Effectiveness of negative pressure wound therapy in complex surgical treatment of necrotizing fasciitis of the upper limb.

Autor:	Lipatov KV; Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia. lipatov_k_v@staff.sechenov.ru., Asatryan A; Department of General Surgery, Wound and Wound Infection Surgery, State Budgetary Institution 'City Clinical Hospital named after S.S. Yudin of Moscow Healthcare Department', Moscow 115446, Russia., Melkonyan G; Department of General Surgery, Physician of The Hospital for War Veterans No 3, Moscow 129336, Russia., Kazantcev AD; Department of General Surgery, Institute of Clinical Medicine named after N.V. Sklifosovsky, Sechenov First Moscow State Medical University (Sechenov University), Moscow 119021, Russia., Solov'eva EI; Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia., Krivikhin DV; Department of General Surgery, Wound and Wound Infection Surgery, State Budgetary Institution 'City Clinical Hospital named after S.S. Yudin of Moscow Healthcare Department', Moscow 115446, Russia., Gorbacheva IV; Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia., Cherkasov UE; Department of General Surgery, I.M. Sechenov First Moscow State Medical University, Moscow 119048, Russia.
Jazyk:	angličtina
Zdroj:	World journal of orthopedics [World J Orthop] 2024 Nov 18; Vol. 15 (11), pp. 1015-1022. Date of Electronic Publication: 2024 Nov 18 (Print Publication: 2024).
DOI:	10.5312/wjo.v15.i11.1015
Abstrakt:	Background: Necrotizing fasciitis (NF) of the upper extremities is a severe surgical pathology, and the incidence of this disease has been steadily increasing in recent decades. Surgical treatment is accompanied by the formation of extensive wounds, which can be treated with significant difficulties. In recent years, negative pressure wound therapy (NPWT) has proven to be highly effective. It is also promising for the treatment of NF. Aim: To explore the effectiveness of NPWT in the treatment of NF of the upper extremities. Methods: The results of the treatment of 36 patients with NF of the upper extremities in two groups (NPWT group and control group; 2022-2023) were retrospectively analyzed. In the NPWT group, the NPWT method (120 mmHg; constant mode) was used after surgical treatment. The number of vacuum-assisted dressings in patients ranged from 1 to 3, depending on the dynamics of the wound process. The duration of fixation of one bandage was up to 2-3 d. In the control group, conventional methods of local wound treatment were used. The following indicators were analyzed: The treatment delay, the prevalence of inflammation, the microbial landscape, the number of debridements, the duration of wound preparation for surgical closure, and the nature of skin plastic surgery. Results: Most patients experienced a significant treatment delay [4 d, interquartile range (IQR): 2-7 d], which led to the spread of the pathological process to the forearm and shoulder. The most common pathogens were Staphylococcus aureus (14; 38.9%) and Streptococcus pyogenes (22; 61.1%). The average number of debridements per patient was 5 (IQR: 3-7), with no difference between groups. The average time to prepare wounds for surgical closure was 11 ± 4 d in the NPWT group and 29 ± 10 d ( P = 0.00001) in the control group. In the NPWT group, the wounds were more often closed with local tissues (15; 83.3%), and in the control group, split-thickness skin grafts were more often used (4; 50%). Conclusion: The predominant isolation of Staphylococcus aureus and/or Streptococcus pyogenes from the lesions allowed us to classify these patients as NF type II. Multiple debridement procedures have become a feature of this disease treatment. The use of NPWT has significantly reduced the time required to prepare wounds for surgical closure. Early closure of wounds allows for more frequent use of local tissue repair, which ensures better results. NPWT is a highly effective way to prepare wounds for early surgical closure in patients with upper extremity NF. Competing Interests: Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript. (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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