Deldar Romina, Abu El Hawa Areeg A, Bovill John D, Hipolito Dionisio, Tefera Eshetu, Bhanot Parag, Fan Kenneth L, Evans Karen K
Department of Plastic Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Department of General Surgery, MedStar Georgetown University Hospital, Washington, D.C.
Plast Reconstr Surg Glob Open. 2022 Mar 7;10(3):e4171. doi: 10.1097/GOX.0000000000004171. eCollection 2022 Mar.
Simultaneous ventral hernia repair with panniculectomy (VHR-PAN) is associated with a high rate of wound complications. Closed incision negative pressure wound therapy (ciNPWT) has been shown to lower complications in high-risk wounds. There is a debate in the literature as to whether ciNPWT is effective at preventing complications in VHR-PAN. The aim of our study was to evaluate if ciNPWT improves outcomes of VHR-PAN.
A retrospective review of patients who underwent VHR-PAN between 2009 and 2021 was conducted. Patients were divided into two groups: (1) those who received standard sterile dressings (SSD), or (2) ciNPWT. Primary outcomes were postoperative complications, including surgical site occurrences (SSO) and hernia recurrence.
A total of 114 patients were identified: 57 patients each in the SSD group and ciNPWT group. The groups were similar in demographics and comorbidities. There were more smokers in the SSD group (22.8% versus 5.3%, = 0.013). Hernia defect size was significantly larger in patients who received ciNPWT (202.0 versus 143.4 cm, = 0.010). Overall SSO was similar between the two groups (23.2% versus 26.3%, = 0.663). At a mean follow-up of 6.6 months, hernia recurrence rate was significantly higher in the SSD group compared with that in the ciNPWT group. (10.5% versus 0%, = 0.027). Smoking, diabetes, component separation, mesh type, and location were not significantly associated with hernia recurrence.
Application of incisional NPWT is beneficial in decreasing hernia recurrence in VHR-PAN, compared with standard dressings. Larger prospective studies are warranted to further elucidate the utility of ciNPWT in abdominal wall reconstruction.
同期行腹直肌前鞘修补术与腹壁成形术（VHR-PAN）会导致较高的伤口并发症发生率。闭合切口负压伤口治疗（ciNPWT）已被证明可降低高危伤口的并发症发生率。关于ciNPWT在预防VHR-PAN并发症方面是否有效，文献中存在争议。我们研究的目的是评估ciNPWT是否能改善VHR-PAN的治疗效果。
对2009年至2021年间接受VHR-PAN手术的患者进行回顾性研究。患者分为两组：（1）接受标准无菌敷料（SSD）的患者，或（2）接受ciNPWT的患者。主要结局指标为术后并发症，包括手术部位事件（SSO）和疝复发。
共纳入114例患者：SSD组和ciNPWT组各57例。两组在人口统计学和合并症方面相似。SSD组吸烟者更多（22.8%对5.3%，P = 0.013）。接受ciNPWT的患者疝缺损尺寸明显更大（202.0对143.4平方厘米，P = 0.010）。两组总体SSO相似（23.2%对26.3%，P = 0.663）。平均随访6.6个月时，SSD组疝复发率明显高于ciNPWT组（10.5%对0%，P = 0.027）。吸烟、糖尿病、组织分离、补片类型和位置与疝复发无显著相关性。
与标准敷料相比，切口NPWT的应用有利于降低VHR-PAN中的疝复发率。需要进行更大规模的前瞻性研究，以进一步阐明ciNPWT在腹壁重建中的作用。
