BACKGROUND AND PURPOSE: 

• Previous studies provide conflicting data on the benefit of prophylactic negative pressure wound therapy  
• Wihbey et al. (Obstetrics & Gynecology, 2018) sought to compare prophylactic negative pressure to standard pressure dressings in class II or III obesity undergoing cesarean section

METHODS: 

• Randomized controlled, non-blinded, study  
• Participants 
  • Women with BMI ≥35 undergoing cesarean section  
• Women received either 
  • Prophylactic negative pressure therapy  
  • Standard surgical dressing 
• Abdominal prep 
  • 2% chlorhexidine alcohol solution 
  • IV antibiotics before skin incision (ACOG guidelines) 
• Primary outcome  
  • Superficial surgical site infection 
  • ≥1 symptom: Pain, swelling, or erythema 
• Secondary outcomes 
  • Composite of wound complications | Wound dehiscence | Seroma | Hematoma within 30 days of surgery 
• Low enrollment of 166 women over 24 months 
  • Interim analysis for futility was conducted and the decision was made to halt the study

RESULTS: 

• 166 women enrolled in the study 
  • 80 prophylactic negative pressure | 81 standard dressing  
  • Mean BMI   
    • 44.9 (±8) for the prophylactic negative wound therapy group 
    • 43.4 (±7) for the standard dressing group 
• No significant difference in composite superficial surgical site infection comparing negative pressure (31%) and standard dressing (30%)  
  • Also no difference in sub-group analysis of BMIs 40-50 or BMI >50   

CONCLUSION: 

• Fully anticipated enrollment was not achieved, future studies are thus needed 
• Causes for reduced enrollment 
  • Consenting required before active labor  
  • Women needed to return for wound check days 5-7 (tertiary center with a rural catchment area – practicality)  
• There was no observed decrease in superficial surgical site infection with prophylactic negative pressure wound therapy in obese women 
• NIH study is ongoing and therefore authors recommend against use of prophylactic negative wound therapy until those results are available

Learn More – Primary Sources: 

Prophylactic Negative Pressure Wound Therapy and Wound Complication After Cesarean Delivery in Women With Class II or III Obesity: A Randomized Controlled Trial 

Related ObG Topics:

What is the Best Practices Prevention Bundle for Post Cesarean Infection?

Can Evidence-Based Interventions Reduce C-section Complications?

Does Azithromycin Cut Infection-associated Costs Following Cesarean Section?

Does Prophylactic Negative-Pressure Decrease Cesarean Section Wound Infections?