Systematic review and evidence based recommendations for the use of Negative Pressure Wound Therapy in the open abdomen

被引:111
作者
Bruhin, A. [1 ]
Ferreira, F. [2 ]
Chariker, M. [3 ]
Smith, J. [4 ]
Runkel, N. [5 ,6 ]
机构
[1] Dept Trauma & Visceral Surg, Luzern, Switzerland
[2] Hosp Pedro Hispano, Matosinhos Porto, Portugal
[3] Aesthet Plast Surg Inst, Louisville, KY USA
[4] Smith & Nephew, Kingston Upon Hull, N Humberside, England
[5] Black Forest Hosp, Dept Gen Surg, Villingen Schwenningen, Germany
[6] Univ Freiburg, Freiburg, Germany
关键词
Negative Pressure Wound Therapy (NPWT); Open abdomen; Temporary abdominal closure; Evidence-based recommendations; Systematic review; VACUUM-ASSISTED CLOSURE; TEMPORARY ABDOMINAL CLOSURE; DAMAGE-CONTROL LAPAROTOMY; MEDIATED FASCIAL TRACTION; DELAYED PRIMARY CLOSURE; COMPARTMENT SYNDROME; RETROSPECTIVE EVALUATION; FLUID EVACUATION; TRAUMA PATIENTS; VENTRAL HERNIA;
D O I
10.1016/j.ijsu.2014.08.396
中图分类号
R61 [外科手术学];
学科分类号
100210 [外科学];
摘要
Introduction: Negative Pressure Wound Therapy (NPWT) is widely used in the management of the open abdomen despite uncertainty regarding several aspects of usage. An expert panel was convened to develop evidence-based recommendations describing the use of NPWT in the open abdomen. Methods: A systematic review was carried out to investigate the efficacy of a range of Temporary Abdominal Closure methods including variants of NPWT. Evidence-based recommendations were developed by an International Expert Panel and graded according to the quality of supporting evidence. Results: Pooled results, in non-septic patients showed a 72% fascial closure rate following use of commercial NPWT kits in the open abdomen. This increased to 82% by the addition of a 'dynamic' closure method. Slightly lower rates were showed with use of Wittmann Patch (68%) and home-made NPWT (vac-pack) (58%). Patients with septic complications achieved a lower rate of fascial closure than non-septic patients but NPWT with dynamic closure remained the best option to achieve fascial closure. Mortality rates were consistent and seemed to be related to the underlying medical condition rather than being influenced by the choice of dressing, Treatment goals for open abdomen were defined prior to developing eleven specific evidence-based recommendations suitable for different stages and grades of open abdomen. Discussion and conclusion: The most efficient temporary abdominal closure techniques are NPWT kits with or without a dynamic closure procedure. Evidence-based recommendations will help to tailor its use in a complex treatment pathway for the individual patient. (C) 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/3.0/).
引用
收藏
页码:1105 / 1114
页数:10
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