Effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction in open abdomen management.

IF 1.7 4区医学 Q2 SURGERY Surgery Today Pub Date : 2024-07-24 DOI:10.1007/s00595-024-02899-7

Kenta Shigeta, Shiei Kim, Ryuta Nakae, Yutaka Igarashi, Taigo Sakamoto, Tomoko Ogasawara, Tomohiko Masuno, Masatoku Arai, Shoji Yokobori

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Abstract

Purpose: To determine the effectiveness of vacuum-assisted wound closure and mesh-mediated fascial traction (VAWCM) in patients undergoing open abdomen management (OAM).

Methods: Data from cases with OAM for at least five days who were admitted to our institution between January 2011 and December 2020 were included. We compared the patient's age, sex, medical history, indication for initial surgery, APACHE II scores, indication for OAM, operative time, intraoperative blood loss, intraoperative transfusion, success of primary fascial closure (rectus fascial closure and bilateral anterior rectus abdominis sheath turnover flap method), success of planned ventral hernia, duration of OAM, and in-hospital mortality between patients undergoing VAWCM (VAWCM cases, n = 27) and vacuum-assisted wound closure (VAWC) alone (VAWC cases, n = 25).

Results: VAWCM cases had a significantly higher success rate of primary fascial closure (70% vs. 36%, p = 0.030) and lower in-hospital mortality (26% vs. 72%, p = 0.002) than VAWC cases. A multivariate logistic regression analysis showed that VAWCM was an independent factor influencing in-hospital mortality (odds ratio, 0.14; 95% confidence interval: 0.04-0.53; p = 0.004).

Conclusion: VAWCM is associated with an increased rate of successful primary fascial closure and may reduce in-hospital mortality.

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真空辅助伤口闭合和网片筋膜牵引在开腹手术中的效果。

目的：确定真空辅助伤口闭合和网眼介导筋膜牵引（VAWCM）对开腹手术（OAM）患者的有效性：方法：纳入 2011 年 1 月至 2020 年 12 月期间在我院接受开腹手术至少五天的病例数据。我们比较了患者的年龄、性别、病史、初次手术指征、APACHE II 评分、开腹手术指征、手术时间、术中失血量、术中输血量、初次筋膜闭合成功率（直肌筋膜闭合和双侧腹直肌前鞘翻转皮瓣法）、结果发现，接受 VAWCM 的患者（VAWCM 病例，n = 27）与单纯接受真空辅助伤口闭合术（VAWC）的患者（VAWC 病例，n = 25）在计划的腹股沟疝成功率、OAM 持续时间和院内死亡率方面存在差异。结果：与 VAWC 病例相比，VAWCM 病例的初级筋膜闭合成功率明显更高（70% 对 36%，p = 0.030），院内死亡率更低（26% 对 72%，p = 0.002）。多变量逻辑回归分析显示，VAWCM是影响院内死亡率的独立因素（几率比0.14；95%置信区间：0.04-0.53；P = 0.004）：结论：VAWCM 与初级筋膜闭合成功率的提高有关，可降低院内死亡率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Surgery Today 医学-外科

CiteScore

4.90

自引率

4.00%

发文量

208

审稿时长

1 months

期刊介绍： Surgery Today is the official journal of the Japan Surgical Society. The main purpose of the journal is to provide a place for the publication of high-quality papers documenting recent advances and new developments in all fields of surgery, both clinical and experimental. The journal welcomes original papers, review articles, and short communications, as well as short technical reports("How to do it"). The "How to do it" section will includes short articles on methods or techniques recommended for practical surgery. Papers submitted to the journal are reviewed by an international editorial board. Field of interest: All fields of surgery.