
6. experiences intraoperative hemorrhage requiring transfusion, disseminated-intravascular coagulopathy (DIC) or other medical or surgical condition during the Cesarean section deemed by the investigator to pose a prohibitively high risk for surgical re-exploration
7. who, in the investigator's opinion, would have any clinically significant condition that would impair the participant's ability to comply with the study procedures
8. has a known allergy or hypersensitivity to silver, or drape materials that contain acrylic adhesives

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Supportive Care
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Active Comparator: Standard Dressing; Standard-of-care includes coverage of the sutured incision with sterile gauze and non-penetrable barrier (e.g., Tegaderm™) consistent with the national standard for dressing Cesarean section incisions.	Device: Standard-of-care Dressing; The standard-of-care is consistent with the national standard for dressing Cesarean section incisions and includes, but not limited to, coverage of the sutured incision with sterile gauze and non-penetrable barrier (e.g., Tegaderm™). The non-penetrable barrier may be left in place for a minimum of 1 day and no longer than 2 days (± 4 hours) to promote epithelialization of the surgical incision edges. After the dressing is removed, the surgical site is left exposed to air to promote further healing. Other therapies include traditional gauze dressings with or without advanced therapies such as hydrocolloids, growth factors, and Negative Pressure Wound Therapy.; Other Names: Standard Dressing
Experimental: Prevena™ (PIMS); PIMS unit is a single patient use, battery-powered, disposable unit that can provide continuous -125 mmHg negative pressure over a 7-day therapy period.	Device: Prevena™ Incision Management System (PIMS); PIMS is a non-significant-risk, FDA Class II, medical device commercially available in the USA, Canada and Europe. The prospective, post-marketing clinical study described in this protocol will assess the effectiveness and functional performance of the system. The PIMS unit is a single patient use, battery-powered, disposable unit that can provide continuous -125 mmHg negative pressure over a 7-day therapy period. It is an easy to use device that also provides audible and visual alerts for low battery, maximum canister volume, and leak conditions. Additional alerts include system error and device life-cycle expiration (8 days). It is contained in a water-resistant housing, which allows the Subject to lightly shower with the device. Wound fluids are contained within the 45 mL canister.; Other Names: NPWT; Negative Pressure Wound Therapy; PIMS

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence of Postoperative Surgical Site Occurrences (SSOs) up to Day 42 (+/- 10 Days) Post Cesarean Section Surgery.	Incidence of postoperative surgical site occurrences (SSOs) post Cesarean section surgery. SSOs include: Unanticipated local inflammatory response; Prolonged drainage; Fluid collection; Dehiscence; Surgical site infection (SSI)	Post-op Day 42 (+/- 10 days) after Cesarean section surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Incidence Rate of Surgical Incision Intervention (SII) up to Day 42 (+/- 10 Days) Post Cesarean Section Surgery.	Incidence rate of surgical incision intervention (SII) post Cesarean section surgery. Interventions include: Antimicrobials for surgical site infection; Surgical drainage of the incision; Surgical incision packing; Adjunctive negative pressure therapy; Debridement; Re-operation	Post-op Day: 42 (+/- 10 days) after Cesarean section surgery

Collaborators and Investigators

• Sponsor: 3M
• Investigators: Principal Investigator: Robert Heine, MD, Duke University

Study record dates

Study Major Dates

• Study Start: February 1, 2012
• Primary Completion (Actual): December 1, 2013
• Study Completion (Actual): December 1, 2013

Study Registration Dates

• First Submitted: October 10, 2011
• First Submitted That Met QC Criteria: October 11, 2011
• First Posted (Estimate): October 12, 2011

Study Record Updates

• Last Update Posted (Actual): August 1, 2022
• Last Update Submitted That Met QC Criteria: July 29, 2022
• Last Verified: July 1, 2022

More Information

Terms related to this study

• Keywords: obesity; pregnancy; wound infection; surgical site infection; obese; cesarean; seroma; hematoma; cesarean delivery; wound management; incision; nosocomial infection; negative pressure wound therapy; wound complication; wound dehiscence; post-operative complication; surgical incision risk; surgical incision infection; cesarean section surgery; surgical closure; wound disruption; subcutaneous approximation; wound separation; subcutaneous closure; massive obesity; superobesity
• Additional Relevant MeSH Terms: Pathologic Processes; Wounds and Injuries; Disease Attributes; Infections; Communicable Diseases; Surgical Wound; Postoperative Complications; Surgical Wound Infection; Wound Infection
• Other Study ID Numbers: AHS.2011.Prevena.Heine.03