WoundVac in Obese Patients Undergoing Lumbar Surgery

Obesity Clinical Trial

Official title:

Post Operative Wound Complications in Patients With BMI ≥35kg/m2 After Posterior Lumbar Spine Surgery: a Randomized Clinical Trial of Closed-Incision Negative-Pressure Therapy

Clinical Trial Details — Status: Not yet recruiting

Administrative data

• NCT number: NCT03688438
• Other study ID #: 18.1023
• Status: Not yet recruiting
• Phase: N/A
• Start date: October 15, 2018
• Est. completion date: October 15, 2020

Study information

• Verified date: September 2018
• Source: Norton Leatherman Spine Center
• Contact: Leah Y Carreon, MD, MSc
• Phone: 5029920488
• Email: spineresearch[@]nortonhealthcare.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This is an open label, randomized clinical trial of Closed-Incision Negative-Pressure Therapy to decrease post-operative wound complications in patients with BMI ≥35kg/m2 after posterior lumbar spine surgery.

Description:

Methods:

Study Design: Prospective open-label randomized clinical trial of CINPT in obese patients. Subjects will be randomized in a 1:1 to Standard of Care (SOC) and CINPT.

Study Arms: (1) Standard of Care (2) CINPT Sample Size: Based on 30% incidence of wound complications in obese patients undergoing lumbar spine surgery, a sample size of 124 (62 in each cohort) will be needed to detect a decreased incidence of 10% with an α of 0.05 and β of 0.2.

Randomization: Randomization will be done with varying blocks of 4, 6 and 8 using opaque sealed envelopes.

Procedures: All patients will receive standard pre operative prophylactic antibiotics with 2g

• 3g Cefazolin or 1g Clindamycin (if patient has known penicillin allergy) based on weight 60 min before incision is made. They will be clipped if needed before being prepped. Each patient will be prepped with alcohol and then either duraprep, chloraprep, or betadine. After the procedure is complete, a subfascial and subcutaneous closed suction drain will be placed in the wound prior to closure. 1 to 3 gram of Vancomycin powder will be placed in the wound. The wound is closed with #1vicryl for the fascial layer followed by 2-0 Vicryl for the subcutaneous layer followed by 3-0 or 4-0 monocryl. In the SOC group, skin glue, Steri-strips, sterile gauze and Tegaderm will be applied to the wound. In the CINPT group, a CINPT dressing will be placed and attached to a compact portable negative pressure unit to deliver 125mmHg continuous pressure for 5 to 7 days. All patients will receive standard wound care instructions before hospital discharge. Patients will return to the clinic in 6±1 days for a wound check and removal of the CINPT.

Primary endpoint: The primary endpoint is the occurrence of a wound complication. A wound complication can include a local inflammatory reaction, wound dehiscence, skin blistering/necrosis, stitch abscess or Incision and drainage for hematoma seroma, deep or superficial infection

Recruitment information / eligibility

• Status: Not yet recruiting
• Enrollment: 124
• Est. completion date: October 15, 2020
• Est. primary completion date: October 15, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

• Adult patients aged =18 years old

• Patients undergoing posterior lumbar fusion with or without interbody fusion

• Body Mass Index of =35kg/m2

• Able to provide Informed Consent

• No prior lumbar spine surgery

Exclusion Criteria:

• Presence of skin infection or any systemic infection

• Known allergy or sensitivity to silver or acrylic adhesive

• Fragile peri-incisional skin

• Patients on anti-coagulation and/or platelet aggregation inhibitors

Related Conditions & MeSH terms

• Lumbar Spine Surgery
• Obesity

Intervention

Device:
• Closed-Incision Negative-Pressure Therapy
A foam or gauze dressing is put directly on the wound. This foam acts as a filter to keep any large particles (such as blood clots or dead, sloughed off tissue) from clogging the vacuum system. A clear, occlusive, adhesive film covers and seals the dressing and wound, creating an airtight seal. A drainage tube leads from under the adhesive film and connects to a portable vacuum pump. This pump removes air pressure over the wound. The pump is programmed for strength of suction, amount of time it is to be applied and if it is to be intermittent or continuous. A chamber on the pump collects drainage and moisture is drawn away from the wound site.

Locations

Country	Name	City	State
United States	Norton Leatherman Spine Center	Louisville	Kentucky

Sponsors (1)

Lead Sponsor	Collaborator
Norton Leatherman Spine Center

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Incidence of wound complication	A wound complication can include a local inflammatory reaction, wound dehiscence, skin blistering/necrosis, stitch abscess or Incision and drainage for hematoma seroma, deep or superficial infection	Within one month after surgery
Secondary	Days to dry wound	Number of days after surgery it took to have the wound become dry	One month after surgery