Mehrabi A, Fonouni H, Wente M, Sadeghi M, Eisenbach C, Encke J, Schmied B M, Libicher M, Zeier M, Weitz J, Büchler M W, Schmidt J
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Clin Transplant. 2006;20 Suppl 17:97-110. doi: 10.1111/j.1399-0012.2006.00608.x.
Advances in surgical techniques and immunosuppression (IS) have led to an appreciable reduction in postoperative complications following transplantation. However, wound complications as probably the most common type of post-transplantation surgical complication can still limit these improved outcomes and result in prolonged hospitalization, hospital readmission, and reoperation, consequently increasing overall transplant cost. Our aim was to review the literature to delineate the evidence-based risk factors for wound complications following kidney and liver transplantation (KTx, LTx), and to present the preventive and therapeutic modalities for this bothersome morbidity. Generally, wound complications are categorized as superficial and deep wound dehiscences, perigraft fluid collections and seroma, superficial and deep wound infections, cellulitis, lymphocele and wound drainage. The results of several studies showed that the most important risk factors for wound complications are IS and obesity. Additionally, there are surgical and/or technical factors, including type of incision, reoperation, and surgeon's expertise, as well as comorbidities such as advanced age, diabetes mellitus, malnutrition, and uremia. Preventive management of wound complications necessitates defining their etiological factors so that their detrimental effects on healing processes can be addressed and reduced. IS modalities and agents, especially sirolimus (SRL), and steroids (ST) should be adjusted according to the patient's co-existing risk factors. SRL should be administered three months after transplantation and ST should be tapered as soon as possible. A body mass index (BMI) lower than 30 kg/m2 is advisable for inclusion in a transplantation program, but higher BMIs do not exclude recipients. Surgical risk factors can be prevented by applying precise surgical techniques. Therapeutic modalities must focus on the most efficient and cost-effective medications and/or interventions to facilitate and improve wound healing.
手术技术和免疫抑制（IS）的进步已使移植术后并发症明显减少。然而，伤口并发症作为移植术后最常见的手术并发症类型，仍会限制这些改善的结果，并导致住院时间延长、再次入院和再次手术，从而增加总体移植成本。我们的目的是回顾文献，以确定肾移植和肝移植（KTx，LTx）术后伤口并发症的循证风险因素，并介绍针对这种令人困扰的发病率的预防和治疗方法。一般来说，伤口并发症分为浅表和深部伤口裂开、移植周围积液和血清肿、浅表和深部伤口感染、蜂窝织炎、淋巴囊肿和伤口引流。多项研究结果表明，伤口并发症最重要的风险因素是IS和肥胖。此外，还有手术和/或技术因素，包括切口类型、再次手术和外科医生的专业技能，以及合并症，如高龄、糖尿病、营养不良和尿毒症。伤口并发症的预防性管理需要确定其病因，以便能够应对并减少其对愈合过程的有害影响。应根据患者并存的风险因素调整IS方式和药物，尤其是西罗莫司（SRL）和类固醇（ST）。SRL应在移植后三个月给药，ST应尽快减量。建议将体重指数（BMI）低于30kg/m²的患者纳入移植计划，但BMI较高并不排除受者。通过应用精确的手术技术可以预防手术风险因素。治疗方法必须侧重于最有效和最具成本效益的药物和/或干预措施，以促进和改善伤口愈合。
