Brad M. White, DO, is a diagnostic radiology resident, Larkin Community Hospital, Miami, Florida. Dustin L. Meyer, DO, is a diagnostic radiology resident, University of South Florida Morsani College of Medicine, Tampa, Florida. Stephen L. Harlin, MD, FACS, is Associate Professor, New College of Florida, Sarasota, Florida.
Adv Skin Wound Care. 2019 Nov;32(11):502-506. doi: 10.1097/01.ASW.0000569120.36663.34.
To assess the efficacy of negative-pressure wound therapy (NPWT) in preparing sternal wounds for flap reconstruction.
Investigators searched standard research databases with terms including "post-sternotomy mediastinitis," "deep sternal wound infection," "negative pressure wound therapy," "vacuum assisted closure," and "VAC." Of 434 reports, 14 studies described patients diagnosed with poststernotomy mediastinitis who underwent NPWT followed by flap reconstruction. Eligible studies were assessed for length of stay, mortality, manufacturer involvement, and methodological rigor.
Among a total 429 patients, median length of stay was 29 (±16) days. There were 41 deaths in this inpatient group (10%). Seventy-one percent of the reports were nonrandomized, and 36% of the studies accurately accounted for baseline differences in severity, whereas 14% failed to report diagnostic criteria. Only one study reported follow-up results. Nine studies (64%) failed to make a statement regarding conflicts of interest. In this analysis of quality, 48% (n = 8) of the studies were of very low to low quality. One study was of high quality.
Investigators failed to find ample support for routine use of NPWT as a "bridge to reconstruction." Serious complications related to the use of NPWT including right ventricular rupture, atrial fibrillation, respiratory arrest, recurrent infection, and a retained sponge were reported in this group of studies. Rigorous evaluative studies that assess the true effectiveness of NPWT as a "bridge to reconstruction" must precede its adoption.
评估负压伤口疗法（NPWT）在准备皮瓣重建的胸骨伤口方面的疗效。
研究人员使用包括“胸骨切开术后纵隔炎”、“深部胸骨伤口感染”、“负压伤口疗法”、“真空辅助闭合”和“VAC”等术语搜索标准研究数据库。在 434 份报告中，有 14 项研究描述了接受 NPWT 后行皮瓣重建的胸骨切开术后纵隔炎患者。评估合格研究的住院时间、死亡率、制造商参与情况和方法学严谨性。
在总共 429 例患者中，中位住院时间为 29（±16）天。该住院患者组有 41 例死亡（10%）。71%的报告是非随机的，36%的研究准确地考虑了严重程度的基线差异，而 14%的研究未能报告诊断标准。只有一项研究报告了随访结果。9 项研究（64%）未能对利益冲突发表声明。在这项质量分析中，48%（n=8）的研究质量非常低或低。有一项研究质量很高。
研究人员未能发现充足的证据支持常规使用 NPWT 作为“重建桥梁”。在这项研究组中，报道了与 NPWT 相关的严重并发症，包括右心室破裂、心房颤动、呼吸骤停、复发性感染和遗留海绵。必须在采用 NPWT 作为“重建桥梁”之前，进行评估其真正有效性的严格评估研究。
