Riot Samuel, de Bonnecaze Guillaume, Garrido Ignacio, Ferron Gwenaël, Grolleau Jean-Louis, Chaput Benoit
Department of Plastic and Reconstructive Surgery, University of Toulouse CHU Rangueil, Toulouse, France.
Department of Otorhinolaryngology, Head and Neck Surgery, University of Toulouse CHU Rangueil-Larrey, Toulouse, France.
Palliat Med. 2015 May;29(5):470-3. doi: 10.1177/0269216314560009. Epub 2014 Dec 18.
The management of malignant wounds remains particularly difficult. They are often malodorous, highly exuding, and painful. In this context, the use of negative pressure wound therapy is usually not recommended. It is, however, an effective procedure for maintaining a good quality of life in certain palliative situations.
Five patients underwent negative pressure wound therapy for a malignant wound in our unit. Three had sarcomas, one patient had a parietal recurrence of breast carcinoma, and one patient had melanoma. They were in a metastatic palliative situation and were no longer receiving specific treatment.
The patients reported a decrease in odor and exudates with negative pressure wound therapy, compared with conventional dressings. No patients complained of pain associated with the suction system itself. Fewer dressing changes reduced the pain and encouraged the resumption of social interactions. The average duration of negative pressure wound therapy before the death of the patients was 49 days. No complications or bleeding were observed. The duration of the patients' stay was shortened by implementing negative pressure wound therapy at home.
We report on our experiences with five patients for whom manufacturers and health authorities contraindicated the use of negative pressure wound therapy because of its potential to encourage tumor growth, although it was considered to be beneficial for all of these patients. This procedure may offer an alternative to conventional wound dressings at the end of life and improve the quality of life of patients by controlling the three most disabling elements: the odor, exudate, and pain associated with changing the dressings. Miniaturization and lower costs could promote the systematic use of negative pressure wound therapy.
恶性伤口的处理仍然特别困难。它们通常有恶臭、渗出严重且疼痛。在这种情况下，通常不建议使用负压伤口治疗。然而，在某些姑息治疗情况下，它是维持良好生活质量的有效方法。
我们科室有5例患者因恶性伤口接受了负压伤口治疗。3例患有肉瘤，1例患有乳腺癌壁层复发，1例患有黑色素瘤。他们处于转移性姑息治疗状态，不再接受特定治疗。
与传统敷料相比，患者报告负压伤口治疗后气味和渗出物减少。没有患者抱怨与吸引系统本身相关的疼痛。换药次数减少减轻了疼痛，并促使社交活动恢复。患者死亡前负压伤口治疗的平均持续时间为49天。未观察到并发症或出血。在家中实施负压伤口治疗缩短了患者的住院时间。
我们报告了5例患者的经验，尽管制造商和卫生当局因负压伤口治疗可能促进肿瘤生长而对其使用提出禁忌，但该治疗方法被认为对所有这些患者都有益。该方法可能为临终时的传统伤口敷料提供一种替代方案，并通过控制最使人丧失能力的三个因素，即与换药相关的气味、渗出物和疼痛，来提高患者的生活质量。小型化和降低成本可能会促进负压伤口治疗的系统应用。
