Department of Surgery, Cork University Hospital, Cork, Ireland.
Breast Cancer Research Centre, Cork University Hospital, Cork, Ireland.
World J Surg. 2020 May;44(5):1526-1537. doi: 10.1007/s00268-019-05335-x.
Negative pressure wound therapy (NPWT) is a promising advance in the management of closed surgical incisions. NPWT application induces several effects locally within the wound including reduced lateral tension and improving lymphatic drainage. As a result, NPWT may improve wound healing and reduce surgical site complications. We aim to evaluate the efficacy of prophylactic application of NPWT in preventing surgical site complications for closed incisions in breast surgery.
This systematic review was reported according to PRISMA guidelines. The protocol was published in PROSPERO (CRD42018114625). Medline, Embase, CINAHL and Cochrane Library databases were searched for studies which compare the efficacy of NPWT versus non-NPWT dressings for closed incisions in breast surgery. Specific outcomes of interest were total wound complications, surgical site infection (SSI), seroma, haematoma, wound dehiscence and necrosis.
Seven studies (1500 breast incisions in 904 patients) met the inclusion criteria. NPWT was associated with a significantly lower rate of total wound complications [odds ratio (OR) 0.36; 95% CI 0.19-069; P = 0.002], SSI (OR 0.45; 95% CI 0.24-0.86; P = 0.015), seroma (OR 0.28; 95% CI 0.13-0.59; P = 0.001), wound dehiscence (OR 0.49; 95% CI 0.32-0.72; P < 0.001) and wound necrosis (OR 0.38; 95% CI 0.19-0.78; P = 0.008). There was no significant difference in haematoma rate (OR 0.8; 95% CI 0.19-3.2; P = 0.75). Statistically significant heterogeneity existed for total wound complications, but no other outcomes.
Compared with conventional non-NPWT dressings, prophylactic application of NPWT is associated with significantly fewer surgical site complications including SSI, seroma, wound dehiscence and wound necrosis for closed breast incisions.
负压伤口治疗（NPWT）是闭合性外科切口管理方面的一项有前途的进展。NPWT 的应用会在伤口内局部产生多种效果，包括减少侧向张力和改善淋巴引流。因此，NPWT 可能会改善伤口愈合并减少手术部位并发症。我们旨在评估预防性应用 NPWT 预防乳房手术中闭合切口手术部位并发症的效果。
本系统评价根据 PRISMA 指南进行报告。该方案已在 PROSPERO（CRD42018114625）中发布。检索了比较 NPWT 与非 NPWT 敷料用于乳房手术中闭合切口的疗效的研究。感兴趣的特定结局包括总伤口并发症、手术部位感染（SSI）、血清肿、血肿、伤口裂开和坏死。
7 项研究（904 例患者的 1500 个乳房切口）符合纳入标准。NPWT 与总伤口并发症发生率显著降低相关[比值比（OR）0.36；95%置信区间（CI）0.19-0.69；P=0.002]、SSI（OR 0.45；95%CI 0.24-0.86；P=0.015）、血清肿（OR 0.28；95%CI 0.13-0.59；P=0.001）、伤口裂开（OR 0.49；95%CI 0.32-0.72；P<0.001）和伤口坏死（OR 0.38；95%CI 0.19-0.78；P=0.008）。血肿发生率无显著差异（OR 0.8；95%CI 0.19-3.2；P=0.75）。总伤口并发症存在统计学显著异质性，但其他结局没有。
与常规非 NPWT 敷料相比，预防性应用 NPWT 与闭合性乳房切口的手术部位并发症显著减少相关，包括 SSI、血清肿、伤口裂开和伤口坏死。
