الفهرس 
Wound HealingOnly 14 pages are availabe for public view
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Abstract
Wound healing is a sequence of physiologic events that include inflammation, epithelialization, fibroplasia, and maturation. Failure of wound healing at the surgical site can lead to seroma, hematoma, wound dehiscence and surgical site infection (Pai et al., 2019).
Obesity is an independent risk factor for post-operative wound healing impairment. The risk of post-cesarean surgical site wound healing impairment has been shown to double for every 5 unit increase in body mass index (BMI) above 30 kg/m, occurring in about 10% of obese women undergoing caesarean section despite prophylactic strategies (e.g., antibiotics) (Mark et al., 2014).
Negative pressure wound therapy (NPWT), also known as a vacuum assisted closure (VAC), involves the controlled application of sub-atmospheric pressure to the local wound environment, using a sealed wound dressing connected to a vacuum to promote healing by primary intention (Scalise et al., 2015).
NPWT is known to affect wound healing through four primary mechanisms (macro-deformation, micro-deformation, fluid removal, and alteration of the wound environment) and various secondary mechanisms (including neurogenesis, angiogenesis, modulation of inflammation, and alterations in bioburden) (Majumder et al., 2020).
Our study was a randomized controlled trial conducted at Maternity hospital, Ain Shams University for six months from August 2020 to January 2021 on 260 obese women undergoing cesarean delivery. The patients were grouped into two groups; each one involved 130 patients.
Informed written consent was obtained from female patients meeting the selection criteria after full explanation of the study procedure. All patients received standard antibiotic prophylaxis per protocol based on patient allergies at least 30 to 60 minutes prior to the skin incision. Cesarean section was done through a Pfannenstiel incision. Closure of the incision was done by interrupted PROLENE Polypropylene Sutures (non-absorbable, mono-filament suture material).
Wound dressing was applied in a sterile fashion. In the intervention group placement of a sterile multilayer dressing (Foam and occlusive adhesive tape) over the closed incision was done. The dressing’s tubing was then attached to a compact, portable negative-pressure therapy unit (Yuwell 7E-A portable suction unit) that delivered -80 mm Hg of continuous pressure to the dressing and removed exudates into a disposable canister for 4 days. Patients were only disconnected from the vacuum for bathroom breaks or when necessary provided that the total time away from the vacuum did not exceed 2 hours per day.
While the control group received the traditional sterile wound dressing of gauze and tape for 4 days. Post-operative data were collected immediately post-operative and through follow up visits up to 30 days post-partum.
Analyzing the current research results revealed that negative pressure wound therapy could be used to reduce the risk of wound dehiscence, surgical site infection, wound seroma, wound haematoma, peri-wound blistering, post-operative pain, post-operative anti-biotics use and overall length of hospital stay in obese women undergoing cesarean delivery.
After the current research and considering previous research efforts, it is recommended to use ENDPS as an alternative to traditional wound dressing for cesarean sections in obese women.
Future research efforts are recommended to be multicentric in nature with larger sample size and different forms of ENDPS.