Frodl A, Geisteuer N, Fuchs A, Nymark T, Schmal H
Department of Orthopedics and Traumatology, Freiburg University Hospital, Freiburg, Germany.
Department of Orthopedics and Traumatology, Asklepios Hospital Harburg, Hamburg, Germany.
EFORT Open Rev. 2022 Aug 4;7(8):526-532. doi: 10.1530/EOR-22-0049.
Incisional negative pressure wound therapy (iNPWT) has shown effectiveness in the treatment of high-risk surgical wounds. Especially patients with diabetes-induced peripheral arterial disease undergoing major limb amputation have a high intrinsic risk for post-surgical wound infections. While normal gauze wound dressings do not cause stimulation of microvasculature, iNPWT might improve wound healing and reduce wound complications. The purpose of this study was to systematically review the literature for rates of wound complications and readmissions, as well as post-surgical 30-day mortality.
We conducted a systematic review searching the Cochrane, PubMed, and Ovid databases. Inclusion criteria were the modified Coleman methodology Score >60, non-traumatic major limb amputation, and adult patients. Traumatic amputations and animal studies were excluded. Relevant articles were reviewed independently by referring to the title and abstract. In a meta-analysis, we compared 3 studies and 457 patients.
A significantly overall lower rate of postoperative complications is associated with usage of iNPWT (odds ratio (OR) = 0.52; 95% CI: 0.30-0.89; P = 0.02). There was no significant improvement for 30-day mortality, when iNPWT was used (OR= 081; 95% CI: 0.46 - 1.45; P = 0.48). Nevertheless, we did not note a significant difference in the readmission rate or revision surgery between the two groups.
Overall, the usage of iNPWT may reduce the risk of postoperative wound complications in major lower limb amputations but does not improve 30-day mortality rates significantly. However, to anticipate surgical-site infection, iNPWT has shown effectiveness and thus should be used whenever applicable.
切口负压伤口治疗（iNPWT）已显示出在治疗高风险手术伤口方面的有效性。特别是患有糖尿病引起的外周动脉疾病并接受大肢体截肢的患者，术后伤口感染的内在风险很高。虽然普通纱布伤口敷料不会刺激微血管，但iNPWT可能会改善伤口愈合并减少伤口并发症。本研究的目的是系统回顾文献中关于伤口并发症发生率、再入院率以及术后30天死亡率的情况。
我们进行了一项系统回顾，检索了Cochrane、PubMed和Ovid数据库。纳入标准为改良的科尔曼方法评分>60、非创伤性大肢体截肢以及成年患者。创伤性截肢和动物研究被排除。通过参考标题和摘要对相关文章进行独立评审。在一项荟萃分析中，我们比较了3项研究和457名患者。
使用iNPWT与术后并发症的总体发生率显著降低相关（优势比（OR）=0.52；95%置信区间：0.30 - 0.89；P = 0.02）。使用iNPWT时，30天死亡率没有显著改善（OR = 0.81；95%置信区间：0.46 - 1.45；P = 0.48）。然而，我们没有注意到两组在再入院率或翻修手术方面存在显著差异。
总体而言，iNPWT的使用可能会降低下肢大截肢术后伤口并发症的风险，但不会显著提高30天死亡率。然而，为了预防手术部位感染，iNPWT已显示出有效性，因此应在适用时使用。
