负压封闭引流术一期修复犬咬伤创面的护理

Nursing of vacuum sealing drainage in the primary stage in repairing exposed dog bite wounds

目的探讨犬咬伤严重暴露创面一期修复的治疗与护理。方法常规清创,创面上安装负压封闭引流装置(VSD),300 mm Hg负压2 h与130 mm Hg负压1 h,交替负压抽吸24 h;转移皮瓣,一期修复创面,皮瓣上再次覆盖VSD,负压吸引72 h,皮瓣及供区皮下放置压脉带纵行剪开(一分为二)形成的半圆环形引流条,皮瓣及供区安装负压封闭引流装置(VSD),300 mm Hg负压2 h与130 mm Hg负压1 h,交替负压抽吸,主动吸引出皮瓣下淤滞的血液,3 d拆除VSD,拔出引流条,整个治疗期间予以特殊护理与康复。结果皮瓣全部成活,伤口疤痕不明显,外形理想,随访6个月至2年,无狂犬病发作。结论利用VSD术前、术后的持续主动负压吸引作用,配合一期修复手术,既可及时、彻底地去除创面残留的病毒、细菌,又可满足患者外观及功能上的特殊要求,对于严重的犬咬伤创面是一种较为理想的修复方法,而做好各种护理是促进良好愈合、缩短愈合时间的重要保证。

Objective To investigate the treatment and nursing of vacuum sealing drainage （VSD） in the primary stage in repairing exposed dog bite wounds. Methods Conventional de- bridement was carried out by VSD on the dog bite wounds. The negative pressure with 300 mmHg for 2 hours and 130 mmHg for 1 hour were interchangeably applied for 24 hours in total. All the pa- tients were presented with flaps transplantation with VSD for 72 hours. Drainage strips were placed which came from half of the drainage tube bellow flap after repairing the tissue defect, and vacuum sealing drainage was placed over the flap and donor size, and initiatively and alternatively aspirated blood stasis in flap and bellow flap with negative pressure of 130mmHg for 1 hour and 300 mmHg for 2 hours. Vacuum sealing drainage was dismantled after 3 days, and the drainages were pulled out. Special nursing and rehabilitation were carried out during the treatment. Results All the flaps survived with no obvious cicatrix. All the patients had no rabies in the 24 - month to 2 - year follow - ups. Conclusion The dog bite wounds can be treated well by combining vacuum sealing drainage with primary repairing. This method can remove the bacteria and virus in the wounds and satisfied patients＇ requirements. Good nursing can promote recovery and shorten the healing time.