Kasten Kody, Yang Andrew, Shaffer Lynn, Kociola Samuel, Holland Conor, Roche Faith Anne, Pilbeam Calvin
Vascular Surgery/General Surgery, Mount Carmel Health System, Columbus, OH, USA.
Vascular. 2025 Apr;33(2):456-461. doi: 10.1177/17085381241247098. Epub 2024 Apr 12.
BackgroundVascular surgical site infections have been reported with an overall incidence of 5-10% for patients undergoing arterial interventions and as high as 10-20% for lower-limb bypass grafting procedures. Given that vascular surgery patients are known to be at a higher risk of postoperative wound infections and other complications, our objective was to evaluate a potential method to reduce such complications. This study compares the rate of wound healing complications between incisional negative pressure wound therapy (NPWT) and conventional dressings in vascular surgery patients with infra-inguinal incisions. The primary endpoint is complete closure of the wound at the 2-week follow-up appointment. Secondary endpoints include frequency infections requiring antibiotics, need for wound revision, and wound dehiscence.MethodsA prospective cohort study with retrospective control group was performed following infra-inguinal vascular surgeries for peripheral arterial disease at the Mount Carmel Health System. The patients included in this study were those who underwent a lower-extremity vascular procedure with primary closure of an incision distal to the groin between January 2014 and July 2018. Patients that had received an infra-inguinal incision with primary closure were included. Patients in the experimental group who had a Prevena Wound VAC were compared with a retrospectively obtained control arm treated with conventional dressings. Data regarding wound healing and complications, specifically infections and wound dehiscence, were obtained.ResultsA total of 201 patients were recruited in our study: 64 in the Prevena group and 137 in the control group. There was a significant reduction in the number of open wounds in the Prevena group compared to the control group at the 2-week follow-up (10.9% Prevena vs 33.6% control; = .0005). When evaluated in aggregate, there was a statistically significant reduction in the number of patients who succumbed to any complication in the Prevena arm compared with traditional dressings (13 (20.3%) Prevena vs 72 (52.6%) control; < .0001).ConclusionThe results of our study suggest there should be a significant consideration for the use of NPWT as a prophylactic measure to reduce the risk of wound complications of primarily closed infra-inguinal incisions in vascular surgery patients following common vascular procedures. Its use is particularly effective for patients at enhanced risk of infection, especially those with poor vascularization from BMI, smoking, and diabetes. This leads to decreased trends in antibiotic use, ED visits, readmissions, and surgical revisions, which translates to decreased utilization of hospital resources and economic burden.
背景
据报道，血管手术部位感染在接受动脉介入治疗的患者中总体发生率为5%-10%，在下肢旁路移植手术中高达10%-20%。鉴于血管外科患者术后伤口感染和其他并发症的风险较高，我们的目标是评估一种减少此类并发症的潜在方法。本研究比较了切口负压伤口治疗（NPWT）与传统敷料在腹股沟下切口血管手术患者中的伤口愈合并发症发生率。主要终点是在2周随访时伤口完全闭合。次要终点包括需要使用抗生素的感染频率、伤口修复的必要性和伤口裂开情况。
方法
在卡梅尔山医疗系统对接受腹股沟下血管手术治疗外周动脉疾病的患者进行了一项带有回顾性对照组的前瞻性队列研究。本研究纳入的患者是2014年1月至2018年7月期间接受下肢血管手术且腹股沟远端切口一期缝合的患者。包括接受腹股沟下切口一期缝合的患者。将使用Prevena伤口负压封闭引流装置的实验组患者与回顾性获得的接受传统敷料治疗的对照组进行比较。获取有关伤口愈合和并发症的数据，特别是感染和伤口裂开情况的数据。
结果
我们的研究共招募了201例患者：Prevena组64例，对照组137例。在2周随访时，Prevena组的开放性伤口数量与对照组相比显著减少（Prevena组为10.9%，对照组为33.6%；P = 0.0005）。总体评估时，与传统敷料相比，Prevena组中出现任何并发症的患者数量在统计学上显著减少（Prevena组13例（20.3%），对照组72例（52.6%）；P < 0.0001）。
结论
我们的研究结果表明，应认真考虑将NPWT作为一种预防措施，以降低血管手术患者在常见血管手术后腹股沟下一期缝合切口伤口并发症的风险。对于感染风险增加的患者，尤其是那些因体重指数、吸烟和糖尿病导致血管化不良的患者，其使用特别有效。这导致抗生素使用、急诊就诊、再入院和手术修复的趋势下降，这意味着医院资源利用和经济负担的降低。
