Department of Paediatric Surgery, Urology & Surgical Simulation, Monash Children's Hospital, Melbourne, Australia.
Department of General Surgery, Monash Health, Melbourne, Australia; Faculty of Medicine, Department of Surgery, School of Clinical Sciences, Nursing and Health Sciences, Monash University, Melbourne, Australia.
J Surg Res. 2024 Nov;303:313-321. doi: 10.1016/j.jss.2024.09.016. Epub 2024 Oct 10.
Surgically treated pilonidal sinus disease (PSD) has high rates of postoperative wound complications, with surgical wound dehiscence (SWD) rates up to 44%. Negative pressure wound therapy (NPWT) is proposed to reduce rates of SWD for other high risk surgical wounds. Our aim was to investigate whether NPWT would reduce rates of SWD compared to conventional passive (CP) dressings for PSD excisions with off-midline primary closure. Our secondary outcomes included patient quality of life and time taken return to normal activities.
We performed a prospective, crossover pediatric/adult randomized controlled trial for patients (12-40 y) with PSD, requiring excision and off-midline primary closure. Participants were randomized to receive a CP (Primapore or Opsite) or NPWT (SNAP) dressing. Follow-up occurred on D3, D7, D10, D14 and then weekly until wound healing. Patients were sent a 2-month postoperative online survey to assess quality of life outcomes.
Fifty patients were recruited, 25 to NPWT & 25 to CP. Mean age and body mass index were 22.6 ± 6.7 y and 26.1 ± 4.5 kg/m, respectively. 36/50 (76%) were male. The overall dehiscence rate was 42% (21/50); 12/25 (48%) for NPWT & 9/25 (36%) for CP, P = 0.6. Five deep (≥5 mm) SWDs occurred in each group, P > 0.9. SWD was associated with increased excision dimensions in the NPWT group only, P = 0.03. Median duration to wound healing was equivalent in nondehisced wounds, (CP 21.0 [14.0-29.5] versus NPWT 21.0 [16.0-24.0] days, P = 0.7). There were no differences in mean time to the following: return to school/work (NPWT 26.1 ± 18.2 versus CP 29.3 ± 14.7 d, P = 0.6), sit normally (NPWT 22.3 ± 16.2 versus CP 20.1 ± 9.4 d, P = 0.7), or return to physical activity (NPWT21.6 ± 17.2 versus CP40.3 ± 2.4 d, P = 0.2).
NPWT did not improve outcomes after excision of PSD with off-midline primary closure. Despite the limited population size, our results do not support its use as a routine preventative measure.
接受手术治疗的藏毛窦疾病（PSD）术后伤口并发症发生率较高，其中手术切口裂开（SWD）发生率高达 44%。负压伤口治疗（NPWT）被提出用于降低其他高风险手术伤口的 SWD 发生率。我们的目的是研究 NPWT 是否会降低 PSD 切除术后采用中线以外一期缝合的 SWD 发生率。我们的次要结果包括患者的生活质量和恢复正常活动所需的时间。
我们对需要切除和中线以外一期缝合的 PSD 患者（12-40 岁）进行了前瞻性、交叉儿科/成人随机对照试验。参与者被随机分配接受 CP（Primapore 或 Opsite）或 NPWT（SNAP）敷料。在 D3、D7、D10、D14 进行随访，然后每周一次直至伤口愈合。患者在术后 2 个月通过在线调查评估生活质量结果。
共招募了 50 名患者，25 名接受 NPWT，25 名接受 CP。平均年龄和体重指数分别为 22.6±6.7 岁和 26.1±4.5kg/m2。36/50（76%）为男性。总体裂开率为 42%（21/50）；NPWT 组 12/25（48%），CP 组 9/25（36%），P=0.6。两组各有 5 例深度（≥5mm）SWD，P＞0.9。SWD 仅与 NPWT 组的切除尺寸增加有关，P=0.03。非裂开伤口的愈合时间中位数相当，（CP 21.0[14.0-29.5]与 NPWT 21.0[16.0-24.0]天，P=0.7）。在以下方面的平均时间无差异：返回学校/工作（NPWT 26.1±18.2 与 CP 29.3±14.7 天，P=0.6），正常坐立（NPWT 22.3±16.2 与 CP 20.1±9.4 天，P=0.7），或恢复体育活动（NPWT21.6±17.2 与 CP40.3±2.4 天，P=0.2）。
NPWT 不能改善中线以外一期缝合切除 PSD 后的结果。尽管研究人群规模有限，但我们的结果并不支持将其作为常规预防措施。
