使用灯芯或切口负性伤口疗法进行损伤控制开腹手术皮肤闭合后的伤口感染率：EAST多中心试验。

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2024-09-19 DOI:10.1016/j.injury.2024.111906

John Cull , Katherine Pellizzeri , Daniel C. Cullinane , Meghan Cochran-Yu , Eric Trevizo , Anna Goldenberg-Sandau , Ryan Field , Jordan M. Kirsch , Jessica K. Staszak , Jeffrey J. Skubic , Raul Barreda , William M. Brigode , Faran Bokhari , Christopher A. Guidry , Jordan Basham

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引用次数: 0

摘要

损伤控制开腹手术（DCL）发生 SSI 的风险很高，为了减轻这种风险，外科医生通常会让皮肤开放，通过二次意向愈合。最近的一项回顾性研究表明，DCL伤口可以通过加装灯芯或切口伤口吸尘器来关闭，伤口感染率可以接受。这是一项前瞻性多中心观察试验，由 7 家机构在 2020 年 7 月至 2022 年 4 月期间进行。纳入了接受 DCL 和筋膜/皮肤闭合术的成人患者，并添加了灯芯或切口伤口 vac。不包括在 DCL 后七天内死亡的患者。研究人员收集了患者的人口统计学特征、初次发病机制、伤口分类、使用的抗生素、手术部位感染、进行的手术以及死亡率数据。分类数据采用费雪精确检验，连续数据采用 Wilcoxon 秩和检验。采用学生 t 检验法评估独立组的平均闭合天数。在 21 个月的时间里，共对 119 名患者进行了分析。大多数患者为男性（n = 66，63%），平均年龄为 51 岁。腹部保持开放的平均天数为 2.6 天。大多数 DCL 都是在急诊患者身上进行的（人数=76，占 63.8%），92 名患者（占 77.3%）的伤口分类为污染或脏污。大多数患者的皮肤都是闭合的，并留有伤口敷料（68.9%）。虽然灯芯组中 III 级和 IV 级伤口类型的比例较高，但与使用切口伤口 VAC 治疗的患者相比，主要使用灯芯治疗的患者的伤口感染风险较低；不过，这一差异在统计学上并不显著。

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Wound infection rate after skin closure of damage control laparotomy with wicks or incisional negative wound therapy: An EAST multi-center trial.

Damage control laparotomy (DCL) has a high risk of SSI and as an attempt to mitigate this, surgeons often leave the skin open to heal by secondary intention. A recent retrospective study showed that DCL wounds could be closed with the addition of wicks or incisional wound vacs with acceptable rates of wound infection. The aim of this prospective trial was to corroborate these results.

This is a prospective multicenter observational trial performed by 7 institutions from July 2020 to April 2022. Adult patients who underwent DCL and fascia/skin closure with the addition of wicks or an incisional wound vac were included. Patients who died within seven days of DCL were excluded. Demographics, mechanism of initial presentation, wound classification, antibiotics given, surgical site infections, procedures performed, and mortality data was collected. Fisher's Exact test was used for categorical data and Wilcoxon Rank Sum test for continuous data. Mean days to closure was assessed using Student's t-test for independent groups. P-values <0.05 were considered indicative of statistical significance.

Over the 21-month period, a total of 119 patients analyzed. Most patients were male (n = 66, 63 %), and the average age was 51 years. The average number of days the abdomen was kept open was 2.6. A majority of the DCLs were performed on acute care patients (n = 76, 63.8 %) and 92 patients (77.3 %) had a wound classification of contaminated or dirty. Most of the patients’ skin was closed with wicks in place (68.9 %). There was a 9.8 % infection rate in patient's skin closed with wicks versus 16.2 % closed with an incisional wound vac (p = 0.361).

Although the wick group had a higher proportion of class III and IV wound types, patients primarily treated with wicks had a lower risk of wound infection compared to those treated with incisional wound VACs; however, this difference was not statistically significant.

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.