封闭负压引流技术在地震骨折伤员感染创面中的应用
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摘要
目的:探讨封闭负压引流(vacuum sealing drainage,VSD)技术在地震骨折伤员创面中防治感染、修复创面中的作用。方法:收集2008年5月12日至2008年6月19日在四川大学华西医院收治并接受VSD治疗的22例开放性四肢骨折合并创面感染病例。所有病例在运用VSD之前,均对创面进行扩创,并全身应用有效抗生素。给伤员施加-18～-14 kPa负压,术后VSD引流8～10 d,严密观察负压引流量、颜色、性质,定期做引流液细菌培养,观察并记录肢体肿胀消退情况及全身炎症反应情况。结果:22例伤员中无1例出现创面活动性出血或透明薄膜脱落现象。3例术后出现引流管堵塞现象,采用无菌生理盐水冲洗引流管、去除淤塞的坏死组织后保持通畅。13例有骨外露的伤员在封闭负压引流的作用下,肉芽组织生长良好。2例术后局部红肿热痛炎性症状缓解不明显,再次行扩创,彻底清除坏死感染组织后症状缓解,其余病例在术后3～5 d内肿胀明显消退,红肿发热也相应缓解。结论:VSD技术的正确应用能够有效缓解感染创面的炎症反应,限制感染的扩散,在有骨外露的创面,VSD还能促进新鲜肉芽组织从周围向中心平整生长,减少II期为覆盖骨外露转移皮瓣的面积。
Objective To investigate the effect of vacuum sealing drainage(VSD) technology on prevention and treatment of infection wound and to repair the infectious fracture wound in earthquake.Methods Twenty-two patients with limb fractures and open infection wound received VSD from May 12,2008 to June 19,2008 in West China Hospital of Sichuan University.Before the VSD,we debrided all wounds and gave effective systemic antibiotics.A-18 ~-14 kPa pressure was exerted to the wound,and the VSD was used for 8~10 days.We took a germiculture regularly.The capacity,color,and nature of negative pressure drainage,the regression of limb swelling,and systemic inflammatory responses were observed.Results There was no active bleeding wound or transparent film off in all patients.Three patients had drainage clogging,and were kept flowing freely using the sterile saline pipe to remove the blockage of necrotic tissues.During the VSD,granulation tissues grew well in the 13 patients with bone exposure of the wounded.Two patients whose symptom of inflammatory was not obviousy eased had another debridement to completely remove the necrosis,and the symptom was relieved.After 3~5 days of VSD,swelling and fever in the other 20 patients significantly subsided.Conclusion VSD can alleviate the wound inflammation,facilitate the growth of the fresh granulation tissue from the surrounding to the center,and reduce the flap transfer area for the Stage II coverage of the exposed bone.
Objective To investigate the effect of vacuum sealing drainage(VSD) technology on prevention and treatment of infection wound and to repair the infectious fracture wound in earthquake.Methods Twenty-two patients with limb fractures and open infection wound received VSD from May 12,2008 to June 19,2008 in West China Hospital of Sichuan University.Before the VSD,we debrided all wounds and gave effective systemic antibiotics.A-18 ~-14 kPa pressure was exerted to the wound,and the VSD was used for 8~10 days.We took a germiculture regularly.The capacity,color,and nature of negative pressure drainage,the regression of limb swelling,and systemic inflammatory responses were observed.Results There was no active bleeding wound or transparent film off in all patients.Three patients had drainage clogging,and were kept flowing freely using the sterile saline pipe to remove the blockage of necrotic tissues.During the VSD,granulation tissues grew well in the 13 patients with bone exposure of the wounded.Two patients whose symptom of inflammatory was not obviousy eased had another debridement to completely remove the necrosis,and the symptom was relieved.After 3~5 days of VSD,swelling and fever in the other 20 patients significantly subsided.Conclusion VSD can alleviate the wound inflammation,facilitate the growth of the fresh granulation tissue from the surrounding to the center,and reduce the flap transfer area for the Stage II coverage of the exposed bone.
引文
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[3]许龙顺,陈绍宗,李学拥,等.负压封闭治疗慢性难愈合创面[J],中国矫形外科杂志,2000,7(10):1015.XU Longshun,CHEN Shaozong,LI Xueyong,et al.Use ofvacuum-sealing technique to treat the chronic and difficultwound[J].Orthop J China,2000,7(10):1015.
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[5]Wongworawat M D,Schnall S B,Holtom P D,et al.Nega-tive pressure dressings as an alternative technique for thetreatment of infected wounds[J].Clin Orthop Relat Res,2003,(414):45-48.
[6]Lew D,Fuseler J W.The effect of stepwise expansion on themitotie activity and vascularity of subdermal tissue and in-duced capsule in the rat[J].J Oral Maxillofac Surg,1991,49(8):848-853.
[7]Lew D,Fuseler J W.The effect of pulsed expansion of sub-fascially placed expanders on the extent and duration of mito-sis in the capsule and rat integument[J].J Oral MaxillofacSurg,1993,51(2):154-158.
[8]Saxena V,Hwang C W,Huang S,et al.Vacuum-assistedclosure:microdeformations of wounds and cell proliferation[J].Plast Reconstruct Surg,2004,114(5):1086-1096.
[2]Mullner T,Mrkonjic L,Kwasny O,et al.The use of nega-tive pressure to promote the healing of tissue defects:a clini-cal trial using the vacuum sealing[J].Br J Plast Surg,1997,50(3):194-199.
[3]许龙顺,陈绍宗,李学拥,等.负压封闭治疗慢性难愈合创面[J],中国矫形外科杂志,2000,7(10):1015.XU Longshun,CHEN Shaozong,LI Xueyong,et al.Use ofvacuum-sealing technique to treat the chronic and difficultwound[J].Orthop J China,2000,7(10):1015.
[4]Banwell P E,Teot L.Topical negative pressure(TNP):the evolution of a novel wound therapy[J].J Wound Care,2003,12(1):22-28.
[5]Wongworawat M D,Schnall S B,Holtom P D,et al.Nega-tive pressure dressings as an alternative technique for thetreatment of infected wounds[J].Clin Orthop Relat Res,2003,(414):45-48.
[6]Lew D,Fuseler J W.The effect of stepwise expansion on themitotie activity and vascularity of subdermal tissue and in-duced capsule in the rat[J].J Oral Maxillofac Surg,1991,49(8):848-853.
[7]Lew D,Fuseler J W.The effect of pulsed expansion of sub-fascially placed expanders on the extent and duration of mito-sis in the capsule and rat integument[J].J Oral MaxillofacSurg,1993,51(2):154-158.
[8]Saxena V,Hwang C W,Huang S,et al.Vacuum-assistedclosure:microdeformations of wounds and cell proliferation[J].Plast Reconstruct Surg,2004,114(5):1086-1096.
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