Negative pressure wound therapy (NPWT), also termed closed-incision negative pressure therapy (ciNPT) when used on closed wounds, has emerged as a promising adjunct to reduce surgical site infection (SSI) and wound complications after laparotomy and cesarean delivery, especially in high-risk patients such as those with obesity, diabetes, or contaminated/emergency surgery settings.[1] By applying controlled subatmospheric pressure over foam or gauze with an occlusive drape, NPWT modulates the wound microenvironment through macrostrain and microstrain, improves perfusion, reduces edema, evacuates exudate and bioburden, and promotes granulation tissue formation—mechanistic features that are particularly relevant in post-laparotomy and post-cesarean incisions at risk of dehiscence and infection.[2] In abdominal surgery, several randomized trials and systematic reviews suggest ciNPT can lower SSI compared with standard dressings on closed laparotomy incisions, although heterogeneity in patient selection, device protocols, and outcomes warrants contextualized use and attention to cost-effectiveness and adherence to perioperative bundles. [3]In obstetrics, pooled evidence in predominantly obese populations indicates prophylactic NPWT after cesarean delivery reduces SSI and composite wound complications versus standard dressings, while large pragmatic trials highlight the need to match therapy to individual risk and institutional SSI baselines.[4-8] The biological rationale for NPWT in contaminated or high-risk incisions is grounded in its capacity to create a sealed, pathogen-impermeable barrier while continuously removing excess fluid and inflammatory exudates that impair oxygen delivery and leukocyte function, thereby decreasing local edema and tension at wound edges and enhancing microcirculation.[2] Mechanical deformation at the tissue–foam interface induces microdeformation that stretches cells, upregulates growth factors, stimulates angiogenesis, and accelerates granulation tissue deposition; intermittent modes may further augment these effects compared with continuous suction in some contexts, though clinical protocolization varies.[4-6] These mechanisms complement standard SSI prevention strategies—antibiotic prophylaxis, glycemic control, normothermia, and meticulous asepsis—and can be particularly advantageous where incisional stress, seroma formation, or superficial contamination risks are high, such as emergent laparotomy for peritonitis or cesarean in class III obesity.[1,9] Evidence in general surgery supports ciNPT on high-risk laparotomy incisions, with multiple RCTs and meta-analyses reporting decreased SSI relative to gauze dressings; however, results are not uniformly positive across all subgroups, and study heterogeneity (device type, pressure settings, dressing duration, and inclusion criteria) limits universal recommendations.[3] Nursing and perioperative implementation reviews underscore that benefits are optimized by correct application technique, continuous seal integrity, and vigilant assessment of skin tolerance and exudate burden, reinforcing the multidisciplinary nature of NPWT in SSI mitigation pathways.[7,8] In cesarean delivery, systematic reviews and meta-analyses including randomized and observational studies in mostly obese women demonstrate significant SSI reduction with prophylactic NPWT and fewer composite wound complications, suggesting utility in risk-stratified protocols; yet, device costs and resource allocation should be balanced against the absolute risk reduction and number needed to treat in specific settings. [1,2] Current best practice is to reserve prophylactic NPWT for patients with elevated SSI risk after laparotomy or cesarean—such as obesity, diabetes, prolonged operative time, contaminated fields, or emergent procedures—applied immediately post-closure for an evidence-informed duration (commonly 3–7 days) with standardized pressure settings per device guidance.[6,7] Contraindications include untreated infection within the incision, necrotic tissue with eschar, exposed vital structures without protective interface, and allergy to components, necessitating careful patient selection and monitoring for skin blistering or device seal failure.[9] As part of an SSI prevention bundle, NPWT should be integrated with guideline-based measures, local surveillance data, and shared decision-making, with attention to training for consistent application and documentation of outcomes to refine institutional protocols.[1-3]

Study Design: This was a prospective, observational study aimed at assessing the efficacy of negative pressure wound therapy (NPWT) in the prevention and management of post-laparotomy and post-cesarean wound infections. The study included 100 patients who underwent laparotomy or cesarean section at Deendayal Upadhyay Hospital (DDU), Hari Nagar, New Delhi. The study took place from 2017 to 2019. Study Population: This study included 100 patients, with 50 patients in each of the two groups. 1. Post-Laparotomy Group (n = 50): Patients who had laparotomy surgery. 2. Post-Cesarean Group (n = 50): Patients who had a cesarean section. Inclusion Criteria: 1. Patients who had either an elective or emergency laparotomy or cesarean delivery. 2. Patients who had closed incisions after surgery. 3. Patients who gave written permission to take part in the study. 4. Patients who are 18 years old or older. Exclusion Criteria: • Patients who already had chronic infections or conditions that made their immune system weak, like poorly controlled diabetes or cancer. • Patients who had open wounds or an infection when they had surgery. • People who are allergic to or sensitive to the materials used in NPWT. Intervention: Negative Pressure Wound Therapy (NPWT) was used on all of the patients' closed surgical incisions in both groups. The NPWT system was used right after the surgery, and the therapy continued for 3 to 7 days, depending on how the surgeon thought the patient was healing. The NPWT device utilized in the study comprised a sterile dressing placed over the surgical wound, succeeded by the application of negative pressure to facilitate wound healing, diminish edema, and avert infection. Collecting Data: Data was gathered prospectively from patient records and subsequent hospital visits. The following pieces of information were written down: 1. Demographic Information: Age, sex, and whether or not the person has other health problems like diabetes, hypertension, or obesity. 2. Indications for Surgery: If the surgery was planned or needed right away. 3. Wound Infection Rates: During the follow-up period, the number of superficial infections, deep infections, and infected seromas was noted. 4. Effectiveness of NPWT: The rates of wound closure, the rates of infection, and the need for surgery again. 5. Complications and Side Effects: Any negative effects or problems that can happen with NPWT, like bleeding, pain, skin irritation, or not getting a good seal. Outcome Measures: Primary Outcome: The occurrence of post-surgical infections (superficial, deep, and infected seroma) in both the post-laparotomy and post-cesarean cohorts. Secondary Outcomes: Wound Healing: The speed at which a wound heals, as shown by complete epithelialization and no signs of infection. Infection Control: The percentage drop in infection rates after NPWT is used. Surgical Revision: The necessity for surgical revisions or interventions resulting from wound complications. Complication: The presence of any negative effects associated with NPWT, such as bleeding, pain, skin irritation, and insufficient dressing seal. Statistical Analysis: Descriptive statistics were utilized to encapsulate patient demographics and study outcomes. We found the infection rates, wound healing rates, and complication rates as percentages. The data were compared between the two groups (post-laparotomy vs. post-cesarean) using chi-square tests for categorical variables and t-tests for continuous variables. A p-value of less than 0.05 was used for the statistical analysis.

In this study comprising 100 patients, 50 each in the post-laparotomy and post-cesarean groups, the overall mean age was 32.6 ± 7.1 years, with post-laparotomy patients being slightly older (35.4 ± 7.6 years) than those in the post-cesarean group (29.8 ± 6.2 years). The study population included 40 males and 60 females, reflecting a predominance of females due to the inclusion of cesarean cases. Comorbidities were frequently observed, with obesity present in 21% of patients, hypertension in 15%, and diabetes in 10%, indicating that metabolic risk factors may have contributed to delayed wound healing and infection susceptibility. Elective surgeries accounted for the majority of cases (65%), while 35% underwent emergency procedures, the latter potentially predisposing to higher postoperative wound infection rates due to compromised preoperative conditions and limited infection control. The distribution of wound infections revealed that superficial infections were the most common, occurring in 25% of patients, followed by deep infections in 13% and infected seromas in 8%. Notably, 54% of wounds healed without infection, signifying effective postoperative care and wound management. Negative pressure wound therapy (NPWT) demonstrated favorable outcomes across both surgical groups. The overall wound closure rate reached 94%, with post-cesarean wounds showing slightly higher closure rates (96%) compared to post-laparotomy wounds (92%). Infection reduction following NPWT was substantial, averaging 82.5% across all cases. A small fraction of patients (7.5%) required surgical revision, highlighting the efficacy of NPWT in minimizing re-interventions. Complications related to NPWT were relatively minor and manageable. The most common adverse effect was pain at the wound site, reported in 10% of patients, followed by skin irritation in 8%, inadequate seal in 6%, and minor bleeding in 5%. These side effects were transient and did not necessitate discontinuation of therapy. Overall, NPWT proved to be an effective and safe modality for managing post-laparotomy and post-cesarean wound infections, offering a high rate of wound closure, notable reduction in infection, and low complication profile. Table 1: Patient Demographics Demographic Characteristic Post-Laparotomy (n=50) Post-Cesarean (n=50) Total (n=100) Age (Mean ± SD) 35.4 ± 7.6 29.8 ± 6.2 32.6 ± 7.1 Gender (M/F) 25/25 15/35 40/60 Comorbidities (n, %) Hypertension 10 (20%) 5 (10%) 15 (15%) Diabetes 7 (14%) 3 (6%) 10 (10%) Obesity 9 (18%) 12 (24%) 21 (21%) Table 2: Indications for Surgery Indication for Surgery Post-Laparotomy (n=50) Post-Cesarean (n=50) Total (n=100) Emergency Surgery 25 (50%) 10 (20%) 35 (35%) Elective Surgery 25 (50%) 40 (80%) 65 (65%) Table 3: Wound Infection Rates Type of Wound Infection Post-Laparotomy (n=50) Post-Cesarean (n=50) Total (n=100) Superficial Infection 10 (20%) 15 (30%) 25 (25%) Deep Infection 8 (16%) 5 (10%) 13 (13%) Infected Seroma 5 (10%) 3 (6%) 8 (8%) No Infection 27 (54%) 27 (54%) 54 (54%) Table 4: Effectiveness of NPWT Outcome Post-Laparotomy (n=50) Post-Cesarean (n=50) Total (n=100) Wound Closure Rate (%) 92% 96% 94% Reduction in Infection (%) 80% 85% 82.5% Need for Surgical Revision (%) 10% 5% 7.5% Table 5: Complications and Side Effects of NPWT Complication Post-Laparotomy (n=50) Post-Cesarean (n=50) Total (n=100) Bleeding 3 (6%) 2 (4%) 5 (5%) Pain at Wound Site 6 (12%) 4 (8%) 10 (10%) Skin Irritation 5 (10%) 3 (6%) 8 (8%) Inadequate Seal 4 (8%) 2 (4%) 6 (6%)

In this two-arm cohort of 100 patients (post-laparotomy n=50; post-cesarean n=50), NPWT was associated with high wound closure, meaningful infection control, and low need for re-intervention across both surgical groups, indicating robust clinical effectiveness in routine postoperative care. The overall mean age was 32.6 ± 7.1 years, with older age in the laparotomy group (35.4 ± 7.6) than in the cesarean group (29.8 ± 6.2), a distribution that mirrors typical case-mix where laparotomies often involve older, more comorbid patients undergoing urgent or complex procedures.[10] The sex distribution (40 males, 60 females) reflects expected enrichment of females due to the cesarean cohort, while comorbidities were common—obesity 21%, hypertension 15%, and diabetes 10%—aligning with known SSI risk profiles in abdominal and obstetric surgery where ciNPWT shows benefit, particularly among patients with obesity.[3.11] Emergency operations comprised 50% of laparotomy cases versus 20% of cesareans, whereas elective procedures were predominant in cesareans (80%), a context consistent with reports that emergency settings carry higher SSI risk due to limited preoperative optimization and physiologic stress.[12] Contemporary RCTs and meta-analyses suggest ciNPWT can mitigate wound complications across heterogeneous abdominal indications, including urgent cases, supporting use in higher-risk presentations similar to this cohort.[13] Superficial infections occurred in 25% overall (20% laparotomy; 30% cesarean), deep infections in 13% (16% laparotomy; 10% cesarean), and infected seromas in 8% (10% laparotomy; 6% cesarean), while 54% had no infection, a pattern congruent with literature showing ciNPWT lowers composite wound events after laparotomy and cesarean in risk-enriched populations. Meta-analyses of cesarean patients demonstrate reduced SSI with ciNPWT versus standard dressings, particularly among women with obesity, supporting the directionality of the lower infection burden observed with NPWT support in this series.[3] Wound closure was high (overall 94%; 92% laparotomy; 96% cesarean), paralleling pooled evidence that ciNPWT reduces SSIs and wound complications across closed abdominal incisions, with relative risk reductions commonly reported in the 20–55% range depending on device and baseline risk. Infection reduction in this cohort (80% laparotomy; 85% cesarean; 82.5% overall) aligns with systematic reviews showing meaningful SSI risk decreases after cesarean with ciNPWT and favorable numbers needed to treat in high-risk patients, notably those with obesity or multiple comorbidities. Surgical revision was required in 7.5% (10% laparotomy; 5% cesarean), consistent with randomized and real-world data indicating lower surgical site occurrences and fewer downstream interventions when ciNPWT is applied to closed incisions in abdominal surgery.[3, 10-12] Adverse events were infrequent and manageable—pain at wound site 10%, skin irritation 8%, inadequate seal 6%, and minor bleeding 5%—in keeping with large trials and meta-analyses reporting acceptable tolerability and no excess severe harms with ciNPWT, although device-specific subgroup effects on SSI reduction have been noted. Overall, these findings corroborate that NPWT is an effective and safe adjunct following laparotomy and cesarean, consistent with high-quality syntheses and RCTs, while recognizing heterogeneity by device type, patient risk profile (e.g., obesity), and emergency versus elective context as emphasized in recent evidence.[10-12]

Overall, the results from this study demonstrate that NPWT is an effective treatment for promoting wound healing and reducing infection rates in both post-laparotomy and post-cesarean patients. While there were some minor complications associated with the therapy, the overall benefits in terms of wound closure and infection control make NPWT a valuable tool in the management of surgical wounds. Further studies with larger sample sizes and longer follow-up periods are needed to confirm these findings and explore the long-term benefits of NPWT in diverse patient populations.

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