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

作     者：Konstantin V Lipatov Arthur Asatryan George Melkonyan Aleksandr D Kazantcev Ekaterina I Solov’eva Denis V Krivikhin Irina V Gorbacheva Urii E Cherkasov 

作者机构：Department of General SurgeryInstitute of Clinical Medicine named after N.V.SklifosovskySechenov First Moscow State Medical University(Sechenov University)Moscow 119021Russia Department of General SurgeryWound and Wound Infection SurgeryState Budgetary Institution“City Clinical Hospital named after S.S.Yudin of Moscow Healthcare Department”Moscow 115446Russia Department of General SurgeryPhysician of The Hospital for War Veterans No 3Moscow 129336Russia Department of General SurgeryI.M.Sechenov First Moscow State Medical UniversityMoscow 119048Russia 

出 版 物：《World Journal of Orthopedics》 (世界骨科杂志（英文）)

年 卷 期：2024年第15卷第11期

页      面：1015-1022页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Necrotizing fasciitis Upper limb Negative pressure wound therapy Vacuum-assisted closure Surgical treatment 

摘      要：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 *** treatment is accompanied by the formation of extensive wounds,which can be treated with significant *** recent years,negative pressure wound therapy(NPWT)has proven to be highly *** is also promising for the treatment of *** To explore the effectiveness of NPWT in the treatment of NF of the upper *** 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 *** the NPWT group,the NPWT method(120 mmHg;constant mode)was used after surgical *** number of vacuum-assisted dressings in patients ranged from 1 to 3,depending on the dynamics of the wound *** duration of fixation of one bandage was up to 2−3 *** the control group,conventional methods of local wound treatment were *** 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 *** 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 *** 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 *** 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 *** 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 Strep