应用负压封闭引流技术防治铡草机致手部损伤感染

Application of vaccum sealing drainage to prevent and treat hand trauma infection caused by chaffcutter

目的观察应用负压封闭引流技术（VSD）预防和治疗铡草机致手外伤感染的临床效果。方法将76例铡草机致手外伤患者随机分为两组：治疗组39例清创后VSD覆盖,持续负压引流7~10 d;对照组37例清创后常规伤口换药治疗。两组二期均行皮瓣修复或游离植皮术修复皮肤缺损。结果治疗后感染：治疗组1例,对照组9例;治疗后二期皮瓣修复游离植皮时间：治疗组（7.9±1.9）d,对照组（12.5±2.1）d;治疗后伤口缩小面积：治疗组（6.1±1.2）cm2,对照组（1.8±1.5）cm2;总住院天数：治疗组（20.0±2.6）d,对照组（29.8±6.8）d。以上各项指标两组比较差异均有统计学意义（P〈0.05）。10例感染患者经清创VSD覆盖、持续吸引加用敏感抗生素后均治愈。术后随访2~3个月,76例皮瓣及植皮均成活,无感染。结论 VSD可有效预防和治疗铡草机致手外伤感染,缩短了疗程,减轻了患者的痛苦,效果满意。

Objective To observe clinical effect of vaccum sealing drainage（ VSD） to prevent and treat hand trauma infection caused by chaffcutter. Methods Seventy-six hand trauma infection patients caused by chaffcutter were randomly divided into two groups,and VSD was used to cover 39 cases after debridement. In treatment group,VSD was applied for 39 cases after debridement for 7 ~ 10 days. In the control group,37 cases were generally changed the dressing and medication after debridement. Skin defect was repaired with skin flap or free flap in the second stage.Results There was one case of infection in treatment group,nine cases of infection in control group. After treatment,the time of repairing with skin flap or free flap in second stage in treatment group was（ 7. 9 ± 1. 9） d,（ 12. 5 ± 2. 1）d in control group. After treatment,the wound lessened area in treatment group was（ 6. 1 ± 1. 2） cm2,（ 1. 8 ± 1. 5）cm2in control group; total hospital-stay time in treatment group was（ 20. 0 ± 2. 6） d,（ 29. 8 ± 6. 8） d in control group. Difference between the two groups had statistical significance（ P〈0. 05）. Ten infected patients were all cured through using VSD again and sensitive antibiotics. Patients were followed up for 2 ~ 3 months after operation,76 cases of skin graft and flap all survived without infection. Conclusions VSD can effectively prevent and treat hand trauma infection caused by chaffcutter,shorten the course of treatment,reduce the pain of patients,reduce the cost of treatment,and the result is satisfactory.