Vacuum Assisted Closure for Cesarean Section

The prevalence of obesity (defined as body mass index (BMI, kg/m2) ≥ 30) has significantly
increased, affecting approximately 35% of adult females in the United States, according to
CDC 2009-2010 statistics. Obesity has a significant impact on pregnancy, including increased
need for cesarean section and post-operative wound complications. Infection rates have been
reported to be between 10 and 30%. The advent in 1997 of negative pressure therapy (NPT),
also known as vacuum assisted closure (VAC), has vastly changed wound care management.
Briefly, VAC has been traditionally applied to a chronic wound to create negative or
sub-atmospheric pressure, thus promoting wound healing by decreasing edema and increasing
blood flow and formation of granulation tissue. Use of this therapy at the time of primary
closure of a surgical incision (first trialed in 2006 and termed "Incisional VAC") has
provided a promising approach to reducing post-operative wound infection. Incisional VAC has
been explored primarily in the orthopedic and cardiothoracic fields, but very few studies
have examined the use on abdominal incisions, and only one to date on cesarean section
incisions.

Inclusion Criteria:

- Patients that have undergone cesarean section for delivery; have a BMI greater or
equal to 35. All cases of cesarean section including primary and repeat, scheduled and
urgent.

Exclusion Criteria:

- Patients who deliver vaginally; age less than 18 years old; silver allergy;
non-English speaking