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.

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.

Pie-crusting技术结合持续封闭式负压引流治疗Morel-Lavallée损伤

目的:探讨应用Pie-Crusting技术联合持续封闭式负压引流(vacuum sealing drainage,VSD)治疗Morel-Lavallée损伤的疗效。方法:选取2011年1月-2015年12月收治的15例Morel-Lavallée损伤的患者。应用Pie-Crusting技术联合持续封闭式负压引流(vacuum sealing drainage,VSD)治疗15例Morel-Lavallée损伤。结果:15例患者术后5~7 d去除封闭式负压引流,损伤部位的皮肤无缺血坏死。引流量390~1750 m L,平均720 m L,患者均无感染迹象。所有患者术后获得随访6~27个月,平均15.2个月,无复发及深部感染,皮肤表面无明显疤痕组织增生。结论:Pie-Crusting技术联合VSD治疗MorelLavallée损伤安全、有效,为骨折早期手术提供必要软组织条件。

Multidisciplinary treatment of a patient with necrotizing fasciitis caused by Staphylococcus aureus: A case report

BACKGROUND Necrotizing fasciitis is a severe bacterial skin infection that spreads quickly and is characterized by extensive necrosis of the deep and superficial fascia resulting in the devascularization and necrosis of associated tissues.Because of high morbidity and mortality,accurate diagnosis and early treatment with adequate antibiotics and surgical intervention are vital.And timely identification and treatment of complications are necessary to improve survival of patient.CASE SUMMARY We report a case of necrotizing fasciitis caused by Staphylococcus aureus in a patient using high doses of glucocorticoid and suffering from secondary diabetes mellitus.He was admitted to our hospital due to redness and oedema of the lower limbs.After admission,necrotizing fasciitis caused by Staphylococcus aureus was considered,and he was discharged after B-ultrasound drainage and multiple surgical operations.In the process of treatment,multiple organ functions were damaged,but with the help of multi-disciplinary treatment,the patient got better finally.CONCLUSION The key to successful management of necrotizing fasciitis is an early and accurate diagnosis.The method of using vacuum sealing drainage in postoperative patients can keep the wound dry and clean,reduce infection rate,and promote wound healing.Interdisciplinary collaboration is a vital prerequisite for successful treatment.

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。

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。

负压封闭吸引对结核术后难愈性创面中相关因子表达及预后的研究

目的探讨应用负压封闭引流(VSD)治疗结核术后出现难愈性创面的患者,研究其相关因子的表达及预后。方法选取2016年1月-2022年5月我院胸外科结核术后出现伤口愈合不良的患者76例,按数字表格法分为观察组和对照组,每组38例,观察组接受VSD治疗,对照组接受外科换药治疗,在治疗前和治疗后第7天用ELISA法测定血清中TNF-α、IL-4、IL-8、IL-10的含量和伤口肉芽组织中TGF-β1、VEGF、HIF-1α的含量及伤口愈合拆线时间。结果比较两组治疗前TNF-α、IL-4、IL-8、IL-10及TGF-β1、VEGF、HIF-1α水平,差异无统计学意义(P>0.05)。治疗后第7天检测,TNF-α、IL-8较治疗前均降低,其中观察组较对照组降低更明显(P<0.05);IL-4、IL-10较治疗前均升高,其中观察组较对照组升高更明显(P<0.05);TGF-β1、VEGF较治疗前均升高,其中观察组较对照组升高更明显(P<0.05);HIF-1α较治疗前均降低,其中观察组较对照组降低更明显(P<0.05)。观察组愈合拆线时间较对照组明显缩短,差异有统计学意义(P<0.05)。结论应用VSD治疗结核术后出现的难愈性创面,可以减轻炎症反应,促进增殖、修复,加速创面愈合。

复合皮移植联合VSD修复碾压伤致肘关节外露

目的:探讨复合皮移植联合负压封闭引流(Vacuum sealing drainage,VSD)在碾压伤伴关节外露创面修复中的临床应用效果及可行性。方法:2020年12月,笔者科室收治1例因左上肢车祸伤致皮肤坏死伴肿胀1 d的患者,入院时查体左上肢肿胀,左前臂、肘部可见约15.0 cm×20.0 cm皮肤坏死,左手感觉功能减退,桡动脉尚可触及,急诊手术探查见肘关节外露、脱位,肱三头肌自肱骨大范围撕脱,尺神经外露、移位,肘关节、尺骨外露范围约3.0 cm×5.0 cm。根据患者病史、临床表现、左上肢X线片及手术探查体征诊断左上肢碾压伤,肘关节外露。应用复合皮移植两步法联合VSD覆盖创面,自体中厚皮片移植修复皮肤缺损。结果:患者左上肢皮肤缺损处愈合良好,术后4个月复查,肘关节屈曲、伸直、旋转功能均恢复良好。结论:对于此例肘关节、骨外露创面,应用复合皮移植后可覆盖骨外露创面,大大降低了手术难度及患者的痛苦,为以后相对小面积骨外露创面的修复提供了新思路。

慢性难治性创口清创减张缝合VSD综合治疗方案临床分析

目的:分析27例通过清创减张缝合封闭式负压引流技术(VSD)综合治疗方案在解决慢性难治性创口术后愈合不良问题中应用的疗效。方法:回顾性分析27例2019年12月-2023年11月我院骨科应用VSD综合治疗方案治疗慢性难治性创口的临床资料,记录患者创面不愈合时间、VSD次数、愈合时间、血红蛋白含量、白蛋白含量,评估VSD综合治疗方案在治疗慢性难治性创口术后愈合不良问题中的作用。结果:共27例不同原因导致大面积或复杂创面不愈合的病人,在经过平均2.1次VSD引流术后采用多层减张缝合闭合创面。在入我科行VSD综合治疗后,创面愈合时间5-56(平均23.2)天,术后随访2-36月,伤口均愈合良好,无复发。结论:清创减张缝合VSD综合治疗方案在治疗慢性难治性创口术后愈合不良问题中有着良好的疗效。