Surgical Robotics Technology
PICO Single Use

Smith+Nephew’s PICO™ significantly reduces surgical site complications

Smith+Nephew, the global medical technology business, is pleased to announce a new publication showing that its PICO Single Use Negative Pressure Wound Therapy System (sNPWT) significantly reduced the odds of surgical site infections (SSIs) by 63%*, the odds of seroma by 77%, and the odds of dehiscence by 30%. A significant benefit of these reduced odds was an almost 2-day reduction in length of stay§, suggesting potential for substantial efficiency gains across the healthcare system1.

The systematic review and meta-analysis included 29 studies on the outcomes of 5,614 patients. It demonstrated that using PICO sNPWT on closed surgical incisions resulted in significant benefits for patients across different surgical specialties, including orthopaedic, obstetric, cardiothoracic, colorectal, vascular and breast surgery, from a wide geographical distibution1.

The development of post-operative surgical site complications (SSCs), which includes SSIs, are a substantial burden for patients and healthcare systems, globally2. It is estimated that 5% of all patients undergoing a surgical procedure will develop an SSI2. In the U.S. alone, more than 500,000 patients are affected by SSIs each year, resulting in about 8,000 deaths annually3. SSIs are also the most common reason for readmission to hospital, accounting for 19.5% of overall readmissions4. However, 60% of all SSIs are considered preventable2.  

“This new meta-analysis is another significant addition to the growing body of evidence supporting PICO therapy for SSC prevention, and helps provide important insights into optimising clinical management strategies for preventing SSIs, which are an increasing concern for healthcare providers and their patients around the world,” said Cathy Dalene, Senior Vice President Global Marketing, Advanced Wound Management, Smith+Nephew.

The unique PICO sNPWT dressing includes the proprietary AIRLOCK Technology for uniform and consistent delivery of therapeutic NPWT across a closed surgical incision and the surrounding zone of injury5. PICO sNPWT has been shown to help reduce SSCs by helping to reduce lateral tensile forces6 and oedema7-9, whilst increasing perfusion10, 11 and lymphatic drainage12 across close surgical incision.

PICO sNPWT has a strong evidence base with 137 published papers of which 21 are published randomised controlled trials (RCTs) and 5 are health economic studies13. This includes medical technology guidance from the UK National Institute for Health and Care Excellence (NICE), which supports the adoption of PICO sNPWT as it provides better outcomes than standard care for helping to prevent SSCs in high-risk patients with closed surgical incisions, with similar overall cost14.

To learn more about PICO sNPWT see

* odds ratio (OR) 0.37, 95% confidence intervals (CI) 0.28 to 0.50, p < 0.001, numbers needed to treat (NNT) 20; compared with standard dressings
 OR 0.23, 95% CI 0.11 to 0.45, p < 0.001, NNT 13; compared to standard dressings
 OR 0.7, 95% CI 0.53 to 0.92, p = 0.01, NNT 26; compared to standard dressings
§ mean difference -1.75, 95% CI -2.69 to -0.81, p < 0.001; compared to standard dressings


  1. Saunders C, Nherera LM, Horner A, Truman P. The incidence of surgical site complications with PICO single-use negative pressure wound therapy compared to conventional dressings when used prophylactically on closed surgical incisions: a systematic literature review and meta-analysis. BJS Open. 2021;[Epub ahead of print]
  2. World Union of Wound Healing Societies (WUWHS), 2016. Closed surgical incision management: Understanding the role of NPWT. Wounds International.
  3. Najjar PA, Smink DS. Prophylactic antibiotics and prevention of SSIs. Surg Clin N Am 2015;95(2):269-283.
  4. Merkow RP, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA 2015;313(5):483-495.
  5. Smith+Nephew October 2017. Project Opal PICO 7 System Stability Testing, Initial Time Point. Internal Report. DS/17/253/R
  6. Loveluck J, Copeland T, Hill J, Hunt A, Martin R. Biomechanical Modeling of the Forces Applied to Closed Incisions During Single-Use Negative Pressure Wound Therapy. ePlasty. 2016.
  7. Birke-Sorensen H, Malmsjo M, Rome P, et al. Evidence-based recommendations for negative pressure wound therapy: treatment variables (pressure levels, wound filler and contact layer)-steps towards an international consensus. J Plast Reconstr Aesthet Surg. 2011;64 Suppl:S1-16.
  8. Scalise A, Calamita R, Tartaglione C, et al. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of Incisional Negative Pressure Wound Therapy. A systematic review of the literature. Int Wound J. 2016;13(6):1260-1281.
  9. Shim HS, Choi JS, Kim SW. A Role for Postoperative Negative Pressure Wound Therapy in Multitissue Hand Injuries. Biomed Res Int. 2018;2018.
  10. Malmsjö M, Huddleston E, Martin R. Biological Effects of a Disposable, Canisterless Negative Pressure Wound Therapy System. ePlasty. 2014;14:1 – 15.
  11. Innocenti M, Santini M, Dreassi E, et al. Effects of Cutaneous Negative Pressure Application on Perforator Artery Flow in Healthy Volunteers: A Preliminary Study. J Reconstr Microsurg. 2018.
  12. Kilpadi DV, Cunningham MR. Evaluation of closed incision management with negative pressure wound therapy (CIM): hematoma/seroma and involvement of the lymphatic system. Wound Repair Regen. 2011;19(5):588-596.
  13. Smith & Nephew 2020. Evidence Pyramid April 2020. EA/AWM/PICO/030/v1.
  14. NICE (2019) PICO negative pressure wound dressings for closed surgical incisions [online] accessible from: Last accessed January 2021

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