Uso de la terapia de presión negativa tópica en heridas cerradas en el trasplante hepático

Abstract

Introduction: Events related to surgical wounds in the context of liver transplantation are frequent due to various risk factors such as immunosuppression, surgical time or hospital stay. Topical negative pressure therapy is a therapeutic method widely used in open wounds for comfort and safety. The use of such systems has recently been recommended in closed surgical wounds, as it may decrease the number of surgical site infections and wound-related events. Liver transplant patients, due to their comorbidities and the complexity of this process, could benefit from the use of this therapy. Despite this, the scientific evidence currently available to make or not this recommendation is very limited. Aims: a) To compare the incidence of surgical site infections in liver transplant patients according to the cure applied: cure with topical negative pressure therapy or conventional cure with surgical dressings; b) identify the prevalence of wound-related surgical complications (wound dehiscence, seroma and hematoma) in the first 30 days after liver transplantation; c) To determine factors (local or general) related to the occurrence of surgical wound-related events; d) To evaluate the quality of life related to health and injuries in this population and e) To state the main problems related to health-related quality of life in these patients. Methods: A randomized clinical trial was conducted at the Virgen de la Arrixaca University Clinical Hospital, from December 2018 to September 2021 in patients undergoing liver transplantation. Patients were randomly assigned to receive their cures with negative pressure therapy with the PICO® system or a standard surgical dressing. Results: 108 people participated, including 54 in the intervention group and 54 in the control group. During the first month post-transplant, 28,7% (n=31) of patients had a wound-related event, the most frequent complication being surgical site infection (n=11), followed by seroma (n=10), hematoma (n=5) and surgical wound dehiscence (n=5). The rate of wound-related events was lower in the group of patients treated with topical negative pressure therapy than in the group treated with a surgical dressing (28,7% vs. 29,6%; p=0,832), as well as specifically the rate of surgical site infections (7,4% vs. 13%; p=0,344). The following were identified as risk factors for developing surgical wound complications: elevated body mass index, smoking status, hypoalbuminemia, thrombocytopenia, transfused fresh frozen plasma units, longer hospital stay and number of hospital readmissions. In relation to quality of life, the group of patients who received topical negative pressure therapy obtained a higher quality of wound-related half-life than the group of patients cured with a surgical dressing (75,20 ± 7,27 vs 72,82 ± 10,57; p=0,234). The main problems identified in relation to quality of life were related to worry about a new wound, sleep disturbance and basic activities of daily living. Conclusion: The use of topical negative pressure therapy in closed wounds did not significantly decrease the number of surgical site infections or wound-related events following liver transplantation. A high body mass index, toxic habits such as smoking, hypoalbuminemia, thrombocytopenia, transfused fresh frozen plasma units, longer hospital stay and the number of hospital readmissions are factors related to the occurrence of wound-related events. Most of the transplant patients had a mean level of wound-related quality of life, with the main problems identified as sleep, activities of daily living, concern about the appearance of a new wound.