Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA.
Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Adv Wound Care (New Rochelle). 2021 Oct;10(10):535-543. doi: 10.1089/wound.2021.0023. Epub 2021 Jun 14.
To analyze long-term outcomes following inpatient treatment of infected wounds with antimicrobial or normal saline instillation during negative pressure wound therapy (NPWT). This was a single-center retrospective study analyzing the course of patients receiving 0.9% normal saline or 0.1% polyhexanide plus 0.1% betaine as instillation for wounds requiring surgery. Measured outcomes included rates of dehiscence, new wounds, re-operations, amputations, and mortality over 5 years. The article adheres to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. Forty-two patients received normal saline instillation and 41 the antiseptic solution. Rates of dehiscence, wound recurrence, and re-operations in the saline and antiseptic cohorts were 6.3% and 5.6%, 9.4% and 5.6%, and 14.3% and 9.8%, respectively ( > 0.05). In patients requiring further surgery, time to wound closure averaged 104 and 130 days in the saline and antiseptic cohorts, respectively ( = 0.81). Five-year amputation and mortality rates were 14.3% and 22% ( = 0.36) and 24% and 17% ( = 0.45) in the saline and antiseptic cohorts, respectively. To compare clinical outcomes associated with two fundamentally different instillation solutions over the full wound care episode and elucidate the potential impact of these results for future applications. This is the first evaluation of nonsurrogate outcomes of different instillations for NPWT in infected wounds. The results indicate that normal saline instillation outcomes are comparable to those of 0.1% polyhexanide plus 0.1% betaine. The clinical success, cost benefit, and accessibility of normal saline can expand the utilization of this therapeutic approach for larger patient populations.
分析在负压伤口治疗（NPWT）期间用抗菌或生理盐水冲洗治疗感染伤口的住院患者的长期结果。这是一项单中心回顾性研究，分析了需要手术的伤口接受 0.9%生理盐水或 0.1%聚己双胍加 0.1%甜菜碱冲洗的患者的病程。测量的结果包括 5 年内的裂开率、新伤口、再手术、截肢和死亡率。文章遵循《观察性研究的报告质量（STROBE）声明》。42 名患者接受生理盐水冲洗，41 名患者接受防腐剂溶液冲洗。生理盐水和防腐剂组的裂开率、伤口复发和再手术率分别为 6.3%和 5.6%、9.4%和 5.6%以及 14.3%和 9.8%（>0.05）。在需要进一步手术的患者中，生理盐水和防腐剂组的伤口闭合时间分别平均为 104 天和 130 天（=0.81）。5 年的截肢率和死亡率分别为 14.3%和 22%（=0.36）和 24%和 17%（=0.45）在生理盐水和防腐剂组。为了比较两种根本不同的冲洗溶液在整个伤口护理过程中与临床结果的关系，并阐明这些结果对未来应用的潜在影响。这是首次评估 NPWT 感染伤口中不同冲洗液的非替代结果。结果表明，生理盐水冲洗的结果与 0.1%聚己双胍加 0.1%甜菜碱相似。生理盐水的临床成功、成本效益和可及性可以扩大这种治疗方法在更大患者群体中的应用。
