Division of Orthopaedic Surgery, University of Ottawa, The Ottawa Hospital-Civic Campus, 1053 Carling Avenue, Ottawa, ON K1Y 4E9, Canada. E-mail address for G. Wilkin:
Department of Cellular and Molecular Medicine, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5, Canada.
J Bone Joint Surg Am. 2014 Aug 20;96(16):1378-85. doi: 10.2106/JBJS.M.01010.
Negative-pressure wound therapy (NPWT) can improve fasciotomy wound closure, but its effects on skeletal muscle are largely unknown. The purpose of this study was to evaluate NPWT effects on skeletal muscle after fasciotomy for compartment syndrome in an animal model and to assess regional variability in muscle fiber regeneration.
Compartment syndrome was induced in the hindlimb of twenty-two adult female pigs with use of a continuous intracompartmental serum-infusion model. Fasciotomy was performed after six hours, and animals were randomized to receive either wet-to-dry gauze dressings (control group) or NPWT dressings (-125 mm Hg, continuous suction) for seven days. Delayed primary wound closure was attempted at seven days, and the peroneus tertius was harvested for analysis seven days or twenty-one days after fasciotomy. Muscles were weighed, and hematoxylin and eosin-stained samples from four regions of the muscle (superficial central, deep central, lateral, and proximal) were mapped for different cellular morphologies.
Muscle weight was greater in the affected limb at all time points with no difference between treatment groups. At seven days, only the deep central samples in the NPWT group had a significantly greater cross-sectional area containing normal fibers as compared with that found in the controls. By twenty-one days, the deep central, lateral, and proximal regions of the NPWT-treated muscles had a smaller cross-sectional area containing normal fiber morphology and a greater cross-sectional area containing only mononucleated cells as compared with the controls.
NPWT did not decrease muscle weight. At twenty-one days, the extent of muscle fiber regeneration after fasciotomy for compartment syndrome was reduced in muscles treated with NPWT for seven days compared with the values in the control group treated with wet-to-dry gauze dressings.
NPWT may be harmful to skeletal muscle after compartment syndrome requiring fasciotomy and local wound care.
负压伤口疗法（NPWT）可改善筋膜切开术后的伤口闭合，但对骨骼肌的影响在很大程度上尚不清楚。本研究的目的是在动物模型中评估筋膜切开术后 NPWT 对骨骼肌的影响，并评估肌肉纤维再生的区域变异性。
使用连续的筋膜内血清输注模型在 22 只成年雌性猪的后肢中诱发筋膜间室综合征。六小时后进行筋膜切开术，动物随机分为接受湿到干纱布敷料（对照组）或 NPWT 敷料（-125mmHg，持续抽吸）治疗 7 天。在 7 天尝试延迟一期伤口闭合，并在筋膜切开后 7 天或 21 天收获第三腓骨以进行分析。测量肌肉重量，并对肌肉的四个区域（浅表中央、深部中央、外侧和近端）的苏木精和伊红染色样本进行绘图，以分析不同的细胞形态。
在所有时间点，患侧肢体的肌肉重量均大于健侧，且治疗组之间无差异。在 7 天时，与对照组相比，仅 NPWT 组的深部中央样本的横截面积中含有更多正常纤维。21 天时，与对照组相比，NPWT 治疗的肌肉的深部中央、外侧和近端区域的正常纤维形态的横截面积更小，而仅含有单核细胞的横截面积更大。
NPWT 并未减轻肌肉重量。在 21 天时，与接受湿到干纱布敷料治疗的对照组相比，接受 7 天 NPWT 治疗的筋膜切开术后间隔综合征患者的肌肉纤维再生程度降低。
NPWT 可能对需要筋膜切开术和局部伤口护理的间隔综合征后骨骼肌有害。
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