Maurya Sanjay, Bhandari Prem Singh
Department of Plastic and Reconstructive Surgery, Command Hospital , Udhampur, India .
Adv Wound Care (New Rochelle). 2016 Sep 1;5(9):379-389. doi: 10.1089/wound.2014.0624.
Wounds sustained in a combat trauma often result in a composite tissue loss. Combat injuries, due to high energy transfer to tissues, lead to trauma at multiple anatomical sites. An early wound cover is associated with lower rate of infections and a faster wound healing. The concept of negative pressure wound therapy (NPWT) in the management of combat-related wounds has evolved from the civilian trauma and the wounds from nontraumatic etiologies. Encouraged by the results of NPWT in noncombat-related wounds, the military surgeons during Operation Iraqi Freedom and Operation Enduring Freedom used this novel method in a large percentage of combat wounds, with gratifying results. The mechanism of NPWT in wound healing is multifactorial and often complex reconstructive procedure can be avoided in a combat trauma setting. Wounds sustained in military trauma are heavily contaminated with dirt, patient clothing, and frequently associated with extensive soft tissue loss and osseous destruction. Delay in evacuation during an ongoing conflict carries the risk of systemic infection. Early debridement is indicated followed by delayed closure of wounds. NPWT helps to provide temporary wound cover during the interim period of debridement and wound closure. Future area of research in combat wounds is related to abdominal trauma with loss of abdominal wall. The concept of negative pressure incisional management system in patients with a high risk of wound breakdown following surgery is under review, and may be of relevance in combat wounds.
战斗创伤中所受的伤口常导致复合组织缺失。由于能量大量传递至组织，战斗损伤会造成多个解剖部位的创伤。早期伤口覆盖与较低的感染率及更快的伤口愈合相关。负压伤口治疗（NPWT）在处理与战斗相关伤口方面的理念源自 civilian trauma 和非创伤性病因导致的伤口。受NPWT在非战斗相关伤口治疗结果的鼓舞，伊拉克自由行动和持久自由行动期间的军医在很大比例的战斗伤口中使用了这种新方法，取得了令人满意的效果。NPWT促进伤口愈合的机制是多因素的，在战斗创伤情况下通常可避免复杂的重建手术。军事创伤中的伤口严重沾染污垢、患者衣物，且常伴有广泛的软组织缺失和骨质破坏。在持续冲突中后送延迟有发生全身感染的风险。应尽早进行清创，随后延迟关闭伤口。NPWT有助于在清创和伤口关闭的过渡期提供临时伤口覆盖。战斗伤口未来的研究领域与腹壁缺失的腹部创伤有关。术后伤口裂开风险高的患者使用负压切口管理系统的理念正在研究中，可能与战斗伤口相关。
