Novel Application of Vacuum Sealing Drainage with Continuous Irrigation of Potassium Permanganate for Managing Infective Wounds of Gas Gangrene

Summary： Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputa- tion. The aim of the present study was to use vacuum sealing drainage （VSD） with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical effi- cacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Am- putations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol （PVA） foam dress- ing and polyurethane （PU） film, with continuous irrigation of 1：5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one pa- tient who suffered from severe septic shock. Emergent resuscitation was performed and the patient re- turned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenviroument and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

Recombinant human epidermal growth factor combined with vacuum sealing drainage for wound healing in Bama pigs

Background:Vacuum sealing drainage(VSD)and epidermal growth factor(EGF)both play an important role in the treatment of wounds.This study aims to explore the effects of the combination of VSD and EGF on wound healing and the optimal concentration and time of EGF.Methods:We tested the proliferation and migration capacity of HaCaT and L929 cells at different EGF concentrations(0,1,5,10,and 100ng/ml)and different EGF action times(2,10,and 30min).A full-thickness skin defect model was established using male,30-week-old Bama pigs.The experiment included groups as follows:routine dressing change after covering with sterile auxiliary material(Control),continuous negative pressure drainage of the wound(VSD),continuous negative pressure drainage of the wound and injection of EGF 10min followed by removal by continuous lavage(V+E 10min),and continuous negative pressure drainage of the wound and injection of EGF 30min followed by removal by continuous lavage(V+E 30min).The wound healing rate,histological repair effect and collagen deposition were compared among the four groups.Results:An EGF concentration of 10ng/ml and an action time of 10min had optimal effects on the proliferation and migration capacities of HaCaT and L929 cells.The drug dispersion effect was better than drug infusion after bolus injection effect,and the contact surface was wider.Compared with other groups,the V+E 10min group promoted wound healing to the greatest extent and obtained the best histological score.Conclusions:A recombinant human epidermal growth factor(rhEGF)concentration of 10 ng/ml can promote the proliferation and migration of epithelial cells and fibroblasts to the greatest extent in vitro.VSD combined with rhEGF kept in place for 10min and then washed,can promote wound healing better than the other treatments in vitro.

Salvage of vascular graft infections via vacuum sealing drainage and rectus femoris muscle flap transposition: A case report

BACKGROUND The management of vascular graft infections continues to be a significant challenge in a clinical situation.The aim of this report is to illustrate the novel vacuum sealing drainage(VSD)technique and rectus femoris muscle flap transposition for vascular graft infections,and to evaluate the prospective of future testing of this surgical procedure.CASE SUMMARY We report the case of a 32-year-old male patient,who presented a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure.Using the VSD and muscle flap transposition,the groin wound and vascular graft infection were finally treated successfully.CONCLUSION Our case report highlights that VSD technique and rectus femoris muscle flap transposition could be considered in patients presenting with a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure,especially in consideration of treatable conditions.

Effect of vacuum sealing drainage combined with biological dressings on the angiogenesis and inflammatory response after diabetic foot ulcer wound grafting

Objective: To study the effect of vacuum sealing drainage combined with biological dressings on the angiogenesis and inflammatory response after diabetic foot ulcer wound grafting. Methods: Patients with diabetic foot who were treated in Sichuan Provincial People's Hospital between May 2014 and February 2017 were selected and randomly divided into vacuum drainage group and normal control group who received vacuum sealing drainage combined with biological dressings as well as conventional debridement and dressing change to deal with the wound respectively. Before treatment as well as 1 d, 3 d and 5 d after treatment, the wound tissue was collected to determine the expression of angiogenesis molecules, angiogenesis signaling pathway molecules and inflammatory response molecules. Results: 1 d, 3 d and 5 d after treatment, VEGF, VEGFR, CD105, MMP9, PI3K, AKT, cyclinD1, p38MAPK and NF-kB protein expression in wound tissue of vacuum drainage group were significantly higher than those of normal control group while COX-2, iNOS, TNF-α and IL-6 mRNA expression were significantly lower than those of normal control group. Conclusion: Vacuum sealing drainage combined with biological dressings promotes the angiogenesis and inhibits the inflammatory response after diabetic foot ulcer wound grafting.

Assessment of the trauma degree and bone metabolism after external fixation combined with vacuum sealing drainage treatment of open tibiofibula fracture

Objective: To evaluate the effect of external fixation combined with vacuum sealing drainage on the trauma degree and bone metabolism in patients with open tibiofibula fracture. Methods:A total of 116 patients with open tibiofibula fracture who received surgical treatment in Luzhou People's Hospital between February 2015 and January 2017 were divided into control group (n=58) and study group (n=58) by random number table. Control group received debridement + external fixation, and study group received debridement + external fixation +vacuum sealing drainage. The differences in the levels of trauma indexes and bone metabolism indexes were compared between the two groups before and after treatment. Results: Before surgery, there was no statistically significant difference in serum levels of trauma indexes and bone metabolism indexes between the two groups. 1 week after surgery, serum acute phase protein Tf level of study group was higher than that of control group whereas CER, Hp and CRP levels were lower than those of control group;stress indexes NE and Cor levels were lower than those of control group;bone metabolism indexes P1NP, BGP and BALP levels were higher than those of control group whereas β-CTX level was lower than that of control group. Conclusion: External fixation combined with vacuum sealing drainage can effectively reduce fracture trauma and promote fracture end healing in patients with open tibiofibula fracture.

Effect of vacuum sealing drainage combined with intermittent insulin flushing on expression of inflammatory factors and apoptosis factors in diabetic lower limb ulcer wound

Objective: To discuss the effect of vacuum sealing drainage combined with intermittent insulin flushing on the expression of inflammatory factors and apoptosis factors in diabetic lower limb ulcer wound. Methods: A total of 48 patients with diabetic lower limb ulcer who were treated in the Endocrine Department of the hospital between January 2016 and January 2017 were divided into the control group and research group by random number table, 24 cases in each group. Control group received vacuum sealing drainage, and research group received vacuum sealing drainage combined with intermittent insulin flushing. The differences in the expression of inflammatory factors and apoptosis genes in the wound exudate were compared between the two groups before and after treatment. Results: Before treatment, the differences in the inflammatory factor contents and apoptsis gene expression in wound exudate were not statistically significant between the two groups of patients. After treatment, inflammatory factors IL-6, IL-1β, TNF-α, CRP, VCAM-1 and FGF2 contents in wound exudate of research group were lower than those of control group;apoptosis gene Bcl-2 mRNA expression in wound exudate of research group was higher than that of control group while Bax, p53 and Fas mRNA expression were lower than those of control group. Conclusions: Vacuum sealing drainage combined with intermittent insulin flushing can effectively reduce the local inflammatory response and promote the granulation cell proliferation in wound of patients with diabetic lower limb ulcer.

Application of vacuum sealing drainage in skin graft of calf pedicle island flap donor-site

Objective: To explore the clinical effect of vacuum sealing drainage on free dermatoplasty in the donor-site of calf pedicled island flap. Method: From January 2016 to January 2018, a total of 70 patients undergoing reconstruction of skin and soft tissue defects in ankles and legs with calf pedicle island flap in Foshan Traditional Chinese Medicine Hospital were selected into our research. Selected patients were divided into VSD group and pressure dressing group according to the order of surgery. The VSD group was treated with free skin grafting and vacuum sealing drainage after separation of donor-site flap. The pressure dressing group was treated with free skin grafting and traditional pressure dressing technology after the separation of donor-site flap. Visual acuity simulation scores (VAS) were observed and recorded on the 1st, 7th, and 14th day after surgery. The unpacking time, skin graft healing time, skin graft survival rate, infection rate and incidence of subcutaneous hematoma were compared between the two groups. Results: The VAS scores on the 7th and 14th day after surgery in the VSD group were lower than those in the pressure dressing group. The unpacking time and skin graft healing time of the VSD group were shorter than those of the pressure dressing group. The survival rate of skin graft in VSD group was higher than that in the pressure dressing group. The infection rate and the incidence of subcutaneous hematoma in the VSD group were lower than those in the pressure dressing group. Conclusion: Vacuum sealing drainage is beneficial to promote the healing of free skin grafts in the donor site of the calf pedicle island flap, relieve pain, reduce adverse reactions, safe and effective, and worthy of clinical promotion.

Effect of Ilizarov external fixation combined with negative pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion

Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective nonunion who were treated in our hospital from August 2016 to August 2018 were divided into two groups according to random number table,with 39 patients in the control group treated with Ilizarov external fixation technology and 40 patients in the study group treated with vacuum pressure sealing drainage and antibiotics on the basis of the control group.Bone healing time and daily walking were recorded.Rasmussen score,serum intercellular adhesion molecule-1(ICAM-1)and IL-6 levels,lower limb Fugl-Meyer motor function score and lower limb BI index score were compared at different time.Results:The daily walking condition of the study group was significantly better than that of the control group(P<0.05),and the healing time of bone was significantly shorter than that of the control group(P<0.05);the Rasmussen score of the study group was higher than that of the control group at 1 month,6 months and 12 months after treatment(P<0.05);the levels of serum ICAM-1 and IL-6 in the two groups after treatment were lower than those before treatment(P<0.05),and the levels of serum ICAM-1 and IL-6 in the study group were lower than those in the control group after treatment(P<0.05).The lower limb Fugl-Meyer motor function score and lower limb BI index score of the two groups after treatment were higher than those before treatment(P<0.05),and the lower limb Fugl-Meyer motor function score and lower limb BI index score of the study group after treatment were higher than those of the control group(P<0.05).Conclusions:Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics can promote the bone healing of patients with infective tibial nonunion,significantly improving their daily walking condition,alleviating inflammation,and recovering the knee joint function and lower limb function well.

Chinese Trauma Surgeon Association for management guidelines of vacuum sealing drainage application in abdominal surgeries-Update and systematic review

Vacuum sealing drainage (VSD) is frequently used in abdominal surgeries. However, relevant guidelines are rare. Chin ese Trauma Surge on Associati on orga nized a committee composed of 28 experts across China in July 2017, aiming to provide an evidence-based recommendation for the application of VSD in abdominal surgeries.Eleven questions regarding the use of VSD in abdominal surgeries were addressed:(1) which type of materials should be respectively chosen for the intraperitoneal cavity, retroperitoneal cavity and superficial incisions?(2) Can VSD be preventively used for a high-risk abdominal incision w让h primary suture?(3) Can VSD be used in severely contaminated/infected abdominal surgical sites?(4) Can VSD be used for temporary abdominal cavity closure under some special conditions such as severe abdominal trauma, infection, liver transplantation and intra-abdominal volume increment in abdominal compartment syndrome?(5) Can VSD be used in abdominal organ inflammation, injury, or postoperative drainage?(6) Can VSD be used in the treatment of intestinal fistula and pancreatic fistula?(7) Can VSD be used in the treatment of intra-abdominal and extra-peritoneal abscess?(8) Can VSD be used in the treatment of abdominal wall wounds, wound cavity, and defects?(9) Does VSD in crease the risk of bleeding?(10) Does VSD increase the risk of intestinal wail injury?(11) Does VSD increase the risk of peritoneal adhesion? Focusing on these questions, evidence-based recommendations were given accordingly. VSD was strongly recommended regarding the questions 2-4. Weak recommendations were made regarding questions 1 and 5-11. Proper use of VSD in abdominal surgeries can lower the risk of infection in abdominal incisions with primary suture, treat severely contaminated/infected surgical sites and facilitate temporary abdominal cavity closure.

给氧负压封闭引流联合湿润烧伤膏序贯治疗高海拔地区下肢慢性溃疡疗效分析

目的探讨给氧负压封闭引流联合湿润烧伤膏序贯治疗高海拔地区下肢慢性溃疡的临床疗效。方法选取2019年1月至2023年3月若尔盖县人民医院收治的60例下肢慢性溃疡患者作为研究对象,按照创面不同治疗方法将其分为观察组(30例)和对照组(30例),观察组患者予以给氧负压封闭引流联合湿润烧伤膏序贯治疗,对照组患者单纯予以湿润烧伤膏治疗,对比两组患者创面肉芽组织状态、病原菌感染情况、愈合率以及住院时间。结果治疗3周后,观察组患者创面肉芽组织评分明显高于对照组、病原菌阳性率低于对照组(Z/χ^(2)=-4.332、4.800,P<0.001、P=0.028);观察组患者治疗3周后创面愈合率明显高于对照组、住院时间明显短于对照组(t=6.517、7.211,P均<0.001)。结论给氧负压封闭引流联合湿润烧伤膏序贯治疗高海拔地区下肢慢性溃疡创面,能够有效促进肉芽组织生长,抑制病原菌增殖,加快创面愈合,缩短住院时间。

Application of vacuum sealing drainage technique in poor healing wounds after heart valve surgery

Background： Poor healing wounds or postoperative infection after open-heart surgery are most commonly seen, especially in secondary surgery for heart diseases, with an incidence rate of 2.2% after a valve replacement surgery. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. It becomes a really troublesome and complicated case when a poor healing occurs in midsternal incision after the heart valve surgery and a higher medical cost may be needed. Methods From January 2009 to February 2013, 162 patients who underwent heart valve surgery through midsternal incision approach and had a poor healing of wound were observed for prospective randomized controlled trial. The patients were randomly assigned to a vacuum sealing drainage group （n = 81） who received vacuum sealing drainage for healing of the wound or a control group （n = 81） who received traditional treating for the infected wound. Their therapeutic effects, healing time and treatment costs, etc were compared. Results Two patients from the vacuum sealing drainage group came back to hospital for repair due to dehiscence of the incision after discharge, and no patient died. Six patients from the control group came back to hospital for repair due to dehiscence of the incision after discharge, two came back to hospital for surgery due to chronic osteomyelitis, and one patient died two weeks later after surgery due to severe chest infection. Wound healing time for vacuum sealing drainage group was 14.6 ± 3.6 days, which was significantly shorter than that of the control group （21.2 ± 7.8 days, P 〈 0.05）, while the medical costs showed no significant difference between the two groups （P 〉 0.05）. Seventy-eight patients （96.29%） in the vacuum sealing drainage group showed a good healing of the wound and sternum after a six-month follow-up. Conclusion The use of vacuum sealing drainage technique in poor-healing wounds after heart valve surgery through midsternal incision approach could achieve good therapeutic efficacy, with shorter wound healing time and similar costs as traditional treatment.

Vacuum sealing drainage technique in the treatment of poor healing wounds after heart valve surgery:experience in cardiac nursing

Background Poor wound healing or postoperative infection after open-heart surgery is most commonly seen. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. Vacuum sealing drainage （VSD） is a new technology to promote wound healing. We studied the use of VSD technique in poor wound healing after heart valve surgery to see if it could achieve good therapeutic efficacy. Methods From 2013 October to 2014 October in Guang- dong General Hospital, 86 cases of the application of vacuum sealing drainage technique in the treatment of cardiac nonunion after valve replacement in patients with nursing observation. The treatment time, death rate and infection rate, etc were compared. Results Wound healing time of 86 patients receiving vacuum sealing drainage was 14.6 ± 3.6 days, and no patient died. Two patients came back to hospital for repair due to dehis- cence of the incision after discharge. Conclusion Nursing observation and drainage management were the key of VSD. VSD technique is worthy to be popularized clinically.

双层人工真皮联合负压封闭引流和自体刃厚皮片移植治疗慢性难愈合创面的疗效

目的 探讨双层人工真皮联合负压封闭引流和自体刃厚皮片移植治疗慢性难愈合创面的临床疗效。方法 前瞻性选取60例慢性难愈合创面患者,按照随机数字表法将其分为对照组(30例)与观察组(30例)。对照组患者Ⅰ期采用单纯负压封闭引流治疗,Ⅱ期采用自体刃厚皮片移植;观察组患者Ⅰ期采用双层人工真皮联合负压封闭引流,Ⅱ期采用自体刃厚皮片移植。观察2组患者移植自体刃厚皮片成活情况、不良反应、瘢痕情况[温哥华瘢痕评估量表(VSS)评分]。对比2组患者治疗前后疼痛程度[视觉模拟量表(VAS)评分]、血清基质金属蛋白酶13(MMP-13)水平、血清金属蛋白酶抑制剂1(TIMP-1)水平及MMP-13/TIMP-1值。结果 治疗后,观察组患者移植自体刃厚皮片成活情况优于对照组,不良反应发生率、植皮区与供皮区VSS评分、疼痛程度低/轻于对照组,差异均有统计学意义(P<0.05);治疗后,2组患者血清MMP-13水平、MMP-13/TIMP-1值均低于治疗前,血清TIMP-1水平均高于治疗前,且观察组变化幅度较对照组更大,差异均有统计学意义(P<0.05)。结论 双层人工真皮联合负压封闭引流和自体刃厚皮片移植治疗慢性难愈合创面效果显著,可增加移植自体刃厚皮片成活率,减少不良反应,减轻瘢痕情况及疼痛程度,调节血清MMP-13、TIMP-1水平。

密闭式创面冲洗-负压引流治疗仪的研制

目的:为解决现有糖尿病足创面处理方法存在的不足,研制一种密闭式创面冲洗-负压引流治疗仪。方法:以密封足套和内桶构建的密闭空间为结构基础,利用单片机控制隔膜泵产生高压雾化水流实现创面的无痛冲洗;通过真空泵和压力传感器产生高精度负压实现VSD治疗。结果:该治疗仪可对糖尿病足创面进行非接触式雾化水流冲洗和负压封闭引流(VSD)治疗,最大冲洗压力为300 kPa,最大负压为-60 kPa(-450mmHg),压力控制精度均优于5%FS。结论:该治疗仪可明显改善创面血液循环,促进肉芽组织生长,在临床治疗上具备很好的应用前景。

四妙勇安汤负压滴灌治疗湿热内蕴型糖尿病足伴严重下肢缺血患者的临床观察

目的观察四妙勇安汤负压滴灌治疗湿热内蕴型糖尿病足伴严重下肢缺血患者的临床疗效。方法选取2021年6月—2023年10月期间邢台医学高等专科学校附属二院收治的糖尿病足(Diabetic foot,DF)伴严重下肢缺血(Critial limb ischemia,CLI)患者60例,采用随机数表法分为对照组和观察组,每组各30例,术前WIFI分级评估,进行相应的血管腔内治疗,血运重建成功后,分别行坏疽趾或趾列开放性切除或溃疡清创术,其中对照组术后采用负压封闭引流(VSD)进行治疗,观察组术后采用四妙勇安汤负压滴灌治疗,1周后拆除VSD敷料查看创面情况,创面内组织细菌培养阴性后,行创面修复,直至创面愈合,分别检测治疗1、2周后血清C反应蛋白(C-reactive protein,CRP)、降钙素原(Procalcitonin,PCT),治疗2周后创面细菌转阴率;检测治疗2周后经皮氧分压(Transcutaneous oxygen pressure,T_(C)PO_(2))及踝肱指数(Ankle-brachialindex,ABI)、创面愈合时间及不良反应。结果治疗后观察组总有效率90.00%(27/30)明显高于对照组80.00%(24/30),差异有统计学意义(P<0.05)。治疗后两组患者CRP、PCT水平均较治疗前降低,差异有统计学意义(P<0.05);且观察组CRP、PCT水平明显低于对照组,差异有统计学意义(P<0.05)。治疗后观察组创面细菌转阴率90%(27/30)明显高于对照组70%(21/30),差异有统计学意义(P<0.05)。治疗后两组患者T_(C)PO_(2)水平均较治疗前升高,差异有统计学意义(P<0.05);且观察组T_(C)PO_(2)水平明显高于对照组,差异有统计学意义(P<0.05),观察组ABI指数与对照组比较,治疗前后差异无统计学意义(P>0.05)。治疗后观察组创面愈合时间(28.63±5.30)d明显优于对照组(40.87±5.14)d,差异有统计学意义(P<0.05)。治疗期间,两组患者均无过敏、肿胀、感染加重等不良反应发生。结论四妙勇安汤负压滴灌治疗糖尿病足伴严重下肢缺血腔内治疗术后湿热内蕴型可有效控制感染,改善局部微循环,缩短创面愈合时间,具有临床应用及推广价值。

负压封闭引流技术对较大体表肿物美容缝合切口愈合质量的影响

目的 观察负压封闭引流技术对较大体表肿物美容缝合切口愈合质量的影响。方法 2020年1月~2023年6月我院收治较大体表肿物病人60例,采用区组随机法分为研究组和对照组。对照组采用美容缝合技术缝合手术切口,研究组在美容缝合的基础上采用负压封闭引流技术。比较两组病人术后切口疼痛数字评价量表(NRS)评分、视觉模拟评分法(VAS)切口愈合满意度评分、温哥华瘢痕评分量表(VSS)评分、病人瘢痕评估量表(PSAS)评分等指标。结果 术后1周,研究组NRS评分为(2.15±0.46)分,对照组为(3.79±0.68)分,研究组疼痛较对照组减轻(P<0.05)。术后2周,研究组病人VAS评分为(1.57±0.63)分,小于对照组的(3.62±0.96)分(P<0.05),研究组切口更加平整,对切口满意度更高。术后6个月,研究组VSS评分为(2.31±1.13)分,对照组为(3.49±1.46)分,研究组PSAS评分为(7.68±1.65)分,小于对照组的(11.33±1.92)分(P<0.05),研究组切口瘢痕更轻,瘢痕情况更优。结论 在较大体表肿物美容缝合切口中使用负压封闭引流技术,能进一步改善切口愈合质量,减轻切口瘢痕,提高病人满意度。

归因分析理论下护理流程再造对骨折负压封闭引流术术后患者的恢复影响

目的 分析归因分析理论下护理流程再造对骨折负压封闭引流术(VSD)术后患者恢复的影响。方法 选取我院2022年2月至2023年3月收治的82例骨折VSD术后患者,随机分为参照组和试验组,每组各41例,参照组采用一般性护理干预,试验组采用归因分析理论下护理流程再造模式,对比两组骨折VSD术后患者二期植皮天数、创面缩小面积、平均骨折愈合时间、住院时间和并发症发生率及两组疼痛评分、焦虑评分改善情况。结果 试验组二期植皮天数、平均骨折愈合时间、住院时间明显短于参照组(P <0.05),创面缩小面积明显大于参照组(P <0.05);试验组骨折患者疼痛评分、焦虑评分改善情况明显优于参照组(P <0.05),并发症发生率低于参照组(P <0.05)。结论 归因分析理论下护理流程再造对骨折VSD术后患者恢复具有良好的应用效果,更有利于缩短患者恢复时间,改善患者疼痛程度和焦虑心理,减少并发症发生。

自体富血小板血浆联合负压封闭引流对糖尿病足溃疡患者创面愈合情况的影响

目的探究自体富血小板血浆联合负压封闭引流对糖尿病足溃疡患者创面愈合情况的影响。方法选取2018年1月至2020年12月大连大学附属中山医院收治的100例Wagner 2~4级糖尿病足溃疡患者作为研究对象,使用抽签法分为对照组与研究组,每组50例。对照组采用常规方案治疗,研究组采用自体富血小板血浆联合负压封闭引流治疗。比较两组临床疗效、瘙痒评分、疼痛评分[数字评分法(NRS)]、肉芽组织血管生成因子[碱性成纤维细胞生长因子(bFCF)、表皮生长因子(EGF)、血管内皮生长因子(VEGF)]水平、临床指标、血糖指标[空腹血糖(FPG)、糖化血红蛋白Alc(HbAlc)、餐后2 h血糖(2 h PBG)]、胰岛素水平[空腹胰岛素(FIns)、稳态模型评估-胰岛素抵抗指数(HOMA-IR)]。结果研究组治疗总有效率为98.00%,高于对照组的80.00%,差异有统计学意义(P<0.05)。治疗后,两组瘙痒评分、NRS评分均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组bFCF、EGF、VEGF水平均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组创面愈合时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。治疗后,两组FPG、HbAlc、2 h PBG、HOMA-IR水平均低于治疗前,FIns水平均高于治疗前,且研究组FPG、HbAlc、2 h PBG、HOMA-IR水平均低于对照组,FIns高于对照组,差异有统计学意义(P<0.05)。结论自体富血小板血浆联合负压封闭引流治疗糖尿病足溃疡效果显著,可促进患者创面愈合,改善患者临床症状,值得临床推广应用。

负压封闭引流技术在Ⅲ级暴露犬咬伤创面处理中的应用

目的 探讨负压封闭引流技术(VSD)在Ⅲ级暴露犬咬伤创面的治疗效果。方法 选取2020年1月至2023年12月在郑州大学第五附属医院接受治疗的90例Ⅲ级暴露犬咬伤创面患者,以随机数字表法分为研究组(n=45)与对照组(n=45),研究组采用常规清创结合VSD治疗,对照组采用常规清创、换药治疗,对两组临床相关指标、疼痛程度、各时间段C反应蛋白(CRP)、并发症发生率进行比较。结果 研究组换药次数较对照组少,二期缝合、肿胀消退、创面愈合及住院时间短,差异有统计学意义(P <0.05);研究组换药时疼痛评分较对照组低,差异有统计学意义(P <0.05);两组治疗前、治疗后1 d CRP水平比较差异无统计学意义(P> 0.05),治疗后2 d两组CRP水平均达到最高值,治疗后2~5 d研究组CRP水平低于对照组,差异有统计学意义(P <0.05);随访6个月,研究组并发症发生率(8.89%)低于对照组(24.44%),差异有统计学意义(P <0.05)。结论 Ⅲ级暴露犬咬伤创面应用常规清创结合VSD进行治疗,能够缩短创面愈合时间,减轻患者疼痛,降低创面感染等并发症发生率。

微骨窗骨搬移联合负压封闭引流治疗糖尿病足:双中心回顾性队列研究

目的 评估微骨窗胫骨横向骨搬移(tibial transverse transport, TTT)的疗效,并探讨其与负压封闭引流(vacuum sealing drainage, VSD)联合治疗的潜在益处。方法 回顾分析自2020年7月至2022年12月收治的Wagner分级≥2级的糖尿病足患者资料。依据治疗方案的差异,将患者分为三组:VSD治疗(VSD组)、微骨窗TTT治疗(TTT组)以及微骨窗TTT联合VSD治疗(联合组)。进行为期1年的随访。记录并比较三组患者的一般资料、术前及术后3个月的溃疡面积、踝肱指数、疼痛目测类比评分,以及术后1年内溃疡复发、手术并发症以及截肢情况。结果 共纳入VSD组患者43例,TTT组43例,联合组42例。三组患者的基线资料差异无统计学意义(P> 0.05)。与TTT组相比,VSD组患者的溃疡愈合时间更长,术后3个月时患者的疼痛评分更高,踝肱指数更低(P <0.05),溃疡面积更大(P=0.029),1年溃疡复发率更高(P=0.021)。与TTT组相比,联合组患者的溃疡愈合时间更短(P=0.046)。术后3个月时溃疡面积(P=0.362)、疼痛评分(P=0.932)、踝肱指数(P=0.671)以及1年溃疡复发率(P=0.710)差异均无统计学意义。结论 微骨窗TTT在促进溃疡愈合,缓解疼痛,改善下肢血运方面的效果明显优于VSD。在应用微骨窗TTT的基础上加用VSD可以进一步缩短伤口愈合时间,降低患者和医护的创面护理负担。