DeFazio Michael V, Economides James M, Anghel Ersilia L, Mathis Ryan K, Barbour John R, Attinger Christopher E
Center for Wound Healing, Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, DC.
Wounds. 2017 Oct;29(10):289-296. doi: 10.25270/wnds/2017.10.289296. Epub 2017 Jul 26.
BACKGROUND/OBJECTIVE: Loss of domain often complicates attempts at delayed wound closure in regions of high tension. Wound temporization with traction-assisted internal negative pressure wound therapy (NPWT), using bridging retention sutures, can minimize the effects of edema and elastic recoil that contribute to progressive tissue retraction over time. The investigators evaluated the safety and efficacy of this technique for complex wound closure.
Between May 2015 and November 2015, 18 consecutive patients underwent staged reconstruction of complex and/or contaminated soft tissue defects utilizing either conventional NPWT or modified NPWT with instillation and continuous dermatotraction via bridging retention sutures. Instillation of antimicrobial solution was reserved for wounds containing infected/exposed hardware or prosthetic devices. Demographic data, wound characteristics, reconstructive outcomes, and complications were reviewed retrospectively.
Eighteen wounds were treated with traction-assisted internal NPWT using the conventional (n = 11) or modified instillation (n = 7) technique. Defects involved the lower extremity (n = 14), trunk (n = 3), and proximal upper extremity (n = 1), with positive cultures identified in 12 wounds (67%). Therapy continued for 3 to 8 days (mean, 4.3 days), resulting in an average wound surface area reduction of 78% (149 cm² vs. 33 cm²) at definitive closure. Seventeen wounds (94%) were closed directly, whereas the remaining defect required coverage with a local muscle flap and skin graft. At final follow-up (mean, 12 months), 89% of wounds remained closed. In 2 patients with delayed, recurrent periprosthetic infection (mean, 7.5 weeks), serial debridement/hardware removal mandated free tissue transfer for composite defect reconstruction.
Traction-assisted internal NPWT provides a safe and effective alternative to reduce wound burden and facilitate definitive closure in cases where delayed reconstruction of high-tension wounds is planned.
背景/目的：在高张力区域，组织缺失常常使延迟伤口闭合变得复杂。采用桥接固定缝线的牵引辅助内部负压伤口治疗（NPWT）进行伤口临时处理，可将水肿和弹性回缩的影响降至最低，而水肿和弹性回缩会导致组织随时间逐渐回缩。研究人员评估了该技术用于复杂伤口闭合的安全性和有效性。
2015年5月至2015年11月期间，18例连续患者接受了复杂和/或污染软组织缺损的分期重建，采用传统NPWT或改良NPWT，通过桥接固定缝线进行滴注和持续皮肤牵引。抗菌溶液滴注仅用于含有感染/外露硬件或假体装置的伤口。回顾性分析人口统计学数据、伤口特征、重建结果和并发症。
18个伤口采用传统技术（n = 11）或改良滴注技术（n = 7）进行牵引辅助内部NPWT治疗。缺损累及下肢（n = 14）、躯干（n = 3）和近端上肢（n = 1），12个伤口（67%）培养结果呈阳性。治疗持续3至8天（平均4.3天），最终闭合时伤口表面积平均减少78%（149 cm²对33 cm²）。17个伤口（94%）直接闭合，其余缺损需要用局部肌皮瓣和皮肤移植覆盖。在最后随访时（平均12个月），89%的伤口保持闭合。2例患者发生延迟性假体周围反复感染（平均7.5周），经系列清创/取出硬件后，需进行游离组织移植以重建复合缺损。
对于计划进行高张力伤口延迟重建的病例，牵引辅助内部NPWT是一种安全有效的方法，可减轻伤口负担并促进最终闭合。
