Section of Colorectal and Minimally Invasive Surgery, Division of General Surgery, The Ottawa Hospital, Ottawa, Ontario, Canada.
Int Wound J. 2018 Oct;15(5):740-748. doi: 10.1111/iwj.12921. Epub 2018 Jun 4.
Impaired perineal wound healing is a major source of morbidity after abdominoperineal resection. Incisional negative pressure wound therapy can improve healing, prevent infections, and decrease the frequency of dehiscence. Our objective was to summarise existing evidence on the use of incisional negative pressure wound therapy on perineal wounds after abdominoperineal resection and to determine the effect on perineal wound complications. Electronic databases were searched in January 2017. Studies describing the use of incisional negative pressure wound therapy on primarily closed perineal wounds after abdominoperineal resection were included. Of the 278 identified articles, 5 were retrieved for inclusion in the systematic review (n = 169 patients). A significant decrease in perineal wound complications when using incisional negative pressure wound therapy was demonstrated, with surgical site infection rates as low as 9% (vs 41% in control groups). The major limitation of this systematic review was a small number of retrieved studies with small patient populations, high heterogeneity, and methodological issues. This review suggests that incisional negative pressure wound therapy decreases perineal wound complications after abdominoperineal resection. Further prospective trials with larger patient populations would be needed to confirm this association and delineate which patients might benefit most from the intervention.
会阴切口愈合不良是腹会阴切除术后发病率的主要原因。切口负压伤口治疗可以促进愈合，预防感染，并减少裂开的频率。我们的目的是总结目前关于腹会阴切除术后会阴切口使用切口负压伤口治疗的证据，并确定其对会阴伤口并发症的影响。2017 年 1 月，我们对电子数据库进行了检索。纳入了描述在腹会阴切除术后一期闭合会阴切口使用切口负压伤口治疗的研究。在 278 篇确定的文章中，有 5 篇被纳入系统评价（n=169 例患者）。结果显示，使用切口负压伤口治疗会阴伤口并发症显著减少，手术部位感染率低至 9%（对照组为 41%）。本系统评价的主要局限性是检索到的研究数量较少，患者人群较小，异质性高，存在方法学问题。本综述表明，切口负压伤口治疗可减少腹会阴切除术后会阴伤口并发症。需要进一步进行前瞻性、更大规模的临床试验，以证实这种关联，并确定哪些患者可能从该干预措施中获益最多。
