负压伤口治疗可能挽救开放性切口疝修补术后感染的补片。
The negative pressure wound therapy may salvage the infected mesh following open incisional hernia repair.
作者信息
Boettge K, Azarhoush S, Fiebelkorn J, De Santo G, Aljedani N, Ortiz P, Anders S, Hünerbein M, Paasch C
机构信息
Franciscan Health General Surgery, Olympia Fields, IL, USA.
Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany.
出版信息
Ann Med Surg (Lond). 2020 Dec 23;61:64-68. doi: 10.1016/j.amsu.2020.12.013. eCollection 2021 Jan.
BACKGROUND
s: Incisional hernias may occur in 10-25% of patients undergoing laparotomy. In cases of a surgical site infection (SSI) after incisional hernia repair (IHR) secondary operative intervention with mesh removal are often needed. There is only minimal data available in the literature regarding the treatment of a wound infection with negative pressure wound therapy (NPWT). Conducting the study at hand, we aimed to provide more evidence on this topic.
METHODS
From April to June 2020 a monocentric retrospective study has been performed. Patients who underwent NPWT due to a SSI with mesh involvement following open IHR from 2007 to 2020 were included. The primary endpoint was the mesh removal rate in the end of NPWT. Main secondary endpoints were the duration of NPWT and the amount of NPWT procedures.
RESULTS
The data of 30 patients were extracted. The average age was 65.9 years (9.9). A total of 13 individuals were male and 17 females. The BMI was on average 31.1 kg/m (4.9). All patients received a polypropylene mesh. The average duration of NPWT was 31.3 days (22.1). The first wound revision with initiation of a NPWT was conducted on average 31.1 days (34.0) after IHR. The average amount of NPWT procedures was 8.3 (7.2). In 5 of 30 patients (16.6%) the mesh was removed (Open sublay group n = 4 (36.34%) vs. open onlay group n = 1 (5.26%), p = 0.047).
CONCLUSION
In cases of SSI following IHR the NPWT may facilitate mesh selvage. Further trials with a larger sample size are mandatory to confirm our hypothesis.
背景
剖腹手术患者中，10%-25%可能发生切口疝。切口疝修补术（IHR）后若发生手术部位感染（SSI），往往需要二次手术取出补片。关于负压伤口治疗（NPWT）用于治疗伤口感染的文献资料极少。开展本研究旨在提供更多关于该主题的证据。
方法
2020年4月至6月进行了一项单中心回顾性研究。纳入2007年至2020年因开放IHR术后SSI且补片受累而接受NPWT治疗的患者。主要终点是NPWT结束时的补片取出率。主要次要终点是NPWT的持续时间和NPWT治疗次数。
结果
提取了30例患者的数据。平均年龄为65.9岁（9.9岁）。男性13例，女性17例。平均体重指数为31.1kg/m²（4.9）。所有患者均接受聚丙烯补片。NPWT的平均持续时间为31.3天（22.1天）。首次伤口清创并开始NPWT平均在IHR术后31.1天（34.0天）进行。NPWT治疗的平均次数为8.3次（7.2次）。30例患者中有5例（16.6%）取出了补片（开放下层组n = 4例（36.34%），开放上层组n = 1例（5.26%），p = 0.047）。
结论
IHR术后发生SSI时，NPWT可能有助于补片保留。需要进一步开展更大样本量的试验来证实我们的假设。
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