Comparison of Surgical Incision Complications in Patients Receiving PICO or Standard Care Following Colorectal Surgery

Surgical Site Complications (SSC's) are responsible for increased morbidity in patients undergoing surgery resulting in prolonged length of stay in the hospital while increasing treatment and hospital costs dramatically. Negative Pressure Wound Therapy (NPWT) use on closed incisions has been reported in the literature to reduce SSC's including Surgical Site Infections (SSI's), with many promising studies in general surgery, including some studies using single use NPWT. However, to date, there are very few randomised controlled trials (RCT's) using this intervention. When using PICOTM (NPWT) for this indication, patients may be discharged from hospital earlier, with the negative pressure incision management in place. This has implications in terms of cost savings for the health care system and enables the patient to be able to return to their normal daily routine more quickly. The hypothesis of this study is that PICO NPWT will reduce frequency of SSC's, in a 30 day follow up period, as compared to standard care in patients undergoing colorectal procedures.


Eligibility Criteria:
INCLUSION CRITERIA

1. The subject or legal guardian must provide written informed consent (reference section 9.1).
2. Subjects eighteen (18) years of age or older.
3. Willing and able to make all required study visits.
4. Able to follow instructions.
5. Males or females.
6. Subject must be classified as a high risk patient in terms of likelihood for SSC's (i.e., heavy smoker (more than 20 cigarettes per day), diabetic, BMI ≥ 30, immunocompromised) or be treated as an emergency patient with obstructed bowel, perforated bowel or peritonitis and be undergoing any of the following procedures:- Left hemicolectomy, right hemicolectomy, extended right hemicolectomy, sigmoidectomy, anterior rectum resection, total colectomy.

EXCLUSION CRITERIA

1. Contraindications or hypersensitivity to the use of the investigational product or its components (e.g., silicone adhesives and polyurethane films \[direct contact with incision\], acrylic adhesives \[direct contact with skin\], polyethylene fabrics and super-absorbent powders \[polyacrylates\]) within the dressing.
2. Subjects with extremely fragile skin who require the use of SECURA non-sting barrier skin wipes and have hypersensitivity to the ingredients in the wipes.
3. Participation in another clinical trial (with use of investigational medicinal product or medical device) within thirty (30) days of Visit 1 or during the study.
4. Subjects with skin features (e.g., tattoos, pre-existing scarring) which, in the opinion of the Investigator, could interfere with the study assessments.
5. Subjects who have participated previously in this clinical trial.
6. Subjects with a reference incision (that is the largest incision that is made during the surgery and the one that is allocated to study treatment) less than 8cm.
7. Subjects with incisions exceeding 40 cm in length.
8. Subjects with incisions that are actively bleeding unless homeostasis has been achieved (to be confirmed during surgery).
9. Patients attending for a re-operation within the last 3 months.
10. Patients undergoing a procedure as part of palliative care (to be confirmed during surgery).
11. Patients with a systemic infection (that is not related to perforated bowel or peritonitis) at the time of surgery.
12. Patients with a known history of poor compliance with medical treatment.
13. Patients who also have a gynaecological procedure carried out during the colorectal procedure.
14. Patients other than those with a disease known to affect the immune system that are on steroids or other immune modulators known to impact healing.
15. Patients with a genetic or acquired healing defect.
16. Exposure of blood vessels, organs, bone or tendon within the incision (to be confirmed during surgery).
17. Subjects with a medical or physical condition that, in the opinion of the Investigator, would preclude safe subject participation in the study.