Cai Stephen S, Gowda Arvind U, Alexander Richard H, Silverman Ronald P, Goldberg Nelson H, Rasko Yvonne M
Division of Plastic Surgery, University of Maryland Medical Center, Baltimore, MD, USA.
Division of Surgical Oncology, University of Maryland Medical Center, Baltimore, MD, USA.
Int Wound J. 2017 Aug;14(4):661-665. doi: 10.1111/iwj.12665. Epub 2016 Oct 3.
The presence of malignancy is considered a contraindication to the use of negative pressure wound therapy (NPWT) because of concerns that it may promote tumourigenesis and expedite metastasis. This notion is extrapolated from studies evaluating NPWT in normal tissues. Despite the absence of direct evidence, the use of this technology in malignant wounds is widely considered a contraindication. We present the case of a patient with treatment-resistant metastatic colon cancer, who developed a chronic abdominal wound with positive margins. A staged reconstruction using NPWT was performed and wound closure allowed the patient to meet eligibility criteria and enrol in a clinical trial for treatment of his oncological disease. Skin closure remained intact until the patient expired 6 months after the wound closure. This case, as well as others in the literature, demonstrated that the use of NPWT should not be considered an absolute contraindication in malignancy. Individualised approaches taking into account the patient's clinical scenario, the available evidence, as well as the risks and benefits of this technology are recommended.
由于担心负压伤口治疗(NPWT)可能促进肿瘤发生并加速转移,恶性肿瘤的存在被视为使用该技术的禁忌症。这一观点是从评估NPWT在正常组织中的研究推断而来的。尽管缺乏直接证据,但在恶性伤口中使用这项技术仍被广泛视为禁忌症。我们报告一例耐治疗性转移性结肠癌患者的病例,该患者出现了切缘阳性的慢性腹部伤口。采用NPWT进行了分期重建,伤口闭合使患者符合入选标准并参加了其肿瘤疾病治疗的临床试验。直到患者在伤口闭合6个月后死亡,皮肤闭合一直保持完好。该病例以及文献中的其他病例表明,NPWT的使用不应被视为恶性肿瘤的绝对禁忌症。建议采用个体化方法,综合考虑患者的临床情况、现有证据以及该技术的风险和益处。