Pappalardo Vincenzo, Frattini Francesco, Ardita Vincenzo, Rausei Stefano
Department of Surgery, Ospedale di Circolo, ASST Settelaghi, Varese, Italy.
Department of Vascular Surgery San Raffaele Hospital, Vita Salute San Raffaele University, Milan, Italy.
Surg Technol Int. 2019 May 15;34:56-67.
Infection and wound dehiscence are common complications after surgery and open surgical wounds are difficult to manage. Usually surgical incisions are closed by fixing the edges together. However, in case of significant tissue loss, infected surgical field, or particular cases, wounds may be left open. In recent years, negative pressure wound therapy (NPWT) has been widely used for management of various complicated wounds and to support postoperative tissue healing. Another emerging indication for NPWT, applied directly to the closed incisions, is to prevent infections or dehiscences in patients with increased risk of surgical-site complications (iNPWT). Furthermore, the combination of negative pressure with intermittent instillation of solution (NPWTi) seems to be effective in the treatment of a variety of complex wounds. Even if the role of NPWT in promoting wound healing has been largely accepted, there is a lack of evidence (few high-level clinical studies) regarding its effectiveness and further research is needed to better understand the mechanisms of action. This article contains a review of recent scientific and clinical research related to indications, contraindications, and mechanisms of action of NPWT to clarify current knowledge, technological evolutions, and future perspectives of devices.
感染和伤口裂开是手术后常见的并发症，开放性手术伤口难以处理。通常通过将边缘固定在一起闭合手术切口。然而，在组织大量缺失、手术区域感染或特殊情况下，伤口可能会保持开放。近年来，负压伤口治疗（NPWT）已广泛用于各种复杂伤口的处理，并支持术后组织愈合。NPWT的另一个新应用是直接应用于闭合切口，以预防手术部位并发症风险增加的患者发生感染或伤口裂开（iNPWT）。此外，负压与溶液间歇性滴注相结合（NPWTi）似乎对多种复杂伤口的治疗有效。尽管NPWT在促进伤口愈合中的作用已被广泛认可，但关于其有效性的证据不足（高水平临床研究较少），需要进一步研究以更好地理解其作用机制。本文对与NPWT的适应证、禁忌证和作用机制相关的近期科学和临床研究进行综述，以阐明当前的知识、技术进展以及该设备的未来前景。
