Chen Bailin, Hao Fabao, Yang Yang, Shang Qingjuan, Guo Chunbao
Department of Pediatric General Surgery and Liver Transplantation, Children's Hospital, Chongqing Medical University, Chongqing Department of Pathology, Linyi People's Hospital, Linyi, Shandong Province Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital, Chongqing Medical University, Chongqing, P.R. China.
Medicine (Baltimore). 2017 Mar;96(13):e6511. doi: 10.1097/MD.0000000000006511.
Surgical site infection (SSI) continues to be an issue in abdominal surgery, especially for contaminated (class III) and dirty-infected (class IV) wounds. Vacuum sealing drainage (VSD) was reported effective in the management of various types of wounds or skin grafts. Our goal was to investigate the efficacy of prophylactic VSD to better orient their medicosurgical care of high-risk incisions following laparotomy in a pediatric population.A total of 331 pediatric patients with contaminated (class III) and dirty-infected (class IV) wounds following emergency laparotomy were retrospectively reviewed between January 2005 and January 2013. Among them, 111 cases were placed with prophylactic VSD when incisions were closed. Clinical outcomes, including, overall surgical site complication, device effectiveness, and mean postoperative LOS were evaluated based on VSD usage or not.VSD was applied for an average of 5.8 days (range, 5-7 days), with 3 to 15 mL sucked fluid. The overall SSIs rate was 3% for patients with prophylactic VSD and 17% for patients with convention dressing (OR, 0.27; 95% CI, 0.10-0.71, P = 0.004). In patients with prophylactic VSD, only 1 of 96 wound developed postoperative incision dehiscence, which is significant reduced compared with patients for conventional dressings (OR, 0.12; 95% CI, 0.01-0.95; P = 0.017) (Table 2). It also exhibited a decreased mean postoperative LOS (P < 0.001) for prophylactic VSD over conventional dressings.Our study demonstrated beneficial postoperative clinical effects of prophylactic VSD for high-risk laparotomy incisions following emergency laparotomy, such as shorter length of hospitalization, which may be attributed to the reduced overall SSIs rate.
手术部位感染（SSI）仍是腹部手术中的一个问题，尤其是对于污染（Ⅲ类）和脏污感染（Ⅳ类）伤口。据报道，负压封闭引流（VSD）在各类伤口或皮肤移植的处理中有效。我们的目标是研究预防性VSD的疗效，以便更好地指导对儿科患者剖腹术后高危切口的药物手术治疗。
回顾性分析了2005年1月至2013年1月期间331例因急诊剖腹手术而出现污染（Ⅲ类）和脏污感染（Ⅳ类）伤口的儿科患者。其中，111例在切口关闭时放置了预防性VSD。根据是否使用VSD评估临床结局，包括总体手术部位并发症、装置有效性和平均术后住院时间。
VSD平均应用5.8天（范围为5 - 7天），吸出液体3至15毫升。预防性使用VSD的患者总体SSI发生率为3%，使用传统敷料的患者为17%（OR，0.27；95%CI，0.10 - 0.71，P = 0.004）。在预防性使用VSD的患者中，96个伤口中只有1个出现术后切口裂开，与使用传统敷料的患者相比显著减少（OR，0.12；95%CI，0.01 - 0.95；P = 0.017）（表2）。与传统敷料相比，预防性使用VSD的患者术后平均住院时间也缩短（P < 0.001）。
我们的研究表明，预防性VSD对急诊剖腹术后的高危剖腹手术切口具有有益的术后临床效果，如缩短住院时间，这可能归因于总体SSI发生率的降低。
