Bilayered negative-pressure wound therapy preventing leg incision morbidity in coronary artery bypass graft patients: A randomized controlled trial

Yongchao Yu, Zhigang Song, Zhiyun Xu, Xiaofei Ye, Chunyu Xue, Junhui Li, Hongda Bi, Yongchao Yu, Zhigang Song, Zhiyun Xu, Xiaofei Ye, Chunyu Xue, Junhui Li, Hongda Bi

Abstract

Backgrounds: The harvesting of great saphenous veins for coronary artery bypass graft (CABG) patients may result in significant complications, including lymphorrhagia, lymphoedema, incision infection, wound dehiscence, and skin flap necrosis. We investigated the function of a self-designed bilayered negative pressure wound therapy (b-NPWT) for reducing the above-mentioned complications using a clinical randomized controlled trial.

Methods: A single-center, pilot randomized controlled trial was conducted. From December 2013 to March 2014, a total of 72 coronary heart disease patients (48 men and 24 women) received CABG therapy, with great saphenous veins were selected as grafts. Patients were equally randomized into a treatment and a control group. After the harvesting of the great saphenous veins and direct closure of the wound with sutures, b-NPWT was used for the thigh incision in the treatment group for 5 days (treatment thigh). Traditional surgical pads were applied to both the shank incisions of the treatment group patients (treatment shank) and the entire incisions of the control group (control thigh, control shank). Postoperative complications were recorded and statistically analyzed based on outcomes of thigh treatment, shank treatment, thigh control, and shank control groups.

Results: The incidence rates of early complications, such as lymphorrhagia, lymphoedema, infection, wound dehiscence, and skin flap necrosis, of the vascular donor site in the thigh treatment group was significantly lower than those in the 3 other groups.

Conclusions: The self-designed b-NPWT can effectively reduce postoperative complications, such as lymphedema, incision infection, wound dehiscence, and skin flap necrosis, in CABG patients who underwent great saphenous veins harvesting.

Trial registration: ClinicalTrials.gov. The unique registration number is NCT02010996.

Conflict of interest statement

The authors report no conflicts of interest.

Figures

Figure 1
Figure 1
Diagrammatic sketch of b-NPWT implementation. A: Harvest of a great saphenous vein through an interrupted incision in the lower limb. B: Insertion of a drainage tube into the bottom of the wound. C: After closure of the incision with sutures, the skin surface of the thigh was protected with multiple vaseline gauzes in which the second drainage tube was inserted. D: The gauze was fixed and compressed on the skin with adhesives tape, and 2 tubes were connected to a negative pressure source (−120 mm Hg) followed by sustained vacuum suction. E: Gloss view of the b-NPWT in a patient. b-NPWT = bilayered negative pressure wound therapy.
Figure 2
Figure 2
Typical cases and long-term follow up. The b-NPWT treatment was immediately implemented covering incision in the thigh of treatment group (A), and removed in day 5 (C), while traditional surgical pad was used to protect the wound in control group in the same period (B, D). Skin and subcutaneous tissue edema (F, G, and H) occurred in T-shank, C-thigh, and C-shank (yellow arrow) without exception; in contrast, local skin remained in contractive appearance in T-thigh for several days after the cessation of b-NPWT (E). Significant complications occurred in T-shank, C-thigh, and C-shank (J, K, L, red arrow), including lymphorrhagia, incision infection, and wound dehiseence, while the incision healed unevenly in T-thigh (I) without hypertrophic scar (M) that usually formed in the control site (N, O, P) during 3 months’ follow up. C-shank = control shank, C-thigh = control thigh, T-shank = treatment shank, T-thigh = treatment thigh.

References

    1. Kim KB, Lim C, Lee C, et al. Off pump coronary artery bypassmay decrease the patency of saphenous vein grafts. Ann Thorac Surg 2001;72:1033–7.
    1. Kamiya H, Watanabe G, Takemura H, et al. Skeletonization of gastroepiploic artery graft in off pump coronary artery bypass grafting: early clinical and angiogragphic assessment. Ann Thorac Surg 2004;77:2046–50.
    1. Raja SG, Dreyfus GD. Internal thoracic: to skeletonize or not to skeletonize? Ann Thorac Surg 2005;79:1805–11.
    1. Maniar HS, Barner HB, Bailey MS. Radial artery patency:are aortocoronary conduits superior to composite grafting? Ann Thorac Surg 2003;76:1498–503.
    1. Cameron J, Trivedi S, Stafford G, et al. Five year angiographic patency of radial aetery bypass grafts. Circulation 2004;110:23–6.
    1. Sabik JF, 3rd, Lytle BW, Blackstone EH, et al. Does competitive flow reduce internal thoracic artery graft patency? Ann Thorac Surg 2003;76:1490–6.
    1. Joung B, Park S, Choi D, et al. The impact of the reoperative severity of target vessel stenosis on the short term patency of radial artery graft. J Yonsei Med 2004;31:635–42.
    1. Bi H, Fang S, Jiang D, et al. Ultrasound-guided scraping of fibrous capsule plus bilayered negative pressure wound therapy for treatment of refractory postmastectomy seroma. J Plast Reconstr Aesthet Surg 2014;11:1748–68.
    1. Raja SG, Haider Z, Ahmad M, et al. Saphenous vein grafts: to use or not to use? Heart Lung Circ 2004;13:403–9.
    1. Zhou M, Yu A, Wu G, et al. Role of different negative pressure values in the process of infected wounds healing treated by vacuum-assisted closure: an experimental study. Int Wound J 2012;10:508–15.
    1. Borgquist O, Ingemansson R, Malmsjö M. Wound edge microvascular blood flow during negative-pressure wound therapy: examining the effects of pressures from −10 to −175 mmHg. Plast Reconstr Surg 2010;125:502–9.
    1. Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 1997;38:563–76. discussion 577.
    1. Argenta LC, Morykwas MJ, Marks MW, et al. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg 2006;117:127–42.
    1. Bassetto F, Lancerotto L, Salmaso R, et al. Histological evolution of chronic wounds under negative pressure therapy. J Plast Reconstr Aesthet Surg 2012;65:91–9.
    1. Borgquist O, Anesäter E, Hedström E, et al. Measurements of wound edge microvascular blood flow during negative pressure wound therapy using thermodiffusion and transcutaneous and invasive laser Doppler velocimetry. Wound Repair Regen 2011;19:727–33.
    1. Murphey GC, Macias BR, Hargens AR. Depth of penetration of negative pressure wound therapy into underlying tissues. Wound Repair Regen 2009;17:113–7.
    1. Kairinos N, Solomons M, Hudson DA. Negative-pres—sure wound therapy I: the paradox of negative—pressure wound therapy. Plast Reconstr Surg 2009;123:589–600.
    1. Kairinos N, Voogd AM, Botha PH, et al. Negative-pressure wound therapy II: negative-pressure wound therapy and increased perfusion. Just an illusion? Plast Reconstr Surg 2009;123:601–12.
    1. Kairinos N, Solomons M, Hudson DA. The paradox of negative pressure wound therapy—in vitro studies. J Plast Reconstr Aesthet Surg 2010;63:174–9.
    1. Erba P, Ogawa R, Ackermann M, et al. Angiogenesis in wounds treated by microdeformational wound therapy. Ann Surg 2011;253:402–9.
    1. Webster J, Scuffham P, Stankiewicz M, et al. Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention. Cochrane Database Syst Rev 2014;10:1458–65.
    1. Hamed O, Muck PE, Smith JM, et al. Use of vacuum-assisted closure (VAC) therapy in treating lymphatic complications after vascular procedures: new approach for lymphoceles. J Vasc Surg 2008;48:1520–3. 1523.e1-4.
    1. Labanaris AP, Polykandriotis E, Horch RE. The effect of vacuum-assisted closure on lymph vessels in chronic wounds. J Plast Reconstr Aesthet Surg 2009;62:1068–75.
    1. Mayar R, Sminia P, McBride WH. Lymphatic fistulas: obliteration by low-dose radiotherapy. Strahlentherapie Onkol 2005;181:660–4.
    1. Woodworth PA, McBoyle MF, Helmer SD, et al. Seroma formation after breast cancer surgery: incidence and predicting factors. Am Surg 2000;66:444–50. discussion 450–1.
    1. Say CC, Donegan W. A biostatistical evaluation of complications from mastectomy. Surg Gynecol Obstet 1974;138:370–6.
    1. Roses DF, Brooks AD, Harris MN, et al. Complications of level I and II axillary dissection in the treatment of carcinoma of the breast. Ann Surg 1999;230:194–201.
    1. Thomson DR, Sadideen H, Furniss D. Wound drainage following groin dissection for malignant disease in adults. Cochrane Database Syst Rev 2014;11:109–33.
    1. Budd DC, Cochran RC, Sturtz DL, et al. Surgical morbidity after mastectomy operations. Am J Surg 1978;135:218–20.
    1. Spiess PE, Hernandez MS, Pettaway CA. Contemporary inguinal lymph node dissection: minimizing complications. World J Urol 2009;27:205–12.
    1. McMasters KM. Why does no one want to perform lymph node dissection anymore? Ann Surg Oncol 2010;17:358–61.
    1. Satzger I, Meier A, Hoy L. Sentinel node dissection delays recurrence and prolongs melanoma-related survival: an analysis of 673 patients from a single center with long-term follow-up. Ann Surg Oncol 2011;18:514–20.
    1. van Vledder MG, van der Hage JA, Kirkels WJ. Cervical lymph node dissection for metastatic testicular cancer. Ann Surg Oncol 2010;17:1682–7.
    1. Wagstaff MJ, Driver S, Coghlan P, et al. A randomized, controlled trial of negative pressure wound therapy of pressure ulcers via a novel polyurethane foam. Wound Repair Regen 2014;22:205–11.
    1. Masden D, Goldstein J, Endara M, et al. Negative pressure wound therapy for at-risk surgical closures in patients with multiple comorbidities: a prospective randomized controlled study. Ann Surg 2012;255:1043–7.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi