调查皮瓣前负压伤口治疗与四肢游离皮瓣重建手术结果之间的关联:系统回顾。

IF 2.2 3区 医学 Q2 SURGERY Journal of reconstructive microsurgery Pub Date : 2024-10-29 DOI:10.1055/a-2434-5798
Madeline C Rocks, Meagan Wu, Victoria Comunale, Nikhil Agrawal, Rebecca S Nicholas, Ali Azad, Jacques H Hacquebord
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引用次数: 0

摘要

背景:尽管之前的研究建议在四肢创伤软组织重建时应在受伤后 72 小时内立即进行皮瓣覆盖,但最近在先进伤口护理技术背景下的证据不再强调立即覆盖的必要性。负压伤口疗法(NPWT)是延长软组织明确覆盖时间的重要工具。本研究旨在阐明术前使用 NPWT 对显微外科重建成功的影响:方法:使用以下数据库进行文献检索,检索时间从开始到 2023 年 2 月:PubMed、OVID 数据库(Embase 和 Cochrane 图书馆)、Web of Science 和 Scopus。在已确定的 301 篇文章中,161 篇经过评估,24 篇被纳入。根据术前是否使用 NPWT 对病例进行了划分。记录了最终覆盖的时间、损伤细节和基本人口统计学特征。比较各组皮瓣失败、感染、骨不连、再次手术和并发症的发生率:共纳入了1027名患者和1047个皮瓣,其中894人(85.39%)接受了皮瓣前NPWT治疗。NPWT组和非NPWT组的最终覆盖平均时间分别为16天和18天。与非 NPWT 组相比,NPWT 组的术后并发症发生率较低,但深部感染除外。与非 NPWT 组相比,NPWT 组的任何皮瓣失败率(3.69% 对 9.80%)和部分皮瓣失败率(2.24% 对 6.54%)均较低:术前 NPWT 与术后并发症的减少有关,其中最重要的是皮瓣失败率。结论:术前 NPWT 可减少术后并发症,尤其是皮瓣失败率,这值得在创伤性四肢重建的决策过程中进一步研究。未来的前瞻性研究需要采用标准化方案并进行更长时间的随访,以更好地了解术前使用 NPWT 在软组织重建中的潜在有益作用。
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Investigating the Association between Preflap Negative-Pressure Wound Therapy and Surgical Outcomes in Extremity Free Flap Reconstruction: A Systematic Review.

Background:  While prior studies have recommended immediate flap coverage within 72 hours of injury for soft tissue reconstruction for traumatic extremity injuries, recent evidence in the setting of advanced wound care techniques de-emphasizes the need for immediate coverage. Negative-pressure wound therapy (NPWT) has been an essential tool for extending the time to definitive soft tissue coverage. This study sought to elucidate the impact of preoperative NPWT use on the success of microsurgical reconstruction.

Methods:  A literature search was conducted using the following databases from their inception up to February 2023: PubMed, OVID databases (Embase and Cochrane Library), Web of Science, and Scopus. Of 801 identified articles, 648 were assessed and 24 were included. Cases were divided based on whether NPWT was used preoperatively or not. Timing to definitive coverage, injury details, and basic demographics were recorded. Rates of flap failure, infection, bone nonunion, reoperation, and complications were compared between groups.

Results:  A total of 1,027 patients and 1,047 flaps were included, of which 894 (85.39%) received preflap NPWT. The average time to definitive coverage for the NPWT and non-NPWT groups was 16 and 18 days, respectively. The NPWT group experienced lower postoperative complication rates than the non-NPWT group in all reported complications except for deep infections. Compared with the non-NPWT group, the NPWT group experienced lower rates of any flap failure (3.69 vs. 9.80%) and partial flap failure (2.24 vs. 6.54%).

Conclusion:  Preoperative NPWT was associated with reduced postoperative complications, most importantly flap failure rates. This merits further investigation into the decision-making process for traumatic extremity reconstruction. Future prospective studies adopting standardized protocols with longer follow-up are required to better understand the potentially beneficial role of preoperative NPWT use in soft tissue reconstruction.

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来源期刊
CiteScore
4.50
自引率
28.60%
发文量
80
审稿时长
1 months
期刊介绍: The Journal of Reconstructive Microsurgery is a peer-reviewed, indexed journal that provides an international forum for the publication of articles focusing on reconstructive microsurgery and complex reconstructive surgery. The journal was originally established in 1984 for the microsurgical community to publish and share academic papers. The Journal of Reconstructive Microsurgery provides the latest in original research spanning basic laboratory, translational, and clinical investigations. Review papers cover current topics in complex reconstruction and microsurgery. In addition, special sections discuss new technologies, innovations, materials, and significant problem cases. The journal welcomes controversial topics, editorial comments, book reviews, and letters to the Editor, in order to complete the balanced spectrum of information available in the Journal of Reconstructive Microsurgery. All articles undergo stringent peer review by international experts in the specialty.
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