Obstetrik ve Jinekolojide Enfekte ve Komplike Yaralarda Negatif Basınçlı Yara Tedavisi: Retrospektif Karşılaştırmalı Bir Çalışma

Öz

Cerrahi bölge enfeksiyonları ve yara komplikasyonları, obstetrik ve jinekolojide ameliyat sonrası morbiditeye önemli katkıda bulunan faktörler olmaya devam etmektedir. Vakum destekli kapatma (VAC) olarak da bilinen negatif basınçlı yara tedavisi (NPWT), cerrahi uygulamada yaygın olarak kullanılsa da, enfekte veya komplike obstetrik ve jinekolojik cerrahi yaralarda terapötik uygulamasına ilişkin kanıtlar sınırlıdır. Bu retrospektif karşılaştırmalı çalışma, üçüncü basamak bir obstetrik ve jinekoloji merkezinde VAC tedavisi ile geleneksel yara pansumanı ile tedavi edilen hastaların klinik özelliklerini ve kısa vadeli sonuçlarını değerlendirdi. Analize yaklaşık 50-60 hasta dahil edildi. Demografik özellikler, cerrahi endikasyonlar, inflamatuar belirteçler, yara özellikleri, hastanede kalış süresi ve yara kapatma yöntemleri analiz edildi. VAC ile tedavi edilen hastalar kontrol grubuna göre anlamlı derecede daha yaşlıydı (51,6±11,1'e karşı 35,7±11,4 yıl, p<0,001), vücut kitle indeksi ise gruplar arasında karşılaştırılabilir düzeydeydi (p=0,135). Cerrahi endikasyon dağılımı istatistiksel anlamlılığa yaklaştı (p=0,066), VAC grubunda benign ve onkolojik vakaların oranı daha yüksekti. Postoperatif yara açılma zamanı, CRP düzeyleri ve hastanede kalış süresi gruplar arasında anlamlı farklılık göstermedi. VAC tedavisine başlama süresi ortalama 8,4 gündü. Hastanede kalış süresi gruplar arasında benzerdi. VAC tedavisi uygulanan hastaların %55,6'sında pozitif yara kültürü saptanırken, geleneksel yara bakımı uygulanan hastaların %75'inde pozitif yara kültürü saptandı. Bu fark istatistiksel olarak anlamlı olmasa da, selülit insidansı VAC grubunda sayısal olarak daha düşüktü. Yara kapatma stratejisinde anlamlı bir fark gözlendi; VAC grubundaki hastaların %100'ünde gecikmeli dikiş uygulanırken, geleneksel pansuman grubunda alternatif kapatma veya ikincil iyileşme yaklaşımları kullanıldı. VAC tedavisi ağırlıklı olarak daha karmaşık cerrahi endikasyonları ve daha yüksek temel risk profilleri olan hastalarda uygulandı. Obstetrik ve jinekolojik yara komplikasyonlarında NPWT'nin terapötik rolünü daha ayrıntılı olarak tanımlamak için ileriye dönük çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

• Vakum destekli kapatma
• negatif basınçlı yara tedavisi
• jinekolojik cerrahi
• obstetrik yaralar
• cerrahi bölge enfeksiyonu

Destekleyen Kurum

Kahramanmaraş Üniversitesi Tıp Fakültesi

Etik Beyan

Çalışma, Kahramanmaraş Sütçü İmam Üniversitesi Tıp Fakültesi yerel etik kurulu tarafından onaylanmıştır (Onay numarası: 241).

Negative Pressure Wound Therapy in Infected and Complicated Wounds in Obstetrics and Gynecology: A Retrospective Comparative Study

Öz

Surgical site infections and wound complications remain significant contributors to postoperative morbidity in obstetrics and gynecology. Although negative pressure wound therapy (NPWT), also known as vacuum-assisted closure (VAC), is widely used in surgical practice, evidence regarding its therapeutic application in infected or complicated obstetric and gynecologic surgical wounds remains limited. This retrospective comparative study evaluated clinical characteristics and short-term outcomes of patients treated with VAC therapy versus conventional wound dressing in a tertiary obstetrics and gynecology center. Approximately 50–60 patients were included in the analysis. Demographic characteristics, surgical indications, inflammatory markers, wound features, hospitalization duration, and wound closure methods were analyzed. Patients treated with VAC were significantly older than controls (51.6±11.1 vs 35.7±11.4 years, p<0.001), while body mass index was comparable between groups (p=0.135). Surgical indication distribution approached statistical significance (p=0.066), with a higher proportion of benign and oncologic cases in the VAC group. Postoperative wound dehiscence timing, CRP levels, and length of hospital stay did not differ significantly between groups. The mean time to initiation of VAC therapy was 8.4 days postoperatively. Length of hospital stay was comparable between groups. Positive wound cultures were identified in 55.6% of patients treated with VAC therapy compared with 75% of patients managed with conventional wound care. Although this difference did not reach statistical significance, the incidence of cellulitis was numerically lower in the VAC group. A significant difference was observed in wound closure strategy, as 100% of patients in the VAC group underwent delayed resuturing, whereas alternative closure or secondary healing approaches were used in the conventional dressing group. VAC therapy was predominantly applied in patients with more complex surgical indications and higher baseline risk profiles. Prospective studies are warranted to further define the therapeutic role of NPWT in obstetric and gynecologic wound complications.

Anahtar Kelimeler

• Vacuum-assisted closure
• negative pressure wound therapy
• gynecologic surgery
• obstetric wounds
• surgical site infection

Destekleyen Kurum

Kahramanmaras University, Medical Faculty

Etik Beyan

The study was approved by the local ethics committee of Kahramanmaraş Sütçü İmam University Faculty of Medicine (Approval number: 241)

Kaynakça

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