de Jesus Lisieux Eyer, Martins Alana Bandeira, Oliveira Pablo Baptista, Gomes Fernanda, Leve Thais, Dekermacher Samuel
Pediatric Surgery and Urology Department, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.
Pediatric Surgery and Urology Department, Servidores do Estado Federal Hospital, Ministry of Health, Rio de Janeiro, Brazil.
J Pediatr Surg. 2018 Apr;53(4):585-591. doi: 10.1016/j.jpedsurg.2017.11.048. Epub 2017 Nov 21.
Negative pressure wound therapy (NPWT) has been widely adopted to treat laparostomy, abdominal compartment syndrome (ACS) and complicated wounds associated with tissue loss. The method presents specific aspects, advantages and indications in Pediatrics. Our aim is to review the evidence available about NPWT in children.
Active search for papers about NPWT in Pediatric patients. Papers referring to orthopedic problems, wound complications after Cardiac Surgery or burns were excluded.
The method shows good results to treat ACS, complicated wounds and abdominal wall malformations in neonates, including prematures. Periwound skin protection, monitoring of fluid losses and fine tuning of negative pressure levels according to age are necessary. Less pain, quicker recovery, less frequent dressing changes, possible recovery of exposed surgical hardware, granulation and shrinkage of the wound are advantages of the method over other kinds of dressing. NPWT is contraindicated over blood vessels and exposed nerves. Debridement is needed before usage over necrotic areas. Enteric fistulae are not contraindications. Complications are rare, mainly foam retention and dermatitis/skin maceration. The possibility of fistulae being caused by NPWT remains debatable.
NPWT is widely used in Pediatrics, including neonates and premature, but the evidence available about the method is scarce and low quality. Complications are uncommon and mostly manageable. A possible causal relationship between NPWY and enteric fistula remains unclear. Adult devices and parameters have been adapted to children's use. Extra care is needed to protect the delicate tissues of Pediatric patients. Comparative research to define differential costs, indications and advantages of the method, specific indications and limits of NWTP in Pediatrics is needed.
Review.
IV.
负压伤口治疗（NPWT）已被广泛应用于治疗剖腹术、腹腔间隔室综合征（ACS）以及与组织缺损相关的复杂伤口。该方法在儿科领域具有特定的特点、优势和适应证。我们的目的是回顾关于儿童NPWT的现有证据。
积极检索关于儿科患者NPWT的文献。排除涉及骨科问题、心脏手术后伤口并发症或烧伤的文献。
该方法在治疗新生儿（包括早产儿）的ACS、复杂伤口和腹壁畸形方面显示出良好效果。需要进行伤口周围皮肤保护、监测液体丢失，并根据年龄微调负压水平。与其他类型的敷料相比，该方法具有疼痛较轻、恢复较快、换药频率较低、可能使外露的手术器械复位、促进伤口肉芽生长和收缩等优点。NPWT在血管和外露神经上方禁用。在坏死区域使用前需要进行清创。肠瘘并非禁忌证。并发症罕见，主要为泡沫残留和皮炎/皮肤浸渍。NPWT导致瘘管形成的可能性仍存在争议。
NPWT在儿科领域广泛应用，包括新生儿和早产儿，但关于该方法的现有证据稀少且质量较低。并发症不常见且大多可控。NPWY与肠瘘之间可能的因果关系仍不明确。成人设备和参数已适用于儿童使用。需要格外小心保护儿科患者的娇嫩组织。需要进行对比研究以确定该方法的成本差异、适应证和优势，以及NPWT在儿科的具体适应证和局限性。
综述。
IV级。
