Ubbink Dirk T, Vermeulen Hester, Segers Patrique, Goslings J Carel
Academisch Medisch Centrum, Afd. Kwaliteit & Procesinnovatie, Amsterdam, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A365.
In surgery, negative pressure wound therapy (NPWT) is applied for thoracic, abdominal, and extremity wounds, particularly if there is traumatic tissue loss, if primary wound closure is not possible or if the wound has to be left open or reopened because of an infection. The NPWT applications are, however, running ahead of scientific evidence to support their use. Although there is plenty of literature available, very little convincing evidence exists based on well-conducted, randomised trials. NPWT can be applied to thoracic wounds (usually due to deep sternal wound infections) to reduce treatment duration. NPWT also appears useful if primary closure of the abdomen is not possible. For traumatic extremity wounds, NPWT can be helpful as a practical temporary wound cover. Possible disadvantages of NPWT are skin irritation, painful dressing changes, entero-atmospheric fistulae, and the risk of bleeding in patients using anticoagulants. The effect of NPWT on wound healing, infection, mortality, and costs remains unclear. To obtain convincing evidence, we call for greater NPWT application in a research context.
在外科手术中，负压伤口治疗（NPWT）适用于胸部、腹部和四肢伤口，特别是在存在创伤性组织缺损、无法进行一期伤口缝合，或因感染而必须让伤口敞开或重新开放的情况下。然而，NPWT的应用领先于支持其使用的科学证据。虽然有大量文献，但基于精心设计的随机试验的令人信服的证据却很少。NPWT可用于胸部伤口（通常由于深部胸骨伤口感染）以缩短治疗时间。如果无法进行腹部一期缝合，NPWT似乎也有用。对于创伤性四肢伤口，NPWT作为一种实用的临时伤口覆盖物可能会有帮助。NPWT的潜在缺点包括皮肤刺激、换药时疼痛、肠-气瘘，以及使用抗凝剂患者的出血风险。NPWT对伤口愈合、感染、死亡率和成本的影响仍不明确。为了获得令人信服的证据，我们呼吁在研究背景下更多地应用NPWT。
