Wang Y J, Ren Z L, Xue J J, Guo L, Gao D W, Hao Q Y, Gao F C, Yang J
Department of Burns & Plastic and Hand & Foot Surgery, Yulin No. 2 Hospital, Yulin 719000, China.
Zhonghua Shao Shang Za Zhi. 2019 Jul 20;35(7):532-536. doi: 10.3760/cma.j.issn.1009-2587.2019.07.010.
To explore the clinical effect of negative pressure wound therapy (NPWT) in emergency limb-salvage operation of destructive injury of limb. From July 2014 to December 2017, 43 patients with destructive injury of limb in one side conformed to the inclusion criteria were admitted to our hospital. The patients were divided to NPWT group of 24 patients [ 21 males and 3 females, aged (38±10) years] and routine dressing change group of 19 patients [ 17 males and 2 females, aged (37±10) years] according to their treatment methods. After the emergency debridement, fracture external fixation, neurovascular exploration, and microsurgical repair were performed, NPWT were applied on wounds of patients in NPWT group and routine dressing change treatment on wounds of patients in routine dressing change group. On 7 to 10 days after the emergency operation, incidence of arterial embolism of patients in the two groups were calculated, and condition of wound infection of patients in the two groups were observed. Complete wound healing time and survival condition of limb were recorded. Data were processed with independent sample test or chi-square test. Incidence of arterial embolism of patients in NPWT group on 7 to 10 days after the emergency operation was 6.67% (3/45), which was close to 5.56% (2/36) of patients in routine dressing change group ((2)=0.043, >0.05). There was 1 patient with wound infection in NPWT group on 7 to 10 days after the emergency operation, obviously less than 6 patients in routine dressing change group ((2)=5.847, <0.05). Complete wound healing time of patients in NPWT group was (30±4) d, significantly shorter than (36±8) d of patients in routine dressing change group (=2.813, <0.01). Limbs of 24 patients in NPWT group survived, which was close to 18 patients in routine dressing change group ((2)=1.293, >0.05). NPWT can significantly reduce tthe wound infection rate and shorten the time of wound healing of limb with destructive injury after emergency operation, which is worthy of popularization in clinic.
探讨负压伤口治疗(NPWT)在肢体破坏性损伤急诊保肢手术中的临床效果。2014年7月至2017年12月,我院收治43例符合纳入标准的单侧肢体破坏性损伤患者。根据治疗方法将患者分为NPWT组24例(男21例,女3例,年龄(38±10)岁)和常规换药组19例(男17例,女2例,年龄(37±10)岁)。进行急诊清创、骨折外固定、神经血管探查及显微外科修复后,NPWT组患者伤口应用NPWT,常规换药组患者伤口进行常规换药治疗。急诊手术后7至10天,计算两组患者动脉栓塞发生率,观察两组患者伤口感染情况。记录伤口完全愈合时间及肢体存活情况。数据采用独立样本t检验或卡方检验处理。急诊手术后7至10天,NPWT组患者动脉栓塞发生率为6.67%(3/45),与常规换药组患者的5.56%(2/36)相近(χ²=0.043,P>0.05)。急诊手术后7至10天,NPWT组有1例患者发生伤口感染,明显少于常规换药组的6例患者(χ²=5.847,P<0.05)。NPWT组患者伤口完全愈合时间为(30±4)天,明显短于常规换药组的(36±8)天(t=2.813,P<0.01)。NPWT组24例患者肢体存活,与常规换药组的18例相近(χ²=1.293,P>0.05)。NPWT可显著降低急诊手术后肢体破坏性损伤的伤口感染率,缩短伤口愈合时间,值得临床推广。