Dohmen Pascal M, Markou Thanasie, Ingemansson Richard, Rotering Heinrich, Hartman Jean M, van Valen Richard, Brunott Maaike, Segers Patrique
Department of Cardiothoracic Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.
Department of Cardiothoracic Surgery, Isala Klinieken Zwolle, Zwolle, Netherlands.
Med Sci Monit. 2014 Oct 4;20:1814-25. doi: 10.12659/MSM.891169.
Negative pressure wound therapy is a concept introduced initially to assist in the treatment of chronic open wounds. Recently, there has been growing interest in using the technique on closed incisions after surgery to prevent potentially severe surgical site infections and other wound complications in high-risk patients. Negative pressure wound therapy uses a negative pressure unit and specific dressings that help to hold the incision edges together, redistribute lateral tension, reduce edema, stimulate perfusion, and protect the surgical site from external infectious sources. Randomized, controlled studies of negative pressure wound therapy for closed incisions in orthopedic settings (which also is a clean surgical procedure in absence of an open fracture) have shown the technology can reduce the risk of wound infection, wound dehiscence, and seroma, and there is accumulating evidence that it also improves wound outcomes after cardiothoracic surgery. Identifying at-risk individuals for whom prophylactic use of negative pressure wound therapy would be most cost-effective remains a challenge; however, several risk-stratification systems have been proposed and should be evaluated more fully. The recent availability of a single-use, closed incision management system offers surgeons a convenient and practical means of delivering negative pressure wound therapy to their high-risk patients, with excellent wound outcomes reported to date. Although larger, randomized, controlled studies will help to clarify the precise role and benefits of such a system in cardiothoracic surgery, limited initial evidence from clinical studies and from the authors' own experiences appears promising. In light of the growing interest in this technology among cardiothoracic surgeons, a consensus meeting, which was attended by a group of international experts, was held to review existing evidence for negative pressure wound therapy in the prevention of wound complications after surgery and to provide recommendations on the optimal use of negative pressure wound therapy on closed median sternal incisions after cardiothoracic surgery.
负压伤口治疗最初是作为一种辅助治疗慢性开放性伤口的概念而引入的。最近，人们越来越有兴趣在手术后的闭合切口上使用该技术，以预防高危患者潜在的严重手术部位感染和其他伤口并发症。负压伤口治疗使用负压装置和特定敷料，有助于使切口边缘贴合在一起，重新分布侧向张力，减轻水肿，刺激灌注，并保护手术部位免受外部感染源的影响。针对骨科环境中闭合切口的负压伤口治疗进行的随机对照研究（在没有开放性骨折的情况下，这也是一种清洁的外科手术）表明，该技术可以降低伤口感染、伤口裂开和血清肿的风险，并且越来越多的证据表明，它还能改善心胸外科手术后的伤口预后。确定预防性使用负压伤口治疗最具成本效益的高危个体仍然是一项挑战；然而，已经提出了几种风险分层系统，应进行更全面的评估。最近推出的一次性闭合切口管理系统为外科医生提供了一种方便实用的方法，可为高危患者提供负压伤口治疗，迄今为止报告的伤口预后良好。尽管更大规模的随机对照研究将有助于阐明这种系统在心胸外科手术中的确切作用和益处，但临床研究和作者自身经验的初步有限证据似乎很有前景。鉴于心胸外科医生对该技术的兴趣日益浓厚，一组国际专家参加了一次共识会议，以审查负压伤口治疗在预防手术后伤口并发症方面的现有证据，并就心胸外科手术后在闭合正中胸骨切口中最佳使用负压伤口治疗提供建议。
