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首页> 外文期刊>JAMA otolaryngology-- head & neck surgery >Prospective evaluation of a negative pressure dressing system in the management of the fibula free flap donor site: A comparative analysis
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Prospective evaluation of a negative pressure dressing system in the management of the fibula free flap donor site: A comparative analysis

机译：负压换药系统在腓骨游离皮瓣供体部位管理中的前瞻性评估：比较分析

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IMPORTANCE: The fibula free flap donor site has been associated with short-term donor site morbidity, most commonly delayed healing. OBJECTIVE: To evaluate the effectiveness of a negative pressure dressing (NPD) system in the management of fibula free flap donor sites that required skin graft closure. DESIGN: Cohort study comparing a prospective cohort whose donor sites were managed with the NPD system from June 2009 through March 2012 with a retrospective cohort whose donor sites were managed with a conventional pressure (bolster) dressing (CPD) from August 2006 through May 2009. SETTING: Tertiary regional head and neck reconstructive and maxillofacial surgery unit. PARTICIPANTS: All patients who had a composite fibula free flap for maxillofacial reconstructive surgery and required donor site closure with split-thickness skin grafts from August 2006 through March 2012. INTERVENTION: Negative pressure dressing used to manage the skin-grafted fibula donor site. MAIN OUTCOMES AND MEASURES: Primary: time until complete healing of the fibula donor site. Secondary: skin graft take rate, infection rate, returns to operating theater for donor site problems, delayed hospital discharge due to donor site problems, and community intervention required for donor site dressing. RESULTS: All healing outcome measures were similar for the 21 patients in the NPD group and the 19 patients in the CPD group, with no statistically significant difference. Two patients in the CPD group required surgical debridement of the fibula donor site, compared with none in the NPD group (P =.22). The NPD group had a higher skin graft take success rate (15 [71%] vs 11 [58%]; P =.51) and required less nursing intervention for donor site dressings (8 [38%] vs 9 [47%]; P =.75) but had a higher wound infection rate (6 [29%] vs 2 [11%]; P =.24). CONCLUSIONS AND RELEVANCE: Our findings would, at best, suggest that NPD may decrease the rate of return to the operating theater for donor site problems. The fibula donor site healing remains problematic, and our results suggest that routine use of the NPD system in the management of the fibula free flap donor site is not justified from a health economic perspective.
机译：重要提示：无腓骨皮瓣供体部位与短期供体部位发病率有关，最常见的是延迟愈合。目的：评估负压敷料（NPD）系统在需要关闭皮肤移植物的无腓骨皮瓣供体部位的治疗中的有效性。设计：队列研究比较了从2009年6月至2012年3月使用NPD系统管理供体部位的前瞻性队列与从2006年8月至2009年5月采用常规压力（加强）敷料（CPD）管理供体部位的回顾性队列。单位：第三区域头颈部重建和颌面外科。对象：2006年8月至2012年3月，所有具有复合腓骨游离皮瓣以进行颌面重建手术并需要使用切开厚度的皮肤移植物封闭供体部位的患者。干预措施：负压敷料用于管理经皮肤移植的腓骨供体部位。主要结果和措施：原发性：直到腓骨供体部位完全愈合的时间。次要的：皮肤移植物的摄取率，感染率，因供体部位问题而返回手术室，由于供体部位问题而导致的出院延迟以及对供体部位换药所需的社区干预。结果：NPD组的21例患者和CPD组的19例患者的所有治疗结果均相似，差异无统计学意义。 CPD组中有2例患者需要手术清除腓骨供体部位，而NPD组中则没有（P = .22）。 NPD组的植皮成功率更高（15 [71％]比11 [58％]; P = .51），并且需要较少的供体部位敷料护理干预（8 [38％]比9 [47％]） ; P = .75），但伤口感染率更高（6 [29％]比2 [11％]; P = .24）。结论和相关性：我们的发现充其量只能表明，NPD可能会降低因施主部位问题而返回手术室的比率。腓骨供体部位的愈合仍然存在问题，我们的结果表明，从健康的经济角度来看，NPD系统在腓骨游离皮瓣供体部位的管理中常规使用是不合理的。

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