Shields David W, Razii Nima, Doonan James, Mahendra Ashish, Gupta Sanjay
Department of Trauma and Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK.
Department of Musculoskeletal Oncology, Glasgow Royal Infirmary, Glasgow, UK.
Bone Jt Open. 2021 Dec;2(12):1049-1056. doi: 10.1302/2633-1462.212.BJO-2021-0103.R1.
The primary objective of this study was to compare the postoperative infection rate between negative pressure wound therapy (NPWT) and conventional dressings for closed incisions following soft-tissue sarcoma (STS) surgery. Secondary objectives were to compare rates of adverse wound events and functional scores.
In this prospective, single-centre, randomized controlled trial (RCT), patients were randomized to either NPWT or conventional sterile occlusive dressings. A total of 17 patients, with a mean age of 54 years (21 to 81), were successfully recruited and none were lost to follow-up. Wound reviews were undertaken to identify any surgical site infection (SSI) or adverse wound events within 30 days. The Toronto Extremity Salvage Score (TESS) and Musculoskeletal Tumor Society (MSTS) score were recorded as patient-reported outcome measures (PROMs).
There were two out of seven patients in the control group (28.6%), and two out of ten patients in the intervention group (20%) who were diagnosed with a SSI (p > 0.999), while one additional adverse wound event was identified in the control group (p = 0.593). No significant differences in PROMs were identified between the groups at either 30 days (TESS, p = 0.987; MSTS, p = 0.951) or six-month (TESS, p = 0.400) follow-up. However, neoadjuvant radiotherapy was significantly associated with a SSI within 30 days of surgery, across all patients (p = 0.029). The mean preoperative modified Glasgow Prognostic Score (mGPS) was also significantly higher among patients who developed a postoperative adverse wound event (p = 0.028), including a SSI (p = 0.008), across both groups.
This is the first RCT comparing NPWT with conventional dressings following musculoskeletal tumour surgery. Postoperative wound complications are common in this group of patients and we observed an overall SSI rate of 23.5%. We propose proceeding to a multicentre trial, which will help more clearly define the role of closed incision NPWT in STS surgery. Cite this article: 2021;2(12):1049-1056.
本研究的主要目的是比较软组织肉瘤（STS）手术后负压伤口治疗（NPWT）与传统敷料用于闭合切口的术后感染率。次要目的是比较不良伤口事件发生率和功能评分。
在这项前瞻性、单中心、随机对照试验（RCT）中，患者被随机分为NPWT组或传统无菌封闭敷料组。共成功招募了17例患者，平均年龄54岁（21至81岁），无一例失访。在30天内进行伤口检查，以确定任何手术部位感染（SSI）或不良伤口事件。记录多伦多肢体挽救评分（TESS）和肌肉骨骼肿瘤学会（MSTS）评分作为患者报告的结局指标（PROMs）。
对照组7例患者中有2例（28.6%），干预组10例患者中有2例（20%）被诊断为SSI（p>0.999），而对照组还发现1例额外的不良伤口事件（p=0.593）。在30天（TESS，p=0.987；MSTS，p=0.951）或6个月（TESS，p=0.400）随访时，两组之间的PROMs均无显著差异。然而，新辅助放疗与所有患者术后30天内的SSI显著相关（p=0.029）。在两组中，发生术后不良伤口事件（包括SSI，p=0.008）的患者术前平均改良格拉斯哥预后评分（mGPS）也显著更高（p=0.028）。
这是第一项比较NPWT与肌肉骨骼肿瘤手术后传统敷料的RCT。该组患者术后伤口并发症很常见，我们观察到总体SSI发生率为23.5%。我们建议进行多中心试验，这将有助于更明确地界定闭合切口NPWT在STS手术中的作用。引用本文：2021；2（12）：1049 - 1056。
