The impact of a muscle pump activator on incisional wound healing compared to standard stockings and compression devices in kidney and kidney-pancreas transplant recipients: A randomized controlled trial

Canadian Urological Association Journal. 2019;26:26

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Abstract

INTRODUCTION We aimed to evaluate the impact of thrombo-embolic-deterrent + intermittent pneumatic compression (TED + IPC) vs. muscle pump activator (MPA) on incisional wound healing in kidney and simultaneous pancreas- kidney (SPK) transplant recipients. METHODS We conducted a single-centre, randomized controlled trial in which 104 patients (kidney n=94; SPK n=10) were randomly assigned to wear TED + IPC (n= 52) or MPA (n=52) for the first six days following surgery. Patient demographics, postoperative outcomes, and incisional wound images were taken using a HIPAA-compliant application on postoperative days (POD) 3, 5, and 30, and assessed using the validated Southampton Wound Care Score. RESULTS There were no demographic differences between the groups. The MPA group had a significant improvement in wound healing on POD 3 (p=0.04) that persisted until POD 5 (p=0.0003). At POD 30, both groups were similar in wound healing outcomes (p=0.51). Bayesian inferential analysis revealed that the use of TED + IPC following transplantation had inferior outcomes compared to the use of MPA with sequential moderate evidence. The rate of complex wound infections was significantly greater in the TED + IPC group compared to the MPA group (29% vs. 12%, respectively; p=0.03). Patients were more satisfied with the use of a MPA device than TED + IPC. No major complications were encountered in either group. CONCLUSIONS The use of a MPA device in the immediate postoperative period leads to a significant improvement in immediate and early wound healing, and decreased number of complex wound infections following kidney and SPK transplantation compared to standard TED + IPC therapy. Patients were more satisfied with the use of a MPA device than TED + IPC.

CET Conclusion

Reviewer: Mr John O'Callaghan, Centre for Evidence in Transplantation, The Royal College of Surgeons of England.
The muscle pump activator (MPA) used in this study is the Geko Plus device that delivers neuro-muscular stimulation via low voltage stimulus of the skin over the common peroneal nerve. It thereby activates the calf and foot muscles. Other trans-cutaneous direct muscular stimulation devices using high voltage intensity have not been widely adopted, due to discomfort. Wound healing was assessed at days 3,5 and 30. There was a significant reduction in superficial wound infections in the MPA arm (13% versus 29%) and wound scores on days 3 and 5. This outcome measure was not blinded and was subjective to the assessor. By day 30 the wound scores were not different between the two arms. Patients were also significantly more likely to report that the MPA device was more comfortable and related to less wound swelling, another subjective judgement, this time by the patients. The funding source is not described.

Methodological quality

Jadad score : 2
Allocation concealment : – YES
Data analysis : – STRICT INTENTION TO TREAT

Study details

Aims : The study aimed to evaluate the impact of thrombo-embolic-deterrent + intermittent pneumatic compression (TED + IPC) vs. muscle pump activator (MPA) on incisional wound healing in kidney and simultaneous pancreas- kidney (SPK) transplant recipients.
Interventions : Patients were randomised to wear TED and IPC or MPA for the first six days post-transplant surgery.
Participants : 104 kidney and simultaneous pancreas-kidney transplant patients (kidney n=94; SPK, n=10).
Outcomes : Outcomes were assessed as length of hospital stay and percentage of wound infection and wound healing on postoperative days 3, 5, and 30, which were assessed using the Southampton Wound Care Score.
Follow up : 30 days.

Metadata

Publication type : Randomised Controlled Trial
Language : English