Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, 1025 Morehead Medical Drive Suite 300, Charlotte, NC, 28204, USA.
Surg Endosc. 2022 Mar;36(3):2169-2177. doi: 10.1007/s00464-021-08485-z. Epub 2021 May 20.
Wound complications following abdominal wall reconstruction (AWR) in a contaminated setting are common and significantly increase the risk of hernia recurrence. The purpose of this study was to examine the effect of short-term negative pressure wound therapy (NPWT) followed by operative delayed primary closure (DPC) of the skin and subcutaneous tissue after AWR in a contaminated setting.
A prospective institutional hernia database was queried for patients who underwent NPWT-assisted DPC after contaminated AWR between 2008 and 2020. Primary outcomes included wound complication rate and reopening of the incision. A non-DPC group was created using propensity-matching. Standard descriptive statistics were used, and a univariate analysis was performed between the DPC and non-DPC groups.
In total, 110 patients underwent DPC following AWR. The hernias were on average large (188 ± 133.6 cm), often recurrent (81.5%), and 60.5% required a components separation. All patients had CDC Class 3 (14.5%) or 4 (85.5%) wounds and biologic mesh placed. Using CeDAR, the wound complication rate was estimated to be 66.3%. Postoperatively, 26.4% patients developed a wound complication, but only 5.5% patients required reopening of the wound. The rate of recurrence was 5.5% with mean follow-up of 22.6 ± 27.1 months. After propensity-matching, there were 73 patients each in the DPC and non-DPC groups. DPC patients had fewer overall wound complications (23.0% vs 43.9%, p = 0.02). While 4.1% of the DPC group required reopening of the incision, 20.5% of patients in the non-DPC required reopening of the incision (p = 0.005) with an average time to healing of 150 days. Hernia recurrence remained low overall (2.7% vs 5.4%, p = 0.17).
DPC can be performed with a high rate of success in complex, contaminated AWR patients by reducing the rate of wound complications and avoiding prolonged healing times. In patients undergoing AWR in a contaminated setting, a NPWT-assisted DPC should be considered.
在污染环境下进行腹壁重建（AWR）后，伤口并发症很常见，并且显著增加疝复发的风险。本研究的目的是探讨在污染环境下，AWR 后短期负压伤口治疗（NPWT）联合延期一期缝合（DPC）对皮肤和皮下组织的效果。
通过查询 2008 年至 2020 年期间在污染环境下接受 NPWT 辅助 DPC 的患者的机构疝数据库，进行前瞻性研究。主要结局包括伤口并发症发生率和切口重新打开。通过倾向匹配创建非 DPC 组。使用标准描述性统计方法，对 DPC 组和非 DPC 组进行单变量分析。
共有 110 例患者在 AWR 后行 DPC。疝平均较大（188±133.6cm），常为复发性（81.5%），60.5%需要进行组件分离。所有患者的 CDC 分级均为 3 级（14.5%）或 4 级（85.5%），并放置生物补片。使用 CeDAR，估计伤口并发症发生率为 66.3%。术后，26.4%的患者发生伤口并发症，但只有 5.5%的患者需要重新打开伤口。复发率为 5.5%，平均随访时间为 22.6±27.1 个月。经过倾向匹配后，DPC 组和非 DPC 组各有 73 例患者。DPC 组的总体伤口并发症发生率较低（23.0% vs 43.9%，p=0.02）。DPC 组有 4.1%的患者需要重新打开切口，而非 DPC 组有 20.5%的患者需要重新打开切口（p=0.005），平均愈合时间为 150 天。总体上疝复发率较低（2.7% vs 5.4%，p=0.17）。
在复杂的污染性 AWR 患者中，DPC 可以通过降低伤口并发症发生率和避免延长愈合时间来获得较高的成功率。在污染环境下接受 AWR 的患者中，应考虑 NPWT 辅助 DPC。
