Einsatz einer präventiven, epikutanen Unterdrucktherapie (Prevena™) bei offener Korrektur von Deformitäten der vorderen Brustwand reduziert das Auftreten von Wundheilungsstörungen

Zusammenfassung

Hintergrund: Eingriffe an der vorderen Brustwand können zu Wundheilungsstörungen führen. Untersucht wird, ob die Anwendung einer präventiven Unterdrucktherapie das Risiko einer Wundheilungsstörung an der vorderen Brustwand nach offener Brustwandkorrektur reduzieren kann.
Methodik: In einer retrospektiven Vergleichsanalyse von 100 Patienten mit offener Korrektur einer Trichter- oder Kielbrustdeformität in den Jahren 2010 bis 2012 wurden 50 aufeinanderfolgend behandelte Patienten, deren Wunde 5 Tage postoperativ mittels Prevena™ (KCI Medizinprodukte GmbH, Wiesbaden) behandelt wurde, mit 50 aufeinanderfolgenden Patienten verglichen, deren Wunde mit einer OPSITE®-Folie (Smith & Nephew, Hamburg) abgedeckt wurde. Die Wundnaht erfolgte nach einem Standard, ebenso die Einlage von Redon-Dränagen. Es wurden daher retrospektiv 2 gleichwertige, repräsentative Patientengruppen gebildet und systematisch anhand standardisiert erhobener Parameter verglichen. Das Wunddressing wurde in beiden Gruppen unmittelbar nach dem Wundverschluss aufgebracht und jeweils bis zum 5. postoperativen Tag belassen. Wundkontrollen erfolgten bei Abnahme des Verbands, bei Entlassung, 6 Wochen und 12 Wochen postoperativ. Zu diesen Zeitpunkten wurde die Wunde auf das Vorliegen von Schwellung, Rötung, Nässen, Schmerzen und Heilungszeichen untersucht. Gegebenenfalls vorliegende Wundfisteln oder Dehiszenzen wurden in Lokalisation und Ausdehnung erfasst.
Ergebnisse: In der Prevena-Gruppe sahen wir 10 % interventionspflichtige Wundheilungsstörungen, in der OPSITE-Gruppe 24 %. Bei Anwendung der Prevena zeigten einige Patienten umschriebene Hauterosionen im Bereich des Übergangs Schwamm-Folie. Diese waren jedoch in allen Fällen innerhalb des Beobachtungszeitraums folgenfrei abgeheilt.
Schlussfolgerungen: Durch Anwendung einer präventiven Vakuumtherapie konnte retrospektiv eine erhebliche Reduktion der Rate von Wundheilungsstörungen nach offenen Brustwandkorrekturen erzielt werden. Statistisch war jedoch kein Signifikanzniveau nachzuweisen (p = 0,074).

Abstract

Introduction: Pectus surgery can lead to postoperative wound complications in some cases. The purpose of this study is to determine whether preventive negative pressure wound therapy (NPWT) could reduce wound complications after open pectus surgery.
Material and Methods: 100 patients after open procedure for the treatment of pectus excavatum or pectus carinatum in the years 2010 to 2012 were retrospectively analysed. 50 patients treated with Prevena™ (KCI Medical Products GmbH, Wiesbaden, Germany) were compared with 50 patients whose wounds were covered with OPSITE® film (Smith & Nephew, Hamburg, Germany). Wound closure was performed following a standard procedure as well as the placement of subcutaneous drains. Therefore two comparable groups of patients were formed and analysed by standardised parameters. The wound dressing was placed epicutaneously immediately after wound closure in the operating room and removed after 5 days in each case. Follow-ups were performed immediately after removal of the wound dressing, at the time of discharge from hospital as well as 6 and 12 weeks after operation. The wounds were checked for tenderness, pain, secretion, redness and fistulas.
Results: The Prevena group showed 10 % wound complications which needed operative treatment, whereas the OPSITE group showed complications in 24 %. Some patients who were treated with Prevena showed superficial skin lesions at the rim of the foam and the film. All of these lesions healed well.
Conclusion: Treating wounds postoperatively with preventive measures (NPWT) showed a remarkable reduction of wound complications following open pectus surgery whereas statistically the difference was not significant (p = 0.074).

Schlüsselwörter

operative Brustwandkorrektur - präventive Unterdruckwundtherapie - Prevena™ - postoperative Wundheilungsstörung - Wundinfektion - VAC

Key words

pectus repair surgery - preventive negative pressure wound therapy - Prevena™ - postoperative wound healing disorder - wound infection - VAC

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