European Journal of Cardiovascular Medicine

Complex surgical wounds present significant management challenges due to their tendency for delayed healing, high susceptibility to infection, and increased risk of complications. These wounds often result from trauma, dehiscence, infection, or chronic disease conditions and require advanced wound care strategies to promote timely and efficient healing (1,2). Traditional wound management techniques, such as moist dressings and conventional gauze therapy, may not be sufficient in optimizing the healing environment for such wounds, often resulting in prolonged hospital stays and increased healthcare costs (3).

Negative Pressure Wound Therapy (NPWT), also known as vacuum-assisted closure, has gained widespread acceptance as a beneficial modality for treating acute and chronic complex wounds. The mechanism of NPWT involves the application of sub-atmospheric pressure to the wound bed through a sealed dressing system, which enhances local blood flow, reduces tissue edema, stimulates granulation tissue formation, and aids in the removal of exudate and infectious material (4,5). Various clinical studies have demonstrated its effectiveness in accelerating wound healing, minimizing bacterial load, and improving patient outcomes compared to conventional methods (6,7).

Despite growing evidence supporting NPWT, its application in different clinical scenarios and wound types continues to be evaluated to establish standardized protocols and identify potential limitations. This study aims to assess the effectiveness of NPWT in the management of complex surgical wounds by comparing clinical outcomes with those achieved through conventional dressing methods.

This prospective, randomized clinical study was conducted over a period of six months in the Department of Surgery at a tertiary care hospital. A total of 60 patients with complex surgical wounds were enrolled after obtaining informed consent.

Inclusion criteria included patients aged 18 to 70 years with complex wounds resulting from surgical site infections, wound dehiscence, or trauma. Exclusion criteria were patients with active malignancy, uncontrolled diabetes, bleeding disorders, or those receiving immunosuppressive therapy.

The participants were randomly divided into two equal groups (n=30 each). Group A received Negative Pressure Wound Therapy (NPWT), while Group B was treated with conventional moist wound dressings. NPWT was applied using commercially available vacuum-assisted closure devices. The dressing consisted of a sterile foam placed in the wound cavity and covered with an occlusive drape connected to a negative pressure unit set at −125 mmHg. Dressings were changed every 48–72 hours. In the control group, saline-moistened gauze dressings were applied and changed twice daily.

Clinical parameters assessed included wound size (measured using a sterile ruler), percentage reduction in wound area, time to complete granulation, infection status (based on clinical signs and wound swab culture), and patient satisfaction (measured using a visual analog scale). Evaluations were performed at baseline and subsequently on Days 7, 14, and 21.

Data were recorded and statistically analyzed using SPSS software version 25. Quantitative variables were expressed as mean ± standard deviation and compared using the Student’s t-test. Categorical data were analyzed using the Chi-square test. A p-value of <0.05 was considered statistically significant.

A total of 60 patients were included in the study, with 30 patients each in Group A (NPWT) and Group B (Conventional Dressing). The mean age of participants was 48.6 ± 12.3 years in Group A and 50.2 ± 11.7 years in Group B. The gender distribution was comparable between groups (p > 0.05).

At the end of 21 days, a significant reduction in wound size was observed in Group A compared to Group B. The mean percentage reduction in wound area was 65.4% ± 10.2 in Group A and 36.7% ± 8.5 in Group B (p < 0.001) (Table 1).

Table 1: Comparison of Wound Area Reduction between Groups

Additionally, the average time to achieve healthy granulation tissue was significantly shorter in the NPWT group (13.5 ± 3.2 days) compared to the conventional group (18.7 ± 4.1 days) (Table 2).

Table 2: Time to Complete Granulation Formation

Infection rates were also lower in Group A, with only 3 patients (10%) developing wound infections, compared to 9 patients (30%) in Group B. This difference was statistically significant (p = 0.04) (Table 3).

Table 3: Postoperative Infection Rates

Patient satisfaction, measured on a scale of 1 to 10, was significantly higher in the NPWT group (mean score 8.4 ± 1.1) compared to the conventional dressing group (6.1 ± 1.3) (Table 4).

Table 4: Patient Satisfaction Scores

These findings indicate that NPWT significantly improves clinical outcomes in complex surgical wound management in terms of wound healing, infection control, and patient satisfaction.

The present study demonstrates that Negative Pressure Wound Therapy (NPWT) significantly enhances wound healing in patients with complex surgical wounds compared to conventional dressing techniques. Patients in the NPWT group showed a greater percentage of wound area reduction, earlier granulation tissue formation, lower infection rates, and higher satisfaction scores.

The significant reduction in wound size observed with NPWT aligns with previous findings suggesting that negative pressure facilitates cellular proliferation, angiogenesis, and contraction of the wound bed (1,2). Mouës et al. noted a similar trend in which NPWT accelerated healing in acute and chronic wounds, supporting its role in optimizing the wound microenvironment (3). By continuously removing exudate and reducing interstitial edema, NPWT improves tissue oxygenation and perfusion, thereby promoting faster recovery (4,5).

Time to complete granulation was notably shorter in the NPWT group, which supports studies by Malmsjö et al. and Hyldig et al., where vacuum-assisted therapy significantly enhanced tissue regeneration compared to conventional moist dressings (6,7). The negative pressure stimulates the proliferation of fibroblasts and increases the expression of vascular endothelial growth factor (VEGF), contributing to rapid granulation (8).

The lower incidence of wound infection in the NPWT group is consistent with previous literature showing that closed negative pressure systems limit bacterial colonization and reduce the risk of cross-contamination (9,10). Stannard et al. observed a similar reduction in surgical site infections when NPWT was used prophylactically in high-risk orthopedic patients (11). Additionally, the use of NPWT decreases dressing change frequency, which further reduces microbial exposure and enhances patient comfort (12).

Patient satisfaction scores were also higher with NPWT, reflecting improved comfort, fewer dressing changes, and better overall outcomes. This observation is consistent with the findings of Schintler et al., who reported greater patient compliance and satisfaction in the NPWT group compared to traditional care (13). Improved mobility and reduced pain during dressing changes also contribute to better patient-reported experiences (14).

Despite its clinical advantages, NPWT does have limitations, including cost and the need for trained personnel for device application and maintenance. Moreover, not all wounds are suitable candidates for NPWT, particularly those with exposed vessels or necrotic tissue without adequate debridement (15).

Overall, this study reinforces the growing body of evidence that NPWT is a highly effective method for managing complex surgical wounds. It offers improved wound healing, reduces complications, and enhances patient outcomes when used judiciously and appropriately

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