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(POD). The RR was calculated as follows:length×width×depth(mm) (4 or 7POD)length×width×depth(mm) (1POD)100− Secondary endpoints were postoperative wound- related complications (POCs) such as surgical site infection (SSI), dermatitis, bleeding, enterocuta-neous fistula, and ventral hernia. We defined events over Clavien-Dindo classification (CD) grade 2 as POCs. SSI was defined by the current Center for Disease Control (CDC) guidelines12). The follow-up periods for enterocutaneous fistula and ventral hernia were within the observation periods, and those for others were 30 days after operation.Outpatient follow-up after discharge was gener-ally scheduled 3 or 4 weeks after discharge, but the schedule thereafter was at the discretion of the outpatient doctor. Whether the stoma reversal wound scarred completely was judged by the medical records.Surgical techniqueStoma reversal was performed using standard techniques with the patient under general anes-thesia, and the bowel anastomosis was either stapled or hand-sewn at the discretion of the surgeon. After fascia closure, skin closure was performed with the subcuticular purse-string method using absorbable monofilament suture material (1 MaxonTM; Covidien, Dublin, Ireland or No.1 PDS plus®; Ethicon, Cincinnati, Ohio., USA). The wound was slightly opened as a drain hole to enable insertion of the tip of the 5-mL syringe to unify its size.In the control group, patients continued washing with saline or water, and dressings were changed once a day.In the NPWT group, NPWT was applied 24 hours after surgery after the confirmation of no postoperative bleeding using the V.A.C® system (Kinetics Concepts Inc. [KCI], an Acelity Company, San Antonio, Texas, USA) or PICO® system (Smith & Nephew Healthcare, Hull, UK). The suction pres-sure of the VAC® system was set 120mmHg, and PICO® was 80mmHg. It was reattached every three days after surgery and removed on 7POD. Statistical analysisCategorical variables were compared using the 6001997, Banerjee et al. reported its tolerability and in 2002, Sutton et al. reported its preventative effects against SSI6, 7). Although many reports mentioning its effectiveness have been published, PSC has problems. As it requires frequent washing, patients must wash the wound every day and the period for scarring is prolonged because the wound is open.Negative-pressure wound therapy (NPWT) is a physical therapy that promotes wound healing through various effects. Wound sealing and the application of NPWT were reported to aid in wound contraction, increase wound blood flow, promote granulation tissue formation, reduce edema, and remove excess exudates and inactive tissues. Recently, there have been reports of NPWT being used for compromised wounds prophylactically with good results8, 9). However, these reports focused on patients with primary linear closure of stoma wounds and did not evaluate healing. Uchino et al. conducted a randomized control trial (RCT) for patients with ulcerative colitis scheduled to undergo ileostomy closure. This study failed to demonstrate the efficacy of NPWT in significantly reducing the wound healing period10). Following this study, Kim et al. are currently conducting an RCT on the effec-tiveness of NPWT for wound healing after stoma reversal11).In this study, to improve wound infection control and the cosmetic outcome after stoma closure, we examined the usefulness of the combination of PSC and NPWT.Materials and methodsWe retrospectively reviewed the medical records of patients who underwent surgery for stoma closure at the Department of Coloproctological Surgery at Juntendo University Faculty of Medi-cine between January 2015 and August 2020. The patients were divided into 2 groups (control group: PSC alone, NPWT group: PSC plus NPWT) by surgeons. The study was approved by the research ethics committee of the Juntendo University Faculty of Medicine (Approval #IRB 20-191). Informed consent was received from all individual partici-pants included in the study by the opt-out method.The primary endpoint of this study was the short-term reduction ratio (RR). We measured the length, width, and depth of the wound of the stoma closure site on the 1st, 4th, and 7th postoperative day ×100

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