Negative pressure wound therapy vs. standard dressings in penile inversion vaginoplasty: Provider perspectives on challenges, benefits, and workload.

Abstract

Penile inversion vaginoplasty (PIV) is the most common genital gender-affirming surgery for transfeminine individuals. Postoperative wound care often involves either traditional bolster dressings or incisional negative pressure wound therapy (iNPWT). While iNPWT has shown potential benefits in wound healing and infection reduction, its impact on nursing workload and practical application in perineal wounds remains underexplored. This study aims to evaluate nursing experiences with iNPWT compared to standard bolster dressings following PIV. A cross-sectional survey was conducted among floor nurses at a single institution with experience managing postoperative PIV patients. The survey assessed challenges encountered with each dressing method, strategies used to address complications, perceived workload, satisfaction, and observations on patient comfort. Descriptive statistics and thematic analysis were used to analyze the data. Sixteen nurses responded (59% response rate), most with ≥3 years of transgender surgical care experience. Overall, 81% reported satisfaction with iNPWT, and 47% perceived it as less burdensome than bolster dressings. Device malfunction, primarily due to air leaks, was the most common issue (81%). However, iNPWT was associated with improved hygiene and reduced need for dressing changes. Nurses employed strategies such as enhanced sealing techniques and increased monitoring to troubleshoot challenges. Despite early technical difficulties, iNPWT was well-received by nursing staff, offering workflow advantages and increased patient comfort. Findings suggest iNPWT is a feasible alternative to bolster dressings in PIV and highlight the importance of nursing support and training for successful implementation.