儿童难愈性四肢软组织感染的封闭负压引流治疗

Vacuum sealing drainage in children with refractory soft tissue infection on the extremities

目的：探讨封闭负压引流技术（VSD）治疗儿童难愈性四肢软组织感染的临床疗效及注意事项。方法对2010年10月至2014年2月收治的43例难愈性四肢软组织感染患儿资料进行回顾性分析。25例采用VSD治疗，18例采用常规手术及传统换药治疗，观察比较2组换药次数、满足植皮（皮瓣）条件时间、住院天数及住院费用，进行统计学分析。结果 VSD组患儿在换药次数、满足植皮（皮瓣）条件时间及住院天数3个计量指标上明显低于传统换药组（P＜0．01），在住院费用上低于传统换药组（P＜0．05）；43例患儿中38例获得随访，随访时间为3～35个月，平均13．1个月，创面外观瘢痕大小、植皮区平整度较满意，肢体功能恢复理想。结论 VSD对传统换药疗效差的严重、难愈性感染创面有良好的疗效，能够明显减少换药次数、住院天数及费用；在应用于儿童时应注意负压值的调节以及儿童自身因素对VSD的影响。

Objective To investigate the efficacy and indications of the vacuum sealing drainage （VSD） tech-nology in children with refractory soft tissue infection of the extremities. Methods We recruited 43 patients who had refractory soft tissue infection of the extremities between October 2010 and February 2014. Of these children, 25 were treated with VSD and 18 routine operation and traditional dress changing. The dressing frequency, the time to skin grafts （flap）, length of hospital stay and cost of hospitalization were compared. Results The frequency of dressing changing , the time to skin graft, the length of hospital stay （all P〈0.01） and cost of hospitalization （P〈0.05） were sig-nificantly lower or shorter in group VSD. A total of 38 patients （88%） were followed up for an average of 13.1 months （range, 3-35 months）. The wound appearance and the skin transplantation area suggested satisfactory therapeutic out-comes. The limbs function also achieved acceptable recovery. Conclusion VSD has ideal efficacy for the treatment of serious and refractory infective wound and can reduce the frequency of dress changing , cost of hospitalization and shorten the length of hospital stay. Titration of appropriate negative pressure and investigation on the impacts of fac-tors related to the children per se on the outcomes of VSD deserve special attention.