Effect of Vacuum Assisted Closure System on Wound Healing Duration in Parastomal Wounds: A Retrospective Study
Dr. Afig Gojayev,
Ankara University Medicine Faculty, Surgical Oncology Clinic, Ankara, Turkey.
Introduction: In cancer patients, wound healing is seriously impaired due to cachexia and tumour-related catabolism. Therefore, several surgical complications may develop in patients with malignant diagnosis. Parastomal wounds are also among the most frequent surgical complications in this patient group which causes serious deterioration of the patientsâ€™ quality of life. Various factors influence the duration of parastomal wound healing and multiple methods are used in its treatment. Among them, new method is the treatment with the VacuumAssisted Closure (VAC) system.
Aim: To examine the effect of VAC system on the duration of wound healing in parastomal wounds.
Materials and Methods: A retrospective study was conducted in which the data of 31 patients who underwent surgery with a diagnosis of intra-abdominal malignancy at the surgical oncology clinic between January 2010 to January 2018, and who developed a parastomal wound were evaluated retrospectively, through the hospital database. The patientsâ€™ clinical and demographic data, peristomal skin complications and the applied treatment methods were determined from the hospital database. The effect of the patient-related factors and the VAC treatment on the duration of wound healing was analysed. The patients whose data could not be accessed and had no stoma complications were excluded from the study. In this study, analyses were performed using IBM SPSS statistical version 23.0.
Results: A total of 38 patients developed parastomal wounds. The seven patients whose data could not be accessed were excluded from the study, so 31 patients who developed parastomal wounds, participated and out of them 10 (32.2%) were men and the mean age was found as 51.77±15.23. There were 20 patients with ileostomy and 11 patients with colostomy. The most frequent diagnosis in the patient population was colorectal cancer. The VAC treatment was applied to 14 (45.2%) of the patients, the others were applied conventional wound care methods. When the relationship between clinical, demographic data, parastomal wound treatment methods and the durations of wound healing were viewed, the effect of being above 65 years of age (p=0.044), presence of Diabetes mellitus (DM) (p=0.012), and having a Body Mass Index (BMI) value of 25 or above (p=0.046) on parastomal wound healing was found to be statistically significant. Parastomal wound healing took a longer time in these patients. When the VAC treatment and other conventional wound treatment methods were compared, the duration of hospital stay was found to be short, statistically and significantly, in the VAC group (p=0.016).
Conclusion: In malignant patients, being above the age of 65, the presence of DM and having a BMI value of 25 and above lengthen the duration of parastomal wound healing. The healing duration in parastomal wounds treated with VAC is shorter than other conventional methods. Thus, VAC is a successful and feasible method in parastomal wound treatment. Although, the results of this retrospective study are helpful in predicting and managing parastomal wounds, but prospective, randomised and large-scale studies are needed.