带倒刺的缝线是否更好？评价三氯生涂层带倒刺缝线在急诊剖腹手术后伤口并发症中的应用。

Is barbed better? Evaluation of triclosan-coated barbed suture on wound complications following emergency laparotomy.

机构信息

From the Division of Trauma and Acute Care Surgery (J.D.), Medical College of Wisconsin, Milwaukee, Wisconsin; and Division of Trauma and Surgical Critical Care (P.M., S.P., S.G., H.L., M.S., K.M., K.I., M.J.M.), LAC+USC Medical Center, University of Southern California, Los Angeles, California.

出版信息

J Trauma Acute Care Surg. 2024 Jul 1;97(1):149-157. doi: 10.1097/TA.0000000000004341. Epub 2024 Apr 10.

DOI:10.1097/TA.0000000000004341

PMID:38595220

Abstract

INTRODUCTION

Emergent laparotomy is associated with significant wound complications including surgical site infections (SSIs) and fascial dehiscence. Triclosan-coated barbed (TCB) suture for fascial closure has been shown to reduce local complications but primarily in elective settings. We sought to evaluate the effect of TCB emergency laparotomy fascial closure on major wound complications.

METHODS

Adult patients undergoing emergency laparotomy were prospectively evaluated over 1 year. Patients were grouped into TCB versus polydioxanone (PDS) for fascial closure. Subanalysis was performed on patients undergoing single-stage laparotomy. Primary outcomes were SSI and fascial dehiscence. Multivariate analysis identified independent factors associated with SSI and fascial dehiscence.

RESULTS

Of the 206 laparotomies, 73 (35%) were closed with TCB, and 133 (65%) were closed with PDS. Trauma was the reason for laparotomy in 73% of cases; damage-control laparotomy was performed in 27% of cases. The overall rate of SSI and fascial dehiscence was 18% and 10%, respectively. Operative strategy was similar between groups, including damage-control laparotomy, wound vac use, skin closure, and blood products. Surgical site infection events trended lower with TCB versus PDS closure (11% vs. 21%, p = 0.07), and fascial dehiscence was significantly lower with TCB versus PDS (4% vs. 14%, p < 0.05). Subanalysis of trauma and nontrauma cases showed no difference in SSI or fascial dehiscence. Multivariable analysis found that TCB decreased the likelihood of fascial dehiscence (odds ratio, 0.07; p < 0.05) following emergency laparotomy. Increased odds of fascial dehiscence were seen in damage-control laparotomy (odds ratio, 3.1; p < 0.05).

CONCLUSION

Emergency laparotomy fascial closure with TCB showed significantly decreased rates of fascial dehiscence compared with closure with PDS and a strong trend toward lower SSI events. Triclosan-coated barbed suture was independently associated with decreased fascial dehiscence rates after emergency laparotomy.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.

摘要

简介

紧急剖腹术与显著的伤口并发症相关，包括手术部位感染（SSI）和筋膜裂开。已证实抗菌涂层的带刺缝线（TCB）用于筋膜闭合可减少局部并发症，但主要是在择期手术中。我们旨在评估 TCB 紧急剖腹术筋膜闭合对主要伤口并发症的影响。

方法

在 1 年期间前瞻性评估接受紧急剖腹术的成年患者。患者分为 TCB 与聚二氧杂环己酮（PDS）用于筋膜闭合。对行单阶段剖腹术的患者进行亚分析。主要结局是 SSI 和筋膜裂开。多变量分析确定与 SSI 和筋膜裂开相关的独立因素。

结果

在 206 例剖腹术中，73 例（35%）用 TCB 闭合，133 例（65%）用 PDS 闭合。73%的剖腹术原因为创伤；27%的剖腹术为损伤控制性剖腹术。总的 SSI 和筋膜裂开发生率分别为 18%和 10%。两组的手术策略相似，包括损伤控制性剖腹术、伤口真空辅助闭合、皮肤闭合和血制品。与 PDS 闭合相比，TCB 闭合的 SSI 事件发生率较低（11% vs. 21%，p=0.07），筋膜裂开发生率显著较低（4% vs. 14%，p<0.05）。创伤和非创伤病例的亚分析显示 SSI 或筋膜裂开无差异。多变量分析发现，TCB 降低了紧急剖腹术后筋膜裂开的可能性（比值比，0.07；p<0.05）。损伤控制性剖腹术的筋膜裂开可能性增加（比值比，3.1；p<0.05）。