Effectiveness of negative pressure wound therapy for the wound of ileostomy closure: a multicenter, phase II randomized controlled trial

被引：8

作者：

Kojima, Koichiro ^{[1
]}

Goto, Mayu ^{[2
]}

Nagashima, Yasuo ^{[2
]}

Saito, Yoko ^{[3
]}

Kawai, Masaya ^{[4
]}

Takebe, Shihori ^{[5
]}

Egawa, Akiko ^{[6
]}

Tanba, Mitsuko ^{[7
]}

Ishikawa, Kazue ^{[8
]}

Matsuoka, Hiroyoshi ^{[9
]}

Masaki, Tadahiko ^{[1
]}

Sunami, Eiji ^{[1
]}

Ohura, Norihiko ^{[10
]}

Teruya, Koji ^{[11
]}

Eto, Ken ^{[12
]}

Nozawa, Keijiro ^{[13
]}

Sakamoto, Kazuhiro ^{[4
]}

Funahashi, Kimihiko ^{[2
]}

机构：

[1] Kyorin Univ, Dept Surg, Sch Med, 6-20-2 Shinkawa, Mitaka, Tokyo 1818611, Japan

[2] Toho Univ, Dept Gen & Gastroenterol Surg, Omori Med Ctr, Tokyo, Japan

[3] Toho Univ, Dept Nursing, WOCN, Omori Med Ctr, Tokyo, Japan

[4] Juntendo Univ, Dept Coloproctol Surg, Sch Med, Tokyo, Japan

[5] Juntendo Univ, Sch Med, Dept Nursing, WOCN, Tokyo, Japan

[6] Jikei Univ, Dept Nursing, WOCN, Sch Med, Tokyo, Japan

[7] Kyorin Univ, Dept Nursing, WOCN, Sch Med, Tokyo, Japan

[8] Teikyo Univ, Dept Nursing, WOCN, Sch Med, Tokyo, Japan

[9] Kyorin Univ, Dept Paramed, Fac Hlth Sci, Tokyo, Japan

[10] Kyorin Univ, Sch Med, Dept Plast Reconstruct & Aesthet Surg, Tokyo, Japan

[11] Kyorin Univ, Dept Hlth & Welf, Fac Hlth Sci, Tokyo, Japan

[12] Jikei Univ, Sch Med, Dept Surg, Tokyo, Japan

[13] Teikyo Univ, Dept Surg, Sch Med, Tokyo, Japan

来源：

BMC SURGERY | 2021年 / 21卷 / 01期

关键词：

Negative pressure wound therapy; Ileostomy closure; Wound healing; Surgical site infection; Purse-string suture; Randomized controlled trial; Phase II trial; SURGICAL SITE INFECTION; SKIN CLOSURE;

D O I：

10.1186/s12893-021-01446-2

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Background The American Society of Surgery and American Society for Surgical Infections issued guidelines for surgical site infections (SSIs) in December 2016. These guidelines recommend a purse-string suture (PSS) for stoma closure as it facilitates granulation and enables open wound drainage. This study investigated the effect of using negative pressure wound therapy (NPWT) along with standard PSS and aimed to determine the optimal period of NPWT use. Methods The patients were divided into three groups as follows: Group A, postoperative wound management alone with gauze exchange as the representative of conventional PSS; Group B, the performed management was similar to that of Group A plus NPWT for 1 week; and Group C, the performed management was similar to that of Group A plus NPWT for 2 weeks. Regarding objective measures, the wound reduction rate was the primary outcome, and the incidence of SSIs, length of hospital stay, and wound healing duration were the secondary outcomes. Results In total, 30 patients (male: 18, female: 12) were enrolled. The average age was 63 (range: 43-84) years. The wound reduction rate was significantly higher in Group B than in Group A on postoperative days (PODs) 7 (66.1 vs. 48.4%, p = 0.049) and 10 (78.6 vs. 58.2%, p = 0.011), whereas no significant difference was observed on POD 14. Compared with Group A, Group C (POD 7: 65.9%, POD 10: 69.2%) showed an increase in the wound reduction rate on POD 7, although the difference was not significant (p = 0.075). SSIs were observed in Groups B (n = 2) and C (n = 2) (20%) but not in Group A (0%). Conclusions The most effective duration of NPWT use for ileostomy closure with PSS in terms of the maximum wound reduction rate was from PODs 3 to 10. However, NPWT did not shorten the wound healing duration. NPWT may reduce the wound size but should be used with precautions for SSIs. The small sample size (30 cases), the use of only one type of NPWT system, and the fact that wound assessment was subjective and not blinded were the limitations of this study. Further studies are needed to confirm our findings. Trial registration: UMIN Clinical Trials Registry; UMIN000032174 (10/04/2018).

引用

页数：10

共 19 条

[1] Purse-string approximation vs. primary closure with a drain for stoma reversal surgery: results of a randomized clinical trial [J].

Amamo, Kunihiko ;

Ishida, Hideyuki ;

Kumamoto, Kensuke ;

Okada, Norimichi ;

Hatano, Satoshi ;

Chika, Noriyasu ;

Tajima, Yusuke ;

Ohsawa, Tomonori ;

Yokoyama, Masaru ;

Ishibashi, Keiichiro ;

Mochiki, Erito .

SURGERY TODAY, 2019, 49 (03) :231-237

[2] Negative pressure wound therapy after partial diabetic foot amputation: a multicentre, randomised controlled trial [J].

Armstrong, DG ;

Lavery, LA .

LANCET, 2005, 366 (9498) :1704-1710

[3]

Azuma Y., 2017, J JPN SOC SURG INFEC, V14, P249

[4] American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update [J].

Ban, Kristen A. ;

Minei, Joseph P. ;

Laronga, Christine ;

Harbrecht, Brian G. ;

Jensen, Eric H. ;

Fry, Donald E. ;

Itani, Kamal M. F. ;

Dellinger, E. Patchen ;

Ko, Clifford Y. ;

Duane, Therese M. .

JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS, 2017, 224 (01) :59-74

[5] Pursestring skin closure after stoma reversal [J].

Banerjee, A .

DISEASES OF THE COLON & RECTUM, 1997, 40 (08) :993-994

[6]

Funahashi K., 2019, J JPN SURG SOC, V120, P51

[7]

HACKAM DJ, 1995, CAN J SURG, V38, P144

[8] Meta-analysis of negative-pressure wound therapy for closed surgical incisions [J].

Hyldig, N. ;

Birke-Sorensen, H. ;

Kruse, M. ;

Vinter, C. ;

Joergensen, J. S. ;

Sorensen, J. A. ;

Mogensen, O. ;

Lamont, R. F. ;

Bille, C. .

BRITISH JOURNAL OF SURGERY, 2016, 103 (05) :477-486

[9] Influence of skin closure technique on surgical site infection after loop ileostomy reversal: Retrospective cohort study [J].

Klink, C. D. ;

Wuenschmann, M. ;

Binneboesel, M. ;

Alizai, H. P. ;

Lambertz, A. ;

Boehm, G. ;

Neumann, U. P. ;

Krones, C. J. .

INTERNATIONAL JOURNAL OF SURGERY, 2013, 11 (10) :1123-1125

[10]

López N, 2014, WOUNDS, V26, P101

← 1 2 →