Negative-Pressure Wound Therapy in the Management of High-Grade XXXX .

@entity1 @entity281 @entity4037 @entity547
BACKGROUND: Despite improved operative techniques, open @entity4037 repair (VHR) surgery in high-risk, potentially contaminated @entity1 remains challenging. As previously reported by our group, the use of a modified negative-pressure wound therapy system (hybrid-VAC or HVAC) in @entity1 with grade 2 @entity547 is associated with lower surgical site occurrence (SSO) and @entity281 ( @entity281 ) rates. Accordingly, the authors aim to evaluate whether the HVAC would similarly improve surgical site outcomes following VHR in @entity1 with grade 3 @entity547 . METHODS: A 4-year retrospective review (2011-2014) was conducted of all consecutive, modified @entity4037 working group (VHWG) grade 3 @entity547 repairs with HVAC closure performed by a single surgeon (FEE) at a single institution. Operative data and 90-day outcomes were evaluated. Overall outcomes (e.g., recurrence, reoperation, mortality) were reviewed for the study group. RESULTS: A total of 117 @entity1 with an average age of 56.7        11.9  years were classified as grade 3 @entity547 and underwent open VHR with subsequent HVAC closure. Fifty @entity1 were male (42.7  %), the mean BMI was 35.2 (  9.5), and 60.7  % had a history of prior @entity547 repair. The average fascial defect size was 201.5 (  167.3)   cm(2) and the mean length of stay was 14.2 (  9.3)   days. Ninety-day outcomes showed an SSO rate of 20.7  % and an  @entity281 rate of  5.2  %. The overall @entity547 recurrence rate was 4.2 % (n=6) with a mean follow-up of 11        7.3  months. CONCLUSION: Modified VHWG grade 3 @entity4037 are associated with significant morbidity. In our series utilizing the HVAC system after VHR, the observed rate of SSO and @entity281 compared favorably to reported series. Further prospective cost-effective studies are warranted to validate these findings.
