External Negative Pressure Dressing System (ENPDS) vs. Traditional Wound Dressing for Cesarean Section Incision in Obese Women: A Randomized Controlled Trial

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).