Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Ann R Coll Surg Engl. 2024 May;106(5):418-424. doi: 10.1308/rcsann.2023.0011. Epub 2023 Jul 12.
The aim was to study the effect of incisional negative pressure wound therapy (iNPWT) in wound healing compared with standard sterile gauze dressings after major lower extremity amputation in patients with peripheral arterial disease (PAD).
This prospective, randomised controlled trial included 50 patients undergoing major lower extremity amputations for PAD. Patients were randomised into iNPWT and standard dressing groups. The patency of blood vessels at the level of the stump was ensured with or without revascularisation. The primary outcome was wound-related complications such as surgical site infection (SSI), wound dehiscence, seroma/haematoma formation or the need for revision amputation. The secondary outcome was the time taken for the eligibility of prosthesis placement.
It was found that only 12% of the patients in the iNPWT group had SSI compared with 36% in the standard dressing group ( = 0.047). Rates of wound dehiscence, seroma/haematoma formation and revision amputation were decreased in the iNPWT group but this was not statistically significant ( > 0.05). There was a significant reduction in the time taken for eligibility of prosthesis placement in the iNPWT group (5.12 ± 1.53 vs 6.8 ± 1.95 weeks, = 0.002).
iNPWT is effective in reducing the incidence of SSI and the time taken for rehabilitation in patients undergoing major lower limb amputation due to PAD.
本研究旨在探讨与传统标准无菌纱布敷料相比，切口负压伤口治疗（iNPWT）在伴有外周动脉疾病（PAD）的患者行下肢大截肢术后伤口愈合方面的效果。
本前瞻性随机对照试验纳入了 50 例行下肢大截肢术治疗 PAD 的患者。患者被随机分为 iNPWT 组和标准敷料组。通过血管再通或不进行血管再通来确保残端血管的通畅性。主要结局是手术部位感染（SSI）、伤口裂开、血清肿/血肿形成或需要进行再次截肢等与伤口相关的并发症。次要结局是适合安装义肢的时间。
发现 iNPWT 组中仅 12%的患者发生 SSI，而标准敷料组中则有 36%（ = 0.047）。iNPWT 组的伤口裂开、血清肿/血肿形成和再次截肢的发生率有所降低，但无统计学意义（ > 0.05）。iNPWT 组适合安装义肢的时间明显缩短（5.12 ± 1.53 周比 6.8 ± 1.95 周， = 0.002）。
iNPWT 可有效降低伴有外周动脉疾病的患者行下肢大截肢术后 SSI 的发生率和康复时间。
