Tilt Alexandra, Falola Reuben A, Kumar Anagha, Campbell Tessa J, Marks Jacob M, Attinger Christopher E, Evans Karen K
Department of Plastic Surgery, Georgetown University Hospital, Washington, DC.
Wounds. 2018 Nov;30(11):317-323. Epub 2018 Aug 23.
Plastic surgeons are often consulted by other surgical teams for management of wound dehiscence following abdominopelvic surgery.
The purpose of this study is to determine whether operative debridement and primary closure of abdominopelvic wounds are safe and expeditious for patients.
A retrospective analysis was conducted on a database of patients who underwent operative debridement and closure at a single institution between January 2011 and December 2015 for dehisced abdominal or pelvic wounds acquired from prior obstetric, gynecologic, transplant, plastic, or general surgery procedures.
Of the 163 patient records identified, 43 patients met inclusion criteria. The median time from final debridement and primary surgical closure to complete wound healing was 27 days. Time to healing differed significantly by index procedure type (P = .004), with obstetric procedures requiring the shortest median time (12.0 days) and general surgery procedures requiring the longest (39.5 days). Wound healing took 3.6 times longer for patients with diabetes (P = .046) and 11.4 times longer for patients who experienced delayed superficial wound healing or redehiscence (P = .003). Nevertheless, with the exception of 4 patients who died of other causes, all wounds (39/39; 100%) achieved complete wound closure.
Operative debridement and closure of abdominopelvic wound dehiscence through a multidisciplinary team approach with plastic surgery results in expeditious wound healing with minimal complications, and it may be safer and more cost effective than healing by secondary intention.
其他外科团队在处理腹盆腔手术后的伤口裂开时，经常会咨询整形外科医生。
本研究的目的是确定对患者进行手术清创和一期缝合腹盆腔伤口是否安全且迅速。
对2011年1月至2015年12月期间在单一机构接受手术清创和缝合的患者数据库进行回顾性分析，这些患者的腹部或盆腔伤口裂开是由先前的产科、妇科、移植、整形或普通外科手术引起的。
在确定的163份患者记录中，43例患者符合纳入标准。从最后清创和一期手术缝合到伤口完全愈合的中位时间为27天。愈合时间因索引手术类型而异（P = 0.004），产科手术所需的中位时间最短（12.0天），普通外科手术所需的时间最长（39.5天）。糖尿病患者的伤口愈合时间延长3.6倍（P = 0.046），经历浅表伤口愈合延迟或伤口再裂开的患者延长11.4倍（P = 0.003）。然而，除4例因其他原因死亡的患者外，所有伤口（39/39；100%）均实现完全愈合。
通过整形外科多学科团队方法对腹盆腔伤口裂开进行手术清创和缝合可实现迅速的伤口愈合，并发症最少，并且可能比二期愈合更安全、更具成本效益。
