Department of Health Sciences, University of York, York, UK.
Bradford Institute for Health Research, Bradford, UK.
J Clin Nurs. 2020 Jul;29(13-14):2557-2571. doi: 10.1111/jocn.15279. Epub 2020 Apr 23.
To explore surgeons' and nurses' perspectives of managing surgical wounds healing by secondary intention.
Every year, more than 10 million surgical operations are performed in the NHS in the UK. Most surgical wounds heal by primary intention, where the edges of the wound are brought together with staples, sutures, adhesive glue or clips. Sometimes wounds are deliberately left open to heal, from the base up, known as "healing by secondary intention." These wounds are often slow to heal, prone to infection and complex to manage.
A qualitative, descriptive approach, using semi-structured interviews.
Interviews with five (general, vascular and plastic) surgeons and 7 nurses (3 tissue viability nurses, 2 district and 1 community nurse, and 1 hospital nurse) working in hospital and community care settings in two locations in the north of England. Data analysis followed the recommended sequential steps of "Framework" approach. Consolidated criteria for reporting qualitative research guided the study report.
Participants reported that the main types of wounds healing by secondary intention that they manage are extensive abdominal cavity wounds; open wounds relating to treatment for pilonidal sinus; large open wounds on the feet of patients with diabetes; and axilla and groin wounds, associated with removal of lymph nodes for cancer. Infection and prolonged time to healing were the main challenges. Negative pressure wound therapy was the most favoured treatment option.
Negative pressure wound therapy was advocated by professionals despite a lack of research evidence indicating clinical or cost-effectiveness. Our findings underscore the need for rigorous evaluation of negative pressure wound therapy, and other wound care treatments, through studies that include economic evaluation.
Clinical decision-making in wound care could be optimised through further robust studies to inform practitioners about the cost-effectiveness of available treatments.
探索外科医生和护士在处理二期愈合的外科伤口方面的观点。
在英国 NHS 系统中，每年有超过 1000 万例手术。大多数外科伤口通过一期愈合，即使用订书钉、缝线、粘性胶水或夹子将伤口边缘合拢。有时，伤口会故意敞开，从底部开始愈合，称为“二期愈合”。这些伤口愈合缓慢，容易感染，处理复杂。
采用半结构化访谈的定性描述方法。
在英格兰北部的两个地点的医院和社区护理环境中，对 5 名（普通、血管和整形）外科医生和 7 名护士（3 名组织活力护士、2 名地区护士和 1 名社区护士以及 1 名医院护士）进行了访谈。数据分析遵循“框架”方法的推荐顺序步骤。有指导的研究报告准则（CONSORT）指导了研究报告。
参与者报告说，他们主要管理的二期愈合伤口类型有：广泛的腹腔伤口；与治疗藏毛窦相关的开放性伤口；糖尿病患者足部的大开放性伤口；以及腋窝和腹股沟伤口，与癌症淋巴结切除有关。感染和愈合时间延长是主要挑战。负压伤口疗法是最受欢迎的治疗选择。
尽管缺乏表明临床或成本效益的研究证据，但专业人员仍然提倡使用负压伤口疗法。我们的发现强调了通过包括经济评估在内的研究，对负压伤口疗法和其他伤口护理治疗方法进行严格评估的必要性。
通过进一步的稳健研究，可以优化伤口护理的临床决策，为从业者提供有关现有治疗方法的成本效益信息。
