Koncar Igor, Cvetković Slobodan, Dragas Marko, Pejkić Sinisa, Lazović Goran, Banzić Igor, Zuvela Marinko, Marković Miroslav, Davidović Lazar
Vojnosanit Pregl. 2016 Jan;73(1):9-15. doi: 10.2298/vsp131222127k.
BACKGROUND/AIM. Surgical and chronic wounds in vascular patients might contribute to limb loss and death. Vacuum-assisted closure (VAC)--Kinetic Concepts, Inc. (KCI), has been increasingly used in Western Europe and the U.S.A. clinical practice for 15 years. Advantages of this method are faster wound healing, wound approximation, lower wound related treatment costs and improved quality of life during treatment. Evidence related to the usage of VAC therapy in vascular patients and cost effectiveness of VAC therapy in a developing country are lacking. The aim of this study was to explore results of VAC therapy in vascular surgery comparing to conventional methods and to test cost effects in a developing country like Serbia.
All patients with wound infection or dehiscence operated at the tertiary vascular university clinic in the period from January 2011-January 2012, were treated with VAC therapy. The primary endpoint was wound closure, while secondary endpoints were hospital stay, the number of weekly dressings, costs of wound care, working time of medical personnel. The patients were divided into groups according to the wound type and location: wound with exposed synthetic vascular implant (25%), laparotomy (13%), foot amputation (29%), major limb amputation (21%), fasciotomy (13%). The results of primary and secondary endpoint were compared with the results of conventional treatment during the previous year.
There was one death (1/42, 2.38%) and one limb loss (1/12, 2.38%) in the VAC group, and 8 deaths (8/38, 21.05%) and 5 (5/38, 13.15%) limb losses in the patients treated with conventional therapy. In the VAC group there was one groin bleeding (1/12, 2.38%), one groin reinfection (1/12, 2.38%) and one resistance to therapy with a consequent limb loss. Costs of hospital stay (p < 0.001) and nursing time (p < 0.001) were reduced with VAC therapy in the group with exposed graft.
VAC therapy is the effective method for care of complicated wounds in vascular surgery. Patients with infection of wound with the exposed synthetic graft significantly benefit form this therapy. Cost effectiveness of VAC therapy is applicable to a developing country scenario, however cautious selection of patients contributes to the effectiveness.
背景/目的。血管疾病患者的手术伤口和慢性伤口可能导致肢体丧失和死亡。负压封闭引流（VAC）——动力概念公司（KCI）的产品，在西欧和美国的临床实践中已被越来越多地使用了15年。该方法的优点包括伤口愈合更快、伤口闭合、与伤口相关的治疗成本降低以及治疗期间生活质量提高。目前缺乏关于VAC疗法在血管疾病患者中的应用以及在发展中国家VAC疗法成本效益的证据。本研究的目的是探讨VAC疗法在血管外科手术中的效果，并与传统方法进行比较，同时在塞尔维亚这样的发展中国家测试其成本效益。
2011年1月至2012年1月期间，在三级血管大学诊所接受伤口感染或裂开手术的所有患者均接受VAC疗法治疗。主要终点是伤口闭合，次要终点包括住院时间、每周换药次数、伤口护理成本、医务人员工作时间。根据伤口类型和位置将患者分为几组：暴露合成血管植入物的伤口（25%）、剖腹手术（13%）、足部截肢（29%）、大肢体截肢（21%）、筋膜切开术（13%）。将主要和次要终点的结果与上一年传统治疗的结果进行比较。
VAC组有1例死亡（1/42，2.38%）和1例肢体丧失（1/12，2.38%），传统治疗组有8例死亡（8/38，21.05%）和5例肢体丧失（5/38，13.15%）。VAC组有1例腹股沟出血（1/12，2.38%）、1例腹股沟再感染（1/12，2.38%）和1例治疗抵抗并导致肢体丧失。在暴露移植物的组中，VAC疗法降低了住院成本（p < 0.001）和护理时间（p < 0.001）。
VAC疗法是血管外科手术中处理复杂伤口的有效方法。伤口感染且暴露合成移植物的患者从该疗法中显著获益。VAC疗法的成本效益适用于发展中国家的情况，然而谨慎选择患者有助于提高疗效。
