Negative pressure dressings have been around for a long, long time. In the early days of damage control surgery, we used to fashion our own from surgical towels, cut-up pieces of plastic bowel bags, Jackson-Pratt drains, and sticky, clear dressings. Some enterprising companies that already made negative pressure wound dressings designed some excellent products for damage control based on this technology. They made damage control closures easy and fast. The literature suggested that they were a useful adjunct that controlled wound drainage and reduced infection rates.

But then the product creep began. In the early 2000’s, we started using these devices after the fascia was closed, but with the skin left open. These cases trended toward complex wounds like wound dehiscence. The literature continued to support this.

Finally, there was pressure from manufacturers for surgeons to apply the negative-pressure sponge to primarily closed surgical wounds. And of course, they showed that many studies supported the idea that this was helpful.

But was it? A phase 3, multicenter, randomized clinical trial was published last year that compared incisional negative-pressure wound therapy (iNPWT) with the “surgeon’s choice” standard dressing after an emergency laparotomy with primary skin closure. Adults from 34 hospitals in the UK and Australia were enrolled over a 2.5-year period. Patients were followed for 30 days to assess length of stay, wound-related readmissions, complications, pain, and quality of life.

Here are the factoids:

• Wound infections were identical between the iNPWT and standard dressing groups (about 28%)
• Among the secondary outcomes listed above, all were identical with the exception of pain; the iNPWT experienced significantly less wound pain at 7 days
• Subgroup analysis of contamination level, BMI, presence of a stoma, and the prep solution used showed no differences in wound infections

The authors concluded that for the average emergency laparotomy  patient after trauma or acute care surgery, routine iNPWT over a primarily closed incision did not appear to reduce SSI or improve other short‑term outcomes compared with a good standard dressing.

Bottom line: This is a nicely done study that casts shade on the use of iNPWT for closed wounds in complex cases. It implies that these devices are of even less use in routine laparotomy wounds. How did we get here? Unfortunately, many of the earlier studies for this use case were clouded by industry support and bias. As one might imagine, it is very difficult for a research group to publish a negative study when they were heavily funded by one of the manufacturers.

Given the significant added cost and logistics of using iNPWT for closed laparotomy, it is hard to justify its blanket use in this population based on these data. Critically look at your own practice and decide if use of iNPWT in these cases makes sense for your hospital.

Reference: Negative Pressure Dressings to Prevent Surgical Site Infection After Emergency Laparotomy: The SUNRRISE Randomized Clinical Trial. JAMA. 2025 Mar 11;333(10):853-863. doi: 10.1001/jama.2024.24764. PMID: 39869330; PMCID: PMC11773404.