Outcomes of Vacuum-Assisted and Conventional Wound Management in Pediatric Abdominal Surgery: A Retrospective Study From a Resource-Limited Setting.

BACKGROUND

Complicated abdominal wounds following pediatric laparotomy, particularly in cases of enterocutaneous fistulae, trauma, or re-exploration, present significant management challenges, especially in resource-limited settings. Despite evidence supporting vacuum-assisted closure (VAC) therapy in adults, its use in pediatric populations remains limited.

AIM: This study aimed to evaluate and compare the outcomes of vacuum-assisted and conventional wound management techniques in pediatric abdominal surgery within a resource-constrained environment.

METHODS

A retrospective observational study was conducted at a tertiary pediatric surgical centre in Northern India from January 2016 to December 2024. A total of 43 children (0-18 years) with complicated postoperative abdominal wounds were included. Patients were divided into two groups: Group 1 (n = 19) underwent traditional wound closure, while Group 2 (n = 24) received wound management using VAC therapy or simple wound manager systems. Primary outcomes were time to wound healing and incidence of wound-related complications. Secondary outcomes included hospital stay, re-exploration, and spontaneous fistula closure.

RESULTS

The wound manager group showed a slightly longer median healing time (15 vs. 12 days) but had zero re-explorations compared to three cases in the traditional group (p = 0.0011). VAC therapy led to earlier granulation (median 6 vs. 10 days), greater complete epithelialization (80 % vs. 40 %, p = 0.04), and spontaneous closure in 20 % of enterocutaneous fistulas. Four patients continued VAC therapy at home without complications.

CONCLUSION

VAC and simple wound manager systems are effective in managing complex pediatric abdominal wounds, reducing the need for reoperation and enhancing healing outcomes. Their adoption in low-resource settings could significantly improve pediatric surgical care.