Willy Christian, Agarwal Animesh, Andersen Charles A, Santis Giorgio De, Gabriel Allen, Grauhan Onnen, Guerra Omar M, Lipsky Benjamin A, Malas Mahmoud B, Mathiesen Lars L, Singh Devinder P, Reddy V Sreenath
Department of Traumatology and Orthopaedic, Septic and Reconstructive Surgery, Research and Treatment Center for Complex Combat Injuries, Wound Centre Berlin, Bundeswehr Hospital Berlin, Berlin, Germany.
Division of Orthopaedic Traumatology, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Int Wound J. 2017 Apr;14(2):385-398. doi: 10.1111/iwj.12612. Epub 2016 May 12.
Surgical site occurrences (SSOs) affect up to or over 25% of patients undergoing operative procedures, with the subset of surgical site infections (SSIs) being the most common. Commercially available closed incision negative pressure therapy (ciNPT) may offer surgeons an additional option to manage clean, closed surgical incisions. We conducted an extensive literature search for studies describing ciNPT use and assembled a diverse panel of experts to create consensus recommendations for when using ciNPT may be appropriate. A literature search of MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials using key words 'prevention', 'negative pressure wound therapy (NPWT)', 'active incisional management', 'incisional vacuum therapy', 'incisional NPWT', 'incisional wound VAC', 'closed incisional NPWT', 'wound infection', and 'SSIs' identified peer-reviewed studies published from 2000 to 2015. During a multidisciplinary consensus meeting, the 12 experts reviewed the literature, presented their own ciNPT experiences, identified risk factors for SSOs and developed comprehensive consensus recommendations. A total of 100 publications satisfied the search requirements for ciNPT use. A majority presented data supporting ciNPT use. Numerous publications reported SSI risk factors, with the most common including obesity (body mass index ≥30 kg/m ); diabetes mellitus; tobacco use; or prolonged surgical time. We recommend that the surgeon assess the individual patient's risk factors and surgical risks. Surgeons should consider using ciNPT for patients at high risk for developing SSOs or who are undergoing a high-risk procedure or a procedure that would have highly morbid consequences if an SSI occurred.
手术部位事件（SSO）影响高达或超过25%接受手术操作的患者，其中手术部位感染（SSI）这一亚组最为常见。市售的封闭式切口负压治疗（ciNPT）可能为外科医生提供一种额外的选择来处理清洁的闭合手术切口。我们对描述ciNPT使用情况的研究进行了广泛的文献检索，并召集了一个多元化的专家小组，以制定关于何时使用ciNPT可能合适的共识性建议。使用关键词“预防”“负压伤口治疗（NPWT）”“主动切口管理”“切口真空治疗”“切口NPWT”“切口伤口VAC”“闭合切口NPWT”“伤口感染”和“SSI”对MEDLINE、EMBASE和Cochrane对照试验中央注册库进行文献检索，确定了2000年至2015年发表的同行评审研究。在一次多学科共识会议上，12位专家回顾了文献，介绍了他们自己使用ciNPT的经验，确定了SSO的风险因素，并制定了全面的共识性建议。共有100篇出版物满足ciNPT使用的检索要求。大多数出版物提供了支持ciNPT使用的数据。众多出版物报告了SSI的风险因素，最常见的包括肥胖（体重指数≥30kg/m²）、糖尿病、吸烟或手术时间延长。我们建议外科医生评估个体患者的风险因素和手术风险。对于发生SSO风险高的患者、正在接受高风险手术的患者或如果发生SSI会产生严重不良后果的手术患者，外科医生应考虑使用ciNPT。
