From the Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
J Am Acad Orthop Surg. 2018 May 1;26(9):295-302. doi: 10.5435/JAAOS-D-17-00054.
Wound complications and surgical site infections after orthopaedic procedures result in substantial morbidity and costs. Traditional postoperative wound care consists of applying sterile, dry gauze and abdominal pads to the surgical site, with more frequent dressing changes performed in cases in which wound drainage is excessive. Persistent incisional drainage is of particular concern because it increases the risk of deep infection. The use of closed incision negative-pressure wound therapy (ciNPWT) to manage delayed wound healing was first reported a decade ago, and the benefits of this treatment modality include wound contraction with diminished tensile forces, stabilization of the wound environment, decreased edema and improved removal of exudate, and increased blood and lymphatic flow. Numerous trauma, plastic surgery, and general surgery studies have demonstrated that ciNPWT improves wound healing. In orthopaedic surgery, ciNPWT has been shown to be clinically effective for incisions at high risk for perioperative complications. However, specific indications for ciNPWT continue to be defined.
骨科手术后的伤口并发症和手术部位感染会导致严重的发病率和费用。传统的术后伤口护理包括在手术部位敷上无菌、干燥的纱布和腹带，在伤口引流过多的情况下，更频繁地更换敷料。持续的切口引流尤其令人担忧，因为它会增加深部感染的风险。十年前首次报道了使用封闭切口负压伤口治疗（ciNPWT）来治疗延迟愈合的伤口，这种治疗方式的好处包括减少张力的伤口收缩、稳定伤口环境、减少水肿和改善渗出物的清除，以及增加血液和淋巴液的流动。大量创伤、整形和普通外科研究表明，ciNPWT 可改善伤口愈合。在骨科手术中，ciNPWT 已被证明对围手术期并发症高风险的切口具有临床疗效。然而，ciNPWT 的具体适应证仍在不断确定中。
