Anchalia Manjulata, Upadhyay Swati, Dahiya Mohit
Department of General Surgery, Apollo Hospitals, Gandhinagar, Gujarat, India.
Wounds. 2020 Dec;32(12):E84-E91.
Advanced wound management of complex surgical wounds remains a significant challenge as more patients are being admitted to the hospital with infected wounds. Reducing recurrent infections and promoting granulation tissue formation are essential to overall wound healing. Negative pressure wound therapy (NPWT) has been widely practiced for 2 decades for the management of such wounds, but NPWT with instillation and dwell time (NPWTi-d) is a relatively recent adjunctive treatment of wounds that require serial debridements.
This study evaluates the advantages and disadvantages of NPWTi-d alone as well as NPWTi-d as an adjunct to standard NPWT in the treatment of complex wounds in patients with serious comorbidities.
In this case series, the NPWTi-d group was given instillation therapy only. In the combined group, instillation therapy was applied and then, as the bioburden in the wound decreased, NPWT therapy was substituted. Repeated volumetric measurements and photographs of the wounds were taken. An approximate 50% decrease in wound dimensions, clearance of slough and necrotic tissue, and the appearance of healthy granulation tissue in the wound bed were considered as the endpoint of therapy.
Four cases in which only NPWTi-d was applied reached the endpoint with 1 to 3 dressings. In the other 4 cases, after NPWTi-d was applied, the bioburden was reduced to a great extent but the wound did not reach the end point. There were a few episodes of troubleshooting (eg, leakage alarm and blocking of the drainage tubes) in the system, and surrounding skin showed maceration. Hence, 2 to 4 courses of NPWT were substituted for the wound to reach the endpoint.
In this study, NPWTi-d proved to be more effective in clearing the bioburden and reducing the number of surgeries for debridement. Complementing it with NPWT led to reduced episodes of troubleshooting and proved to be more cost-effective. Thus, NPWT may be considered as an adjunct therapy in select cases of complex wounds. However, more evidence is required.
随着越来越多感染伤口的患者入院，复杂手术伤口的高级伤口管理仍然是一项重大挑战。减少反复感染和促进肉芽组织形成对于伤口的整体愈合至关重要。负压伤口治疗（NPWT）已广泛应用于此类伤口的管理长达20年，但带滴注和停留时间的负压伤口治疗（NPWTi-d）是一种相对较新的辅助治疗方法，用于需要连续清创的伤口。
本研究评估单独使用NPWTi-d以及NPWTi-d作为标准NPWT辅助手段在治疗伴有严重合并症的患者复杂伤口中的优缺点。
在本病例系列中，NPWTi-d组仅接受滴注治疗。在联合组中，先进行滴注治疗，然后随着伤口内生物负荷的降低，改用NPWT治疗。对伤口进行反复的体积测量并拍照。伤口尺寸减小约50%、清除腐肉和坏死组织以及伤口床出现健康的肉芽组织被视为治疗终点。
仅应用NPWTi-d的4例患者经1至3次换药达到终点。在其他4例患者中，应用NPWTi-d后，生物负荷大幅降低，但伤口未达到终点。系统出现了一些故障情况（如泄漏警报和引流管堵塞），周围皮肤出现浸渍。因此，改用2至4个疗程的NPWT使伤口达到终点。
在本研究中，NPWTi-d在清除生物负荷和减少清创手术次数方面被证明更有效。辅以NPWT可减少故障情况，且被证明更具成本效益。因此，在某些复杂伤口病例中，NPWT可被视为辅助治疗方法。然而，还需要更多证据。
