P403 - A Multi-Center RCT Comparing Purse-String Closure to Primary Linear Closure with Mechanically Powered Negative Pressure Dressing for Stoma Reversal Wounds

Abstract Podium Presenter(s)

• 

  Anthony Lim, MD

  Resident Physician
  University of Southern California/Los Angeles General Medical Center
  Los Angeles, California, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.

Author(s)

• 

  Alexis Peters, MD

  Resident Physician
  University of Southern California/Los Angeles General Medical Center
  University of Southern California/Los Angeles General Medical Center
  Los Angeles, CA, United States

  Disclosure information not submitted.
• 

  Aubrey Swinford, MD

  Research Fellow
  Keck Medicine of USC
  University of Southern California
  South Pasadena, CA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• 

  Jordan Martucci, MD

  Resident
  University of Southern California/ Los Angeles General
  Keck Hospital of USC/ Los Angeles General Medical Center
  Los Angeles, CA, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no financial relationships with ineligible companies.
• AG

  Abhinav Gupta, MD

  General Surgery Resident
  University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• 

  Brian N. Williams, MD

  Surgery Resident
  University of Southern California
  University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• 

  Yasamin Taghikhan, DO

  Resident
  UC Davis Health Graduate Medical Education
  San Jose, CA, United States

  Disclosure information not submitted.
• LD

  Li Ding, MD, MPH

  Biostatistician
  University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• 

  Kyle G. Cologne, MD

  Professor of Surgery
  Keck School of Medicine of the University of Southern California
  Keck School of Medicine of the University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• MD

  Marjun Philip Duldulao, MD

  Los Angles, CA

  Disclosure information not submitted.
• CH

  Christine Hsieh, MD

  Assistant Professor of Clinical Surgery
  Keck School of Medicine, University of Southern California
  Los Angeles, California, United States

  Disclosure information not submitted.
• SK

  Sarah Koller, MD

  Los Angeles, CA

  Disclosure information not submitted.
• 

  Ankit Sarin, MD MHA

  Associate Professor and Chief of Colorectal Surgery
  University of California Davis
  Sacramento, California, United States

  Disclosure information not submitted.
• 

  Erik R. Noren, MD, FACS, FASCRS

  Assistant Clinical Professor
  University of California Davis
  University of California Davis School of Medicine
  Sacramento, California, United States

  All of the relevant financial relationships listed below have been mitigated.
  This individual has no relevant relationships with ineligible companies.

Senior Author(s)

• JS

  Joongho Shin, MD

  Clinical Associate Professor
  Keck Medicine of USC
  Pasadena, California, United States

  Disclosure information not submitted.

Purpose/Background: Stoma reversal wounds are commonly left open to close by secondary intention or partially closed using the purse-string closure technique (PSC). Compared to the primary linear skin closure technique (PLC), PSC has been shown to result in lower SSI but delay wound closure and lower patient satisfaction. Negative pressure wound therapy has been shown to reduce rates of SSI over closed incisions, and more specifically in stoma reversal wound closure, but its use has been limited by significantly higher cost. We previously reported that use of a novel, low-cost, self-contained, mechanically powered negative pressure dressing (MP-NPD) has shown favorable results when applied to a primarily closed stoma reversal wound. This study assesses the outcomes of primary linear closure with MP-NPD compared to purse-string closure after stoma reversal. We hypothesize that PLC + MP-NPD results in faster healing times compared to PSC while maintaining comparable SSI rates.

Methods/Interventions: This was a multi-institutional, randomized controlled trial in which patients who underwent stoma reversal were randomized to purse-string skin closure (PSC) or primary linear skin closure dressed with MP-NPD for 6 days (PLC + NPD) from January 2023 to April 2025. A power analysis for a two-sample comparison of means was conducted to detect a 30% difference in healing times between groups (two-sided α = 0.05, 80% power, 1:1 allocation). 30-day post-operative outcomes were collected. Healing times were recorded and photographic documentation of incisions was obtained up to 2 years post-operatively. Results between both arms were compared using bivariate analysis. Healthcare professionals and non-healthcare observers were then asked to score photos of incisions on appearance at 0 days, 3 days, 2 weeks, 1 month, 2 months, 3 months, 1 year, and 2 years in a blinded fashion. Wound grade, satisfaction, and description scores were then analyzed using multivariable analysis.

Results/Outcomes: A total of forty-six patients were included. Time to apposition of skin was shorter for PLC + NPD group compared to PSC group (8.33 ± 7.96 days [95% CI: 4.37-12.29] vs. 42.63 ± 19.49 days [95% CI: 32.24-53.01], respectively; p < 0.001). Time to wound epithelization was also faster in the PLC + NPD group (23.5 ± 17.62 days [95% CI: 14.74-32.26] for PLC + NPD group vs. 40.26 ± 19.63 days [95% CI: 30.80-49.73] for PSC group; p = 0.005). There were no differences in post-operative fluid collection, SSI, superficial dehiscence, or fascial dehiscence between the two groups. Average wound ratings were significantly higher for the PLC + NPD than the PSC wounds at each time point analyzed in multivariable analysis.

Conclusion/Discussion: Application of a mechanically powered negative pressure dressing to primarily closed stoma reversal wounds results in more rapid healing time and superior cosmesis compared to wounds closed with purse-string technique. There was no significant difference in SSIs or complications between the two groups. The MP-NPD provides a compelling opportunity to safely and conveniently close prior ostomy sites in a primary fashion with improved cosmetic results.

Figure 1.
Depiction of MP-NPD (A), stoma reversal wound closed by PLC + MP-NPD at 2 months post-operatively (B), and PSC at 2 months post-operatively (C).
Table 1.
30-day clinical outcomes and long-term wound healing of PSC versus PLC + MP-NPD.