Vakuumtherapie mit PHMB Gaze zur Behandlung postoperativer subkutaner Bauchdeckeninfektionen

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• 作者：Dr. C. Marquardt (1)
  P. Koppes (1)
  U. Krohs (2)
  A. Mares (3)
  R. Paglinawan (4)
  D. H枚fer (5)
  T. Schiedeck (1)
  
• 关键词：Postoperative Komplikationen ; Chirurgische Wundinfektion ; Vakuumtherapie ; Kolorektale Chirurgie ; Wundbehandlung ; Postoperative complications ; Surgical site infection ; Negative pressure wound therapy ; Colorectal surgery ; Wound management
• 刊名：coloproctology
• 出版年：2014
• 出版时间：October 2014
• 年：2014
• 卷：36
• 期：5
• 页码：364-369
• 全文大小：651 KB
• 参考文献：1. Argenta LC, Morykwas MJ (1997) Vacuum-assisted closure: a new method for wound control and treatment: clinical experience. Ann Plast Surg 38:563鈥?77 ternal" href="http://dx.doi.org/10.1097/00000637-199706000-00002" target="_blank" title="It opens in new window">CrossRef
  2. Baier PK, Gl眉ck NC, Baumgartner U et al (2010) Subcutaneous Redon drains do not reduce the incidence of surgical site infections after laparotomy. A randomized controlled trial on 200 patients. Int J Colorectal Dis 25:639鈥?43. doi:10.1007/s00384-010-0884-y ternal" href="http://dx.doi.org/10.1007/s00384-010-0884-y" target="_blank" title="It opens in new window">CrossRef
  3. Chariker ME, Jeter KF, Tintle TE (1989) Effective management of incisional and cutaneous fistulae with closed suction wound drainage. Contemp Surg 34:59鈥?3
  4. Davydov YA, Malafeeva AP, Smirnov AP (1986) Vacuum therapy in the treatment of purulent lactation mastitis. Vestn Khir 9:66鈥?0
  5. Fleischmann W, Strecker W, Bombelli M, Kinzl L (1993) Die Vakuumversiegelung zur Behandlung des Weichteilschadens bei offenen Frakturen. Unfallchirurg 96(9):488鈥?92
  6. Marquardt C, Egglseder T, Schiedeck T (2008) Gauze versus foam for topical negative pressure wound therapy (NPWT) in postoperative subcutaneous wound infections after abdominal operations. First clinical observations. 18th Conference of the European Wound Management Association in Lissabon, Portugal, 14.鈥?6.05.2008
  7. Marquardt C, Krohs U, Bil E et al (2010) Challenge in wound care: management of the open abdomen with intestinal fistula and stoma. 23rd Annual Symposium on Adanced Wound Care & Wound Healing Society (SAWC/WHS), Orlando, April 17鈥?0
  8. Morykwas MJ, Argenta LC, Shelton-Brown EI et al (1997) Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation. Ann Plast Surg 38:553鈥?62 ternal" href="http://dx.doi.org/10.1097/00000637-199706000-00001" target="_blank" title="It opens in new window">CrossRef
  9. Nationales Referenzzentrum f眉r Surveillance von nosokomialen Infektionen (2011) In: Robert Koch-Institut (Hrsg) Definition nosokomialer Infektionen (CDC-Definitionen), 7.聽Aufl., Berlin, S聽8鈥?
  10. Pastor C, Baek JH, Varma MG et al (2010) Validation of the risk index category as a predictor of surgical site infection in elective colorectal surgery. Dis Colon Rectum 53:721鈥?27 ternal" href="http://dx.doi.org/10.1007/DCR.0b013e3181cc573b" target="_blank" title="It opens in new window">CrossRef
  11. Tan A, Gollop ND, Klimach SG et al (2014) Should infected laparotomy wounds be treated with negative pressure wound therapy? Int J Surg 12:26鈥?9 ternal" href="http://dx.doi.org/10.1016/j.ijsu.2013.11.002" target="_blank" title="It opens in new window">CrossRef
  
• 作者单位：Dr. C. Marquardt (1)
  P. Koppes (1)
  U. Krohs (2)
  A. Mares (3)
  R. Paglinawan (4)
  D. H枚fer (5)
  T. Schiedeck (1)
  
  1. Abteilung f眉r Allgemein- und Viszeralchirurgie, Klinikum Ludwigsburg, Posilipostr. 4, 71640, Ludwigsburg, Deutschland
  2. Abteilung f眉r Viszeral-, Kinder- und Gef盲脽chirurgie, Klinikum Konstanz, Konstanz, Deutschland
  3. Abteilung f眉r Allgemeinchirurgie, Privatklinik Padre Luis Tezza, Lima, Peru
  4. Medela AG, Healthcare, Baar, Schweiz
  5. Abteilung Hygiene, Umwelt und Medizin, Hohenstein Institute, B枚nnigheim, Deutschland
  
• ISSN：1615-6730

文摘

Methods In a prospective case control study of 16 patients, the healing rate of secondary suturing of subcutaneous wound infections after median laparotomy wounds for colorectal surgery was investigated, whereby the wounds had previously been conditioned using negative pressure wound therapy (NPWT) with polyhexamethylene biguanide (PHMB) gauze. Results After opening the infected wound the average wound volume was 203聽ml. A d茅bridement of the wounds was carried out to remove necrotic and sloughed tissue then the first NPWT dressing was applied. The NPWT with PHMB gauze could be changed on average every 3 days at the bedside which was possible because the pain level during each dressing change was recorded as an average of 1 on the visual analog scale (VAS). After an average of 3 NPWT dressing changes, the wounds showed no signs of infection and secondary suturing was carried out at the bedside using local anesthesia. For the first 7 patients, subcutaneously placed capillary drainage without suction was used in the wounds (group 1). As the healing rate was low (29鈥?) subcutaneously placed round channel drainage under suction were used for the next 9 patients (group 2) and the healing rate was 89鈥? after secondary suture. The average costs for NPWT treatment including labor costs were calculated as 322.20聽EUR per patient. Conclusion All procedures could be performed at the bedside and all patients were satisfied with the treatment and results. The NPWT therapy with PHMB gauze provides an economic method for lowering the total treatment time and costs as well as unnecessary usage of operating theaters.