External Negative Pressure Dressing System (ENPDS) vs. Traditional Wound Dressing for Cesarean Section Incision in Obese Women: A Randomized Controlled Trial
Authors: Mokhtar Dalia M , Elkady Marwan O , Elsokkary Mohammed S 
Published: August 2023

Background
Obesity is associated with increased cesarean section delivery rates and surgical site wound complication with associated increased post-operative morbidity, post-operative pain and length of hospital stay.

Aim of the Work
The objective of this study is to determine whether negative pressure wound therapy reduces the risk of post-cesarean wound dehiscence among obese women compared with standard surgical wound care.

Patients and Methods
A Randomized controlled trial (RCT)was carried out at Ain-Shams University Maternity Hospital in the period between August 2020 and February 2021. The participants of this study were 260 pregnant women aged 18 years old or older who underwent cesarean delivery. Intervention group had an ENPDS placed for 4 days and control group had a traditional surgical dressing placed for 4 days and both group were followed up for 30 days post-operatively.

Results
The study reveal that wound dehiscence was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.002). The study also reveal and display that SSI was statistically significantly lower in ENPDS group compared with traditional dressing group (p value = 0.017). After adjustment for the effect of BMI and history of CS, PA surgery or SSI, ENPDS was independently associated with reduced incidence of SSI (odds ratio = 0.262, 95% CI = 0.090 to 0.759, P-value = 0.014). The study reveal that the incidence of wound dehiscence and SSI is statistically significantly lower in ENDPS group compared with traditional dressing group (p value =0.004, 0.012,) respectively. The incidence of wound seroma and haematoma was lower in ENDPS group however, not statistically significant compared with traditional dressing group (p value= 0.066, 0.498) respectively.The study reveals that using ENDPS has a beneficial/ protective effect as regards wound dehiscence and SSI with relative risk (0.25, 0.31) respectively with 95% CI (0.1 TO 0.65 - 0.12 TO 0.83) respectively and NNT (8.7, 11.8) respectively with 95% CI (5.4 to 22.2. - 6.7 to 52.2) respectively.It also shows that ENDPS has a beneficial /protective effect as regards wound seroma and wound hematoma formation with relative risk (0.14, 0.20) respectively even though the 95% CI was (0.02 to 0.14 - 0.01 to 4.13) respectively and the NNT was (21.7, 65.5) respectively. The study reveals that peri-wound blistering, the need for post-operative therapeutic anti-biotics and re-admission was statistically significantly lower in ENDPS group compared to the traditional dressing group (p value= 0.001, 0.005, 0.010) respectively. The study reveals that post-operative pain was less in ENDPS group with p value = &lt;0.001, post-operative mobility was more limited in ENDPS group when compared with the traditional dressing group with p value = &lt;0.001. However, the length of hospital stay was statistically significantly longer in ENDPS group with p value = &lt;0.001

Conclusions
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 and overall length of hospital stay for obese women undergoing cesarean delivery.