Prophylactic NPWT and Superficial SSIs in Emergency Laparotomy

Closed incision negative pressure wound therapy (ciNPWT) is gaining traction as a preventive tool against surgical site infections (SSIs). High-quality evidence in emergency general surgery is limited, but a new multicenter randomized controlled trial from Hungary, published in the International Wound Journal in 2025, helps to directly address this gap. In fact, results demonstrated a statistically significant reduction in superficial SSIs among high-risk emergency laparotomy patients.

A Targeted Solution for a Persistent Problem
SSIs remain one of the most frequent and costly postoperative complications—particularly in emergency abdominal surgery, where infection rates can reach 30% or more. Despite the use of perioperative antibiotics, chlorhexidine skin prep, and thermal regulation, these standard measures are often insufficient in high-risk cases.

Compared to conventional approaches, ciNPWT has demonstrated utility in infection prevention, wound healing, fluid management, and comfort from fewer dressing changes and added mobility, most commonly in open wounds. But evidence supporting its use in closed surgical wounds has been limited.

This prospective, randomized trial by Herczeg et al.aimed to characterize the potential benefit of prophylactic NPWT in abdominal surgical wounds.  enrolled 90 adults undergoing high-risk emergency laparotomy across eight surgical centers in Hungary were eligible for the study. Patients were randomized to receive either:

• ciNPWT: A five-day application of silver-impregnated mesh and hydrophilic foam, sealed and connected to a portable negative pressure device (−90 to −120 mmHg), or
• Standard care: Conventional sterile gauze or absorbent dressings, following local postoperative protocols.

Blinded wound assessments were conducted on day 5 and day 30. The primary endpoint was any SSI requiring suture removal and wound reopening (Clavien-Dindo grade II or higher). The secondary endpoint was the rate of full-thickness abdominal wall dehiscence requiring re-operation.

The investigators found that:

• Overall SSI rates were significantly lower in the ciNPWT group (22.2%) compared to control (44.4%) (p=0.025).
• The ciNPWT group showed a statistically significant reduction in superficial SSIs, with an incidence of 20% compared to 40% in the control group (p=0.038).
• No statistically significant differences were observed between the test and control groups in deep SSI (4.4% in both groups) and abdominal dehiscence (2.2% and 4.4%, respectively).
• Baseline differences in age and ASA score were noted but did not independently predict infection in multivariate analysis.

Real-World Relevance and Clinical Takeaways
Unlike previous studies that focused on elective or mixed-surgery populations, this trial specifically targeted emergency laparotomies, where infection control is most challenging. Though the final enrollment fell short of initial power estimates, likely due to pandemic-related disruptions, the effect size proved sufficient to reach significance, likely owing to the high baseline SSI risk. Despite inconsistent initiation of ciNPWT postoperatively, application was initiated within a few hours, consistent with previous reports varying up to three days.

Based on these findings, routine use of ciNPWT may be warranted in emergency laparotomies with class III–IV wounds or elevated infection risk scores.

Cost-effectiveness remains underexplored, though modeling studies in cardiac and orthopedic populations suggest long-term savings. Further trials should expand to elective cases and lower-risk populations to clarify the scope of benefit.

As hospitals seek to reduce preventable complications without adding unnecessary cost or complexity, ciNPWT may emerge as a promising intervention in the surgical infection prevention toolkit, particularly when time, tissue quality, and patient status already stack the odds against uncomplicated healing.

Reference:
Herczeg A, Szijártó A, Fülöp A, et al. Prophylactic negative pressure wound therapy reduces superficial surgical site infection risk of emergency surgery patients: Results of a multicenter randomised prospective clinical trial. International Wound Journal. 2025;22:e70718. doi:10.1111/iwj.70718