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下肢创伤伤口管理:负压伤口治疗在骨科环境中的相对重要性。

Lower Extremity Traumatic Wound Management: Relative Significance of Negative Pressure Wound Therapy in the Orthopedic Setting.

作者信息

Lok Evania, Oe Timothy, Ng Sally

机构信息

Department of Plastic and Reconstructive Surgery, Austin Health, Melbourne, Australia.

Department of Surgery (Austin Precinct), University of Melbourne, Australia.

出版信息

Adv Wound Care (New Rochelle). 2025 Jul;14(7):327-343. doi: 10.1089/wound.2023.0133. Epub 2024 Aug 22.

DOI:10.1089/wound.2023.0133
PMID:39001834
Abstract

Lower extremity traumatic wounds are associated with numerous perioperative challenges. Their etiologies determine the characteristics and extent of the injury. The timing of subsequent surgical intervention and wound healing optimization after lower extremity trauma are integral to successful perioperative lower extremity wound management. Managing trauma to the lower extremities uses a multidisciplinary surgical approach. The objective of this review is to summarize lower limb trauma assessment, advancements in lower extremity trauma management, and the clinical applications of advanced wound care in lower limb traumatic wounds. The advent of lower limb reconstruction and the development of advanced wound care modalities have helped to improve the management of these complex injuries. The extensive involvement of bone, soft tissues, nerves, and blood vessels of severe lower extremity trauma wounds presents a challenge for clinicians in both the acute care setting and during patient rehabilitation. If not properly managed, these injuries may be subject to a decline in limb function and may possibly result in limb loss. To reveal developing limb-threatening conditions, serial examinations should be performed. The majority of lower limb traumatic wound will benefit from the perioperative administration of an appropriate negative pressure wound therapy (NPWT)-based system, which can help to promote granulation tissue and remove wound exudate before definitive closure and/or reconstruction. NPWT should be included as an important adjunct in the surgical management of lower limb traumatic wounds.

摘要

下肢创伤性伤口伴随着众多围手术期挑战。其病因决定了损伤的特征和程度。下肢创伤后后续手术干预的时机以及伤口愈合的优化对于围手术期下肢伤口的成功管理至关重要。处理下肢创伤采用多学科手术方法。本综述的目的是总结下肢创伤评估、下肢创伤管理的进展以及高级伤口护理在下肢创伤性伤口中的临床应用。下肢重建的出现和高级伤口护理模式的发展有助于改善对这些复杂损伤的管理。严重下肢创伤伤口中骨骼、软组织、神经和血管的广泛受累给急性护理环境中的临床医生以及患者康复期间带来了挑战。如果处理不当,这些损伤可能会导致肢体功能下降,并可能导致肢体丧失。为了发现发展中的肢体威胁状况,应进行系列检查。大多数下肢创伤性伤口将受益于围手术期给予适当的基于负压伤口治疗(NPWT)的系统,该系统可在最终闭合和/或重建之前帮助促进肉芽组织生长并清除伤口渗出物。NPWT应作为下肢创伤性伤口手术管理的重要辅助手段。

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