Lauerman Margaret H, Scalea Thomas M, Eglseder W Andrew, Pensy Raymond, Stein Deborah M, Henry Sharon
Am Surg. 2018 Nov 1;84(11):1790-1795.
Little data exist about management of wounds created by debridement in necrotizing soft tissue infections (NSTIs). Multiple wound coverage techniques exist, including complete primary wound closure, split-thickness skin grafting, secondary intention, and flap creation. We hypothesized that all wound coverage techniques would be associated with high rates of successful wound coverage and low crossover rates to other wound coverage techniques. NSTIs over a three-year period were retrospectively reviewed. Both the initial and secondary wound coverage techniques (if necessary) were recorded. The primary outcome was the ability to achieve complete wound coverage. Overall, 46 patients with NSTIs had long-term data available. Of the patients undergoing split-thickness skin grafting as the initial wound coverage technique, 8/8 (100%) achieved complete wound coverage; and of those undergoing flap creation, 1/1 (100%) achieved complete wound coverage; and of those undergoing complete primary wound closure, 4/4 (100%) achieved complete wound coverage. Of the patients undergoing secondary intention as the initial wound coverage technique, 5/33 (15.2%) achieved complete wound coverage and 28/33 (84.8%) required a secondary wound coverage technique with split-thickness skin grafting. All 46 patients achieved long-term successful wound coverage. Time to wound coverage did not vary with initial wound coverage technique ( = 0.44). Split-thickness skin grafting, flap creation, complete primary wound closure, and secondary intention are all reasonable choices for initial wound coverage for NSTIs. Although secondary intention had a low success rate as an initial wound coverage technique, all patients ultimately achieved complete wound coverage without a significant increase in time to coverage.
关于坏死性软组织感染（NSTIs）清创术后伤口处理的数据较少。存在多种伤口覆盖技术，包括完全一期伤口闭合、中厚皮片移植、二期愈合和皮瓣制作。我们假设所有伤口覆盖技术都将与高伤口覆盖成功率和低转换至其他伤口覆盖技术的发生率相关。对三年期间的NSTIs进行了回顾性研究。记录了初始和二次伤口覆盖技术（如有必要）。主要结局是实现完全伤口覆盖的能力。总体而言，46例NSTIs患者有长期数据可用。作为初始伤口覆盖技术接受中厚皮片移植的患者中，8/8（100%）实现了完全伤口覆盖；接受皮瓣制作的患者中，1/1（100%）实现了完全伤口覆盖；接受完全一期伤口闭合的患者中，4/4（100%）实现了完全伤口覆盖。作为初始伤口覆盖技术接受二期愈合的患者中，5/33（15.2%）实现了完全伤口覆盖，28/33（84.8%）需要采用中厚皮片移植的二次伤口覆盖技术。所有46例患者均实现了长期成功的伤口覆盖。伤口覆盖时间不因初始伤口覆盖技术而异（ = 0.44）。中厚皮片移植、皮瓣制作、完全一期伤口闭合和二期愈合都是NSTIs初始伤口覆盖的合理选择。尽管二期愈合作为初始伤口覆盖技术成功率较低，但所有患者最终均实现了完全伤口覆盖，且覆盖时间无显著增加。
