様々な解剖学的部位に対する閉塞切開陰圧創傷治療の臨床経験。

Clinical Experiences with Closed Incisional Negative Pressure Wound Treatment on Various Anatomic Locations.

• Burak Ozkan
• Nilgun Markal Ertas
• Ulas Bali
• Cagri A Uysal

抄録

背景 閉鎖切開部陰圧創傷治療(ciNPWT)は、外科的切開部の合併症を予防するための有望な方法の一つである。我々の目的は、新しい適応を持つ様々な解剖学的部位でのciNPWTの経験を共有することである。平均年齢は49.6歳であった。すべての切開部は縫合され、清潔で、非感染であった。患者の性別、年齢、併存疾患、創傷の解剖学的位置、およびciNPWTの適応症を記録した。結果 患者1人あたりの平均適用回数は3回であった。髄膜脊髄炎で手術を受けた乳児のフラップドナー部位では、1回のciNPWT施術で縫合糸の脱離が1回認められた。他の患者では、手術部位の感染、創部剥離、およびciNPWTに関連した合併症は認められなかった。また、体幹、下肢、骨盤、上肢、頭皮への適用が大部分を占めていた。結論 ciNPWTは、術後の創傷の剥離や手術部位の感染予防に信頼性が高く有効である。再置換手術での除炎、頭皮での脳脊髄液（CSF）瘻形成、慢性コルチコステロイド使用時の創部破壊などの合併症予防のために、さまざまな部位や適応症で安全に使用できる。

Background Closed incisional negative pressure wound treatment (ciNPWT) is one of the promising methods for the prevention of complications in surgical incisions. The mechanisms of ciNPWT have previously been elucidated and in this series, we demonstrate various, as of yet, underreported uses for the technology. Our aim is to share our experience with ciNPWT on various anatomic sites with novel indications.  Materials and methods ciNPWT was used in 24 patients. The mean age was 49.6. All the incisions were sutured, clean, and non-infected. Patients' sex, age, comorbidities, anatomic location of the wound, and the indications for ciNPWT were recorded. Results The mean number of applications was three per patient. One suture dehiscence after one session of ciNPWT was encountered in a flap donor site of an infant operated for meningomyelocele. Late-term seroma and hematoma formation were encountered in two patients. No surgical site infection, wound dehiscence, and ciNPWT related complications were seen in other patients. The majority of the applications were on the trunk, lower extremity, pelvis, upper extremity, and scalp respectively. Indications for ciNPWT utilization were preventing dehiscence, seroma, and hematoma formation in the majority of the patients. Conclusion ciNPWT is reliable and effective in the prevention of post-operative wound dehiscence and surgical site infections. It can be used safely in various locations and different indications for preventingcomplications such as preventing dehiscence in revision surgeries, cerebrospinal fluid (CSF) fistula formation in the scalp, and wound breakdown in chronic corticosteroid use.

Copyright © 2020, Ozkan et al.