背景：外科医生可以使用许多手术切口闭合的技术，但是关于在手术结束时以及在什么情况下应使用哪种技术的指导很少。假设：手术结束时切口的管理缺乏共识，并且各个外科医生之间存在差异。方法：对手术结束后的切口管理进行外科感染学会会员调查。提供了几个案例场景来测试操作类型的影响，术中污染，和切口管理的血流动力学稳定性(例如，闭合筋膜或皮肤，使用切口/伤口真空辅助闭合[VAC]装置)。要达成共识，需要三分之二的参与者作出回应。数据分析采用χ2检验和logistic回归，a=0.05。反应异质性通过香农指数(SI)量化。结果：在78名受访者中，对于选择性脾切除术(91%闭合皮肤/干燥敷料)达成共识.开腹阑尾切除术和左结肠切除术/结肠末造口术的异质性最大（SI，分别为1.68和1.63）。在创伤剖腹手术中，大多数患者对血流动力学不稳定(53%-67%)使用损伤控制,但对血流动力学稳定的患者(0%-1.3%;p<0.001)不使用损伤控制.对于血液动力学稳定的创伤脾切除术患者（87％）的闭合皮肤/干燥敷料和对于血液动力学不稳定的结肠切除/吻合的筋膜开放/伤口VAC（67％）的其他共识。直肠损伤的粪便改道和结肠切除/吻合术（两者在血流动力学稳定时）具有高度异质性（SI，分别为1.56和1.48）。在穿透性创伤中，在血流动力学稳定的患者中，人们的观点是更多地使用湿干敷料和切口/伤口VAC，污染增加。结论：在血流动力学不稳定的创伤患者中，损伤控制是有利的。穿透性创伤后使用干湿敷料和切口/伤口VAC溢出。然而,大多数情况下没有达成共识。手术结束时有关切口管理的实践差异很大。需要前瞻性研究和循证指导，以指导最终操作时的决策。
Background: Many techniques for closure of surgical incisions are available to the surgeon, but there is minimal guidance regarding which technique(s) should be utilized at the conclusion of surgery and under what circumstances. Hypothesis: Management of incisions at the conclusion of surgery lacks
consensus and varies among individual surgeons. Methods: The Surgical Infection Society membership was surveyed on the management of incisions at the conclusion of surgery. Several case scenarios were provided to test the influences of operation type, intra-operative contamination, and hemodynamic stability on incision management (e.g., close fascia or skin, use of incision/wound vacuum-assisted closure [VAC] device). Responses by two-thirds of participants were required to achieve
consensus. Data analysis by χ2 test and logistic regression, a = 0.05. Response heterogeneity was quantified by the Shannon index (SI). Results: Among 78 respondents,
consensus was achieved for elective splenectomy (91% close skin/dry dressing). Open appendectomy and left colectomy/end-colostomy had the greatest heterogeneity (SI, 1.68 and 1.63, respectively). During trauma laparotomy, the majority used damage control for hemodynamic instability (53%-67%) but not for hemodynamically stable patients (0%-1.3%; p < 0.001). Additional
consensus was achieved for close skin/dry dressing for hemodynamically stable trauma splenectomy patients (87%) and fascia open/wound VAC for hemodynamically unstable colon resection/anastomosis (67%). Fecal diversion for rectal injury and colon resection/anastomosis (both when hemodynamically stable) had high heterogeneity (SI, 1.56 and 1.48, respectively). In penetrating trauma, sentiment was for more use of wet-to-dry dressings and incision/wound VAC with increased contamination in hemodynamically stable patients. Conclusions: Damage control was favored in hemodynamically unstable trauma patients, with use of wet-to-dry dressings and incision/wound VAC with spillage after penetrating trauma. However, most scenarios did not achieve
consensus. High variability of practices regarding incision management at the conclusion of surgery was confirmed. Prospective studies and evidence-based guidance are needed to guide decision making at end-operation.
