From the Department of Surgery, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC location AMC, University of Amsterdam; and Menzies Health Institute Queensland and School of Nursing and Midwifery, Griffith University.
Plast Reconstr Surg. 2022 Jul 1;150(1):176e-188e. doi: 10.1097/PRS.0000000000009232. Epub 2022 May 19.
Infected wounds extend healing time and are associated with higher treatment costs than noninfected wounds. Several observational studies indicate that negative-pressure wound therapy with instillation can effectively reduce bacterial bioburden and improve wound healing. Only a few randomized trials with small sample sizes have been published, and a meta-analysis directly comparing negative-pressure wound therapy with instillation to current standard care is lacking. It is therefore uncertain whether negative-pressure wound therapy with instillation actually improves wound healing. The authors performed a systematic review and hypothesized that negative-pressure wound therapy with instillation reduces wound closure time.
The PubMed, Embase, and CENTRAL databases were searched up to December of 2020 for English studies that compare negative-pressure wound therapy with instillation-to either negative-pressure wound therapy without instillation or to other types of wound care-for the treatment of acute or chronically infected wounds. Time to wound closure was analyzed using a random effects meta-analysis in predefined subgroups according to study design and comparative wound care.
The authors identified 14 studies describing 1053 patients. Meta-analysis of three randomized trials shows no significant difference in time to wound closure between negative-pressure wound therapy with instillation and that without (mean difference, 0.48 day; 95 percent CI, -0.70 to 1.65; I ² = 0 percent). Data from eleven observational studies indicate that negative-pressure wound therapy with instillation reduces wound closure time (from 1.6 to 16.8 days; no pooled data). Because of imprecision and risk of bias, the available evidence provides only low-level certainty.
There is currently insufficient evidence to support or discard the use of negative-pressure wound therapy with instillation for infected wounds. More randomized trials are needed to determine whether a beneficial effect can be substantiated.
感染性伤口会延长愈合时间，并导致治疗费用高于非感染性伤口。几项观察性研究表明，带冲洗的负压伤口疗法可以有效降低细菌生物负荷并改善伤口愈合。仅有少数样本量较小的随机试验已经发表，并且缺乏直接比较带冲洗的负压伤口疗法与当前标准治疗的荟萃分析。因此，尚不确定带冲洗的负压伤口疗法是否确实可以改善伤口愈合。作者进行了一项系统评价，并假设带冲洗的负压伤口疗法可以缩短伤口闭合时间。
作者检索了 PubMed、Embase 和 CENTRAL 数据库，截至 2020 年 12 月，以获取比较带冲洗的负压伤口疗法（与不带冲洗的负压伤口疗法或其他类型的伤口护理相比）治疗急性或慢性感染性伤口的英文研究。根据研究设计和比较性伤口护理，使用随机效应荟萃分析在预先定义的亚组中分析伤口闭合时间。
作者确定了 14 项研究，共描述了 1053 例患者。对三项随机试验的荟萃分析显示，带冲洗的负压伤口疗法与不带冲洗的负压伤口疗法之间在伤口闭合时间上无显著差异（平均差异 0.48 天；95%CI，-0.70 至 1.65；I ² = 0%）。来自 11 项观察性研究的数据表明，带冲洗的负压伤口疗法可以缩短伤口闭合时间（从 1.6 天至 16.8 天；无汇总数据）。由于存在不精确性和偏倚风险，现有证据仅提供低水平的确定性。
目前尚无足够的证据支持或排除使用带冲洗的负压伤口疗法治疗感染性伤口。需要更多的随机试验来确定是否可以证实其有益效果。
