Negative pressure wound therapy and functional dressings in primary repair of spinal cord injury complicated with lacunar soft tissue defects: a comparison of efficacies
10.3760/cma.j.cn501098-20230514-00256
- VernacularTitle:负压创面治疗技术与功能性敷料Ⅰ期修复脊髓损伤并发腔隙性软组织缺损创面的疗效比较
- Author:
Jie YANG
1
;
Xi YU
;
Qian WANG
;
Hongchen HE
;
Hongying JIANG
Author Information
1. 四川大学华西医院康复医学中心/四川大学华西护理学院，成都 610041
- Keywords:
Negative-pressure wound therapy;
Spinal cord injuries;
Soft tissue injuries
- From:
Chinese Journal of Trauma
2023;39(10):925-932
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacies of negative pressure wound therapy (NPWT) and functional dressings in primary repair of spinal cord injury complicated with lacunar soft tissue defects.Methods:A retrospective cohort study was conducted to analyze the clinical data of 30 patients with spinal cord injury complicated with lacunar soft tissue defects. The patients were admitted to West China Hospital, Sichuan University from January 2020 to December 2022, including 20 males and 10 females; aged 23-54 years [(42.1±7.8)years]. Wound site was located at the sacrococcygeal region in 16 patients, the buttock in 11, and the femoral trochanter in 3. Wound area was 28-36 cm 2 [(32.1±2.1)cm 2]. Time of wound formation was at range of 1-4 months [(2.0±0.8)months]. Among them, 15 patients received functional dressing treatment after mechanical/ultrasonic debridement (dressing treatment group), and 15 patients received NPWT treatment on the basis of mechanical/ultrasonic debridement (negative pressure treatment group). The following items were compared between the two groups: the time of primary wound repair, results of bacterial culture of wound secretions before and at the end of primary wound repair, and levels of serum interleukin-6 (IL-6) and C-reactive protein (CRP) as well as Bates-Jensen wound assessment tool (BWAT) score before, at 5 days after the primary repair and at the end of the primary repair. Results:All the patients were followed up for 3-6 months [(4.1±0.9)months]. The time of primary wound repair in the negative pressure treatment group was (13.4±2.3)days, which was markedly shorter than that in the dressing treatment group [(22.8±2.5)days] ( P<0.01). Before the primary repair, 11 patients in the negative pressure treatment group showed positive bacterial culture of wound secretions [73.3% (11/15)], and 9 patients in the dressing treatment group were positive [60.0% (9/15)] ( P>0.05). At the end of primary repair, there was 1 patient with positive bacterial culture of wound secretions in the negative pressure treatment group [6.7% (1/15)], which was less than 7 patients in the dressing treatment group [46.7% (7/15)] ( P<0.05). The numbers of positive patients at the end of the primary repair were lower than those before the primary repair in both groups, and the difference in the negative pressure treatment group was statistically significant ( P<0.01), with no significant difference found in the dressing treatment group ( P>0.05). Before the primary repair, the IL-6, CRP and BWAT score were 20.5(8.4, 32.3)pg/ml, 24.2(14.7, 33.0)mg/L, and (37.1±4.8)points in the negative pressure treatment group, comparable with 13.8(11.8, 35.4)pg/ml, 23.6(13.1, 52.3)mg/L, and (35.2±4.7)points in the dressing treatment group (all P>0.05). At 5 days after primary repair, the IL-6, CRP and BWAT score in the negative pressure treatment group were 20.2(7.9, 28.6)pg/ml, 20.0(11.6, 30.5)mg/L, and (34.9±4.3)points, comparable with 11.6(8.9, 20.6)pg/ml, 25.3(10.0, 50.3)mg/L, and (35.2±4.5)points in the dressing treatment group (all P>0.05). At the end of primary repair, the IL-6, CRP and BWAT score were 2.3(1.5, 4.5)pg/ml, 4.8(3.7, 6.9)mg/L, and (23.6±1.8)points in the negative pressure treatment group, statistically different from 4.4(3.3, 6.9)pg/ml, 8.4(5.5, 31.4)mg/L, and (31.4±3.3)points in the dressing treatment group (all P<0.01). The IL-6, CRP and BWAT score at the end of the primary repair were significantly different compared with those before and at 5 days after the primary repair in the two groups ( P<0.05 or 0.01). However, no significant difference was found between the two groups before and at 5 days after the primary repair (all P>0.05). Conclusion:Compared with functional dressings, NPWT can shorten the time required for primary repair of spinal cord injury complicated with lacunar soft tissue defects, control the inflammatory state of the wound, improve the trend of wound healing, and create a good condition for secondary repair treatment of the wound.
