Kong Roderick, Shields David, Bailey Oliver, Gupta Sanjay, Mahendra Ashish
Department of Musculoskeletal Oncology, Glasgow Royal Infirmary, 84 Castle Street, Glasgow, G4 0ET Scotland, United Kingdom.
Open Orthop J. 2017 May 31;11:502-507. doi: 10.2174/1874325001711010502. eCollection 2017.
Following excision of musculoskeletal tumours, patients are at high risk of wound issues such as infection, dehiscence and delayed healing. This is due to a multitude of factors including the invasive nature of the disease, extensive soft tissue dissection, disruption to blood and lymphatic drainage, residual cavity and adjuvant therapies. The use of negative pressure wound therapy (NPWT) has a growing body of evidence on its beneficial effect of wound healing such as promoting cell differentiation, minimising oedema and thermoregulation. Traditionally, these dressings have been used for open or dehisced wounds; however recent research has investigated its role in closed wounds.
To evaluate the effect of NPWT in patients with closed wounds, either primarily or with flap coverage, in our high risk group. Consecutive patients who had a NPWT dressing applied were selected, and a control group was established by a blinded researcher with matching for tissue diagnosis, surgical site, gender and age. The primary outcome measured was documented for wound complications, with secondary data collected on radiotherapy and wound drainage.
Patients were well matched between the intervention (n=9) and control (n=9) groups for gender, age and tissue diagnosis. Both groups had 1 patient who underwent preoperative radiotherapy. A total of 3 wound infections occurred in the control group and none in the NPWT group. Overall there was a trend towards lower drain output and statistically significantly reduced infection rate in the NPWT group.
In this short series, despite the NPWT patients having more additional risk factors for wound issues, they resulted in fewer infections. The sample size is not sufficient to have statistically significant reduction. Further evaluation on the value of NPWT in this patient group should be prospectively evaluated.
切除肌肉骨骼肿瘤后，患者出现伤口问题（如感染、裂开和愈合延迟）的风险很高。这是由多种因素导致的，包括疾病的侵袭性、广泛的软组织解剖、血液和淋巴引流的破坏、残留腔隙以及辅助治疗。负压伤口治疗（NPWT）在伤口愈合方面的有益作用（如促进细胞分化、减轻水肿和调节体温）的证据越来越多。传统上，这些敷料用于开放性或裂开的伤口；然而，最近的研究探讨了其在闭合性伤口中的作用。
评估NPWT对我们高危组中主要为闭合性伤口或有皮瓣覆盖的患者的效果。选择连续应用NPWT敷料的患者，并由一名盲法研究人员建立对照组，使其在组织诊断、手术部位、性别和年龄方面相匹配。测量的主要结局是记录伤口并发症，并收集关于放疗和伤口引流的次要数据。
干预组（n=9）和对照组（n=9）在性别、年龄和组织诊断方面匹配良好。两组均有1例患者接受了术前放疗。对照组共发生3例伤口感染，NPWT组无感染发生。总体而言，NPWT组有引流液输出降低的趋势，且感染率在统计学上显著降低。
在这个短系列研究中，尽管接受NPWT治疗的患者有更多导致伤口问题的额外风险因素，但感染较少。样本量不足以在统计学上有显著降低。应前瞻性评估NPWT在该患者群体中的价值。
