Vilar-Compte Diana, Castillejos Armando, Hernandez-Mello Norma, Robles-Vidal Carlos, Volkow Patricia
Department of Infectious Diseases, National Cancer Institute, Tlalpan, Mexico; Email:
Wounds. 2010 Dec;22(12):316-21.
Objective. To present a 4-year experience of surveillance and management of surgical wound complications in a cohort of patients who underwent breast cancer surgery at a cancer hospital.
A descriptive follow-up study was undertaken at a teaching, referral cancer hospital in Mexico City (National Cancer Institute). Patients (n = 1774) underwent 1888 breast cancer surgeries. The main outcome measures were wound complications (surgical site infections [SSI], flap necrosis, and dehiscence).
There were 873 (46.2%) wound complications recorded. The most frequent complications were SSI (n = 387, 20.5%), flap necrosis (n = 274, 14.5%), and dehiscence (n = 212, 11.2%). Most patients with infections were treated with oral antibiotics and local wound management (n = 353, 91.9%) with positive results. Flap necrosis and dehiscence were treated under the wound bed preparation model with debridement plus combined (concomitant or sequential) dressings and ointments that favored wound healing, achieving closure at the last appointment in 189 (48.4%) patients. Average time to closure for necrotized and dehisced wounds was 52.4 ± 45.7 and 45.2 ± 36.1 days, respectively.
An average delay of 10 days on the initiation of adjuvant treatment was observed in patients with a wound complication (SSI, flap necrosis, or dehiscence) compared to patients without wound complications (P = 0.002). The frequency of wound complications was high. Active surveillance allowed the authors to diagnose wound complications early in their development. Local wound management under the wound preparation model and use of antibiotics when an infection is suspected were successful therapies in most patients.
目的。介绍一家癌症医院中一组接受乳腺癌手术患者的手术伤口并发症监测与管理的4年经验。
在墨西哥城的一家教学型转诊癌症医院（国家癌症研究所）进行了一项描述性随访研究。患者（n = 1774）接受了1888例乳腺癌手术。主要观察指标为伤口并发症（手术部位感染[SSI]、皮瓣坏死和裂开）。
记录到873例（46.2%）伤口并发症。最常见的并发症为SSI（n = 387，20.5%）、皮瓣坏死（n = 274，14.5%）和裂开（n = 212，11.2%）。大多数感染患者接受口服抗生素和局部伤口处理（n = 353，91.9%），效果良好。皮瓣坏死和裂开采用伤口床准备模式进行处理，包括清创加联合（同时或序贯）敷料和药膏，有利于伤口愈合，在最后一次随访时189例（48.4%）患者伤口实现闭合。坏死和裂开伤口的平均闭合时间分别为52.4±45.7天和45.2±36.1天。
与无伤口并发症的患者相比，有伤口并发症（SSI、皮瓣坏死或裂开）的患者辅助治疗开始时间平均延迟10天（P = 0.002）。伤口并发症发生率较高。积极监测使作者能够在伤口并发症发展早期进行诊断。在伤口准备模式下进行局部伤口处理以及在怀疑感染时使用抗生素，对大多数患者来说是成功的治疗方法。
