Division of Trauma and Acute Care Surgery, Department of Surgery, Baylor Scott & White Healthcare, Temple, TX.
Division of Trauma and Acute Care Surgery, Department of Surgery, Baylor Scott & White Healthcare, Temple, TX.
J Am Coll Surg. 2018 Apr;226(4):507-512. doi: 10.1016/j.jamcollsurg.2017.12.008. Epub 2017 Dec 21.
A new proprietary negative pressure wound device has been developed to apply negative pressure therapy to closed wounds (closed-NPWT). We postulated that closed-NPWT management of contaminated and dirty wounds would lead to faster wound healing and no significant difference in wound complications.
An IRB approved, prospective randomized trial was performed. Patients were consented preoperatively, but not entered nor assigned treatment until intraoperative findings were known. Patients were randomly assigned to either open-NPWT or a wound closed with skin staples and external closed-NPWT. Primary outcome was time to complete wound healing, defined as complete epithelization of the wound. Secondary outcomes were wound complications including wound infection, seroma, and dehiscence. Statistical analysis was performed using chi-square test, Fisher exact test, t-test, and Wilcoxon Rank-Sum test with significance of p < 0.05.
Twenty-five closed-NPWT and 24 open-NPWT patients were analyzed. There were no significant differences in sex, mean age, BMI, smoking history, steroid use, comorbidities, or indication for surgery in the 2 groups. One patient in the open-NPWT group and 2 patients in the closed-NPWT group developed a wound infection (p = 1.0). Four open-NPWT and 3 closed-NPWT patients died from complications unrelated to the wound. Wound healing occurred at a median of 48 days (range 6 to 126 days) for the open-NPWT group vs a median of 7 days (range 6 to 12 days) for the closed-NPWT group (p < 0.0001).
Wound healing was significantly faster in contaminated and dirty wounds when managed with closed-NPWT. There was no difference in wound complications between the 2 treatment groups. This approach shows promise for closed management of contaminated and dirty wounds and warrants additional prospective studies with larger patient groups.
一种新的专利负压伤口装置已被开发出来，用于对闭合伤口（闭合-NPWT）进行负压治疗。我们推测，对污染和脏污的伤口进行闭合-NPWT 管理将导致更快的伤口愈合，并且伤口并发症没有显著差异。
进行了一项经 IRB 批准的前瞻性随机试验。患者在术前同意，但直到术中发现后才入组和分配治疗。患者随机分配到开放式-NPWT 或用皮肤钉和外部闭合-NPWT 闭合的伤口。主要结果是伤口完全愈合的时间，定义为伤口完全上皮化。次要结果是伤口并发症，包括伤口感染、血清肿和裂开。使用卡方检验、Fisher 确切检验、t 检验和 Wilcoxon 秩和检验进行统计分析，p<0.05 具有统计学意义。
分析了 25 例闭合-NPWT 和 24 例开放式-NPWT 患者。两组在性别、平均年龄、BMI、吸烟史、类固醇使用、合并症或手术指征方面无显著差异。开放式-NPWT 组中有 1 例患者和闭合-NPWT 组中有 2 例患者发生伤口感染（p=1.0）。4 例开放式-NPWT 和 3 例闭合-NPWT 患者因与伤口无关的并发症死亡。开放式-NPWT 组的伤口愈合中位数为 48 天（范围 6 至 126 天），而闭合-NPWT 组的伤口愈合中位数为 7 天（范围 6 至 12 天）（p<0.0001）。
在污染和脏污的伤口中，使用闭合-NPWT 进行管理可显著加快伤口愈合。两组治疗组之间的伤口并发症无差异。这种方法为污染和脏污伤口的闭合管理提供了希望，并需要进行更大患者群体的前瞻性研究。
