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封闭式吸痰管在气管切开患者中的应用与护理

【摘要】 目的 总结封闭式吸痰管在气管切开患者应用过程中的价值。 方法 2008年7月-2009年7月对60例气管切开患者，使用封闭式吸痰管进行吸附痰液，并根据临床观察情况予以护理。 结果 封闭式吸痰管有利于减轻患者肺部并发症、降低吸痰所引起的血液动力学的改变、防止交叉感染，减轻了护士工作量及提高了护理质量。 结论 封闭式吸痰管适用于气管切开患者的临床应用与推广。

持续封闭冲洗负压引流在深部窦道感染伤口中的应用

目的　总结持续封闭冲洗负压引流治疗术在后深部窦道伤口感染治疗中的效果。 方法　回顾性分析2010年10月－2011年10月收治的7例深部窦道伤口感染患者的临床资料，总结采用持续封闭冲洗负压引流进行伤口治疗的方法及疗效。 结果　7例患者经过3～5 d持续封闭冲洗负压引流治疗，拔管后2～3 d伤口闭合，上皮覆盖，伤口全部愈合。 结论　采用持续封闭冲洗负压引流治疗深部窦道伤口感染，方法简便，费用低廉，可有效促进伤口愈合。

Reconstruction of ankle and foot with combination of free perforator flaps and skin graft

Objective To evaluate the clinical outcomes of free perforator flaps combined with skin graft for reconstruction of ankle and foot soft tissue defects. Methods Between June 2014 and October 2015, 20 cases of ankle and foot soft tissue defects were treated. There were 16 males and 4 females, aged from 19 to 61 years (mean, 43.3 years). Injury was caused by traffic accident in 7 cases, by crashing in 9 cases, and machine twist in 4 cases. The locations were the ankle in 6 cases, the heel in 3 cases, the dorsum pedis in 4 cases, and the plantar forefoot in 7 cases of avulsion injury after toes amputation. The size of wound ranged from 15 cm×10 cm to 27 cm×18 cm. The time from injury to treatment was from 11 to 52 days (mean, 27 days). The anterolateral thigh perforator flap was used in 11 cases, thoracodorsal antery perforator flap in 3 cases, medial sural artery perforator flap in 4 cases, deep inferior epigastric perforator flap in 1 case, and anteromedial thigh perforator flap in 1 case, including 5 chimeric perforator flaps, 5 polyfoliate perforator flaps, 3 flow-through perforator flaps, and 3 conjoined perforator flaps. The size of the perforator flap ranged from 10.0 cm×6.5 cm to 36.0 cm×8.0 cm, the size of skin graft from 5 cm×3 cm to 18 cm×12 cm. Results Venous crisis occurred in 2 flaps which survived after symptomatic treatment; 18 flaps survived successfully and skin grafting healed well. The follow-up time ranged 4-18 months (mean, 8.3 months). The flaps had good appearance, texture and color, without infection. The patients could walk normally and do daily activities. Only linear scars were observed at the donor sites. Conclusion Free perforator flap can be used to reconstruct defects in the ankle and foot, especially in the weight-bearing area of the plantar forefoot. A combination of free perforator flap and skin graft is ideal in reconstruction of great soft tissue defects in the ankle and foot.

REPAIR OF SKIN AND SOFT TISSUE DEFECTS OF LOWER LIMBS WITH VACUUM SEALING DRAINAGE COMBINED WITH FLAPS

Objective To explore the feasibil ity, indications, and effects of vacuum seal ing drainage (VSD) combined with flaps for repairing skin and soft tissue defects of lower l imbs. Methods From June 2006 to November 2009, 15 patients with skin and soft tissue defects of lower l imbs were treated with VSD combined with flaps (VSD group, n=5) and only flaps (non-VSD group, n=10). In VSD group, there were 3 males and 2 females with an average age of 46 years (range, 32-69 years), including 3 cases of traffic accident injury, 1 case of skin necrosis after amputation, and 1 case of plate exposureafter operation. The locations were lower leg in 1 case, ankle in 2 cases, dorsum of foot in 1 case, and forefoot in 1 case. The defect size ranged from 6.5 cm × 6.0 cm to 23.0 cm × 17.0 cm. The disease course ranged from 2 hours to 2 months. In non- VSD group, there were 5 males and 5 females with an average age of 50 years (range, 23-58 years), including 6 cases of traffic accident injury, 1 case of crush injury in earthquake, 1 case of osteomyel itis, and 2 cases of plate exposure after operation. The locations were lower leg in 1 case, ankle in 3 cases, forefeet and dorsum of feet in 4 cases, and heel in 2 cases. The defect size ranged from 4 cm × 4 cm to 20 cm × 12 cm. The disease course ranged from 1 hour to 2 months. There was no significant difference in general data between 2 groups (P gt; 0.05). Results In VSD group, the preoperative hospital ization days, postoperative hospital ization days, and total hospital ization days were (11.8 ± 9.5), (35.4 ± 28.3), and (47.2 ± 35.8) days, respectively; the size of flap was (232.8 ± 142.0) cm2; and the infection rate after VSD-use was 0. In non-VSD group, the preoperative hospital ization days, postoperative hospital ization days, and total hospital ization days were (25.8 ± 12.4), (33.9 ± 28.1), and (59.7 ± 32.4) days, respectively; the size of flap was (97.3 ± 93.6) cm2; and the infection rate after 8 to 14 days of regular therapy was 80%. There were significant differences in the preoperative hospital ization days and the size of flap between 2 groups (P lt; 0.05). All flaps were al ive except 3 partial necrosis (1 case in VSD group, 2 cases in non-VSD group). The 3 flaps healed by skin grafting and suturing. The donor sites healed by first intention. All patients were followed up 5-41 months (22.1 months on average). All flaps were good in color, texture, and wear abil ity. Conclusion It is effective to apply VSD combined with proper flap to repair skin and soft tissue defects of lower l imbs, which can cut down infection rate, improve blood supply, shorten the preoperative hospital ization days, and facil itate heal ing, but whether it can shorten the postoperative hospital ization days and total hospital ization days need further research.

Several Problems in Catheter-Related Bloodstream Infection

TREATMENT OF TIBIAL TRAUMATIC OSTEOMYELITIS WITH VACUUM SEALING DRAINAGE COMBINED WITH OPEN BONE GRAFT

ObjectiveTo explore the effectiveness of vacuum sealing drainage (VSD) combined with open bone graft for tibial traumatic osteomyelitis. MethodsBetween June 2007 and December 2012, 23 cases of tibial traumatic osteomyelitis were treated, including 15 males and 8 females with an average age of 32.5 years (range, 22-48 years). The time from injury to admission was 7-18 months (mean, 8.6 months). There was local bone scarring in 15 cases, the size ranged from 8 cm×4 cm to 15 cm×8 cm. The CT multi-planar reconstruction was carried out preoperatively. Eleven cases had segmental bone sclerosis with a length of 1.5 to 3.8 cm (mean, 2.6 cm); 12 cases had partial bone sclerosis with a range of 1/3 to 2/3 of the bone diameter. On the basis of complete debridement, infection was controlled by VSD; bone defect was repaired by VSD combined with open bone graft. After there was fresh granulation tissue, the wound was repaired by free skin graft or local skin flap transfer. ResultsNail infection occurred in 2 cases, which was cured after the use of antibiotics. The wound healed at the first stage after repairing. All cases were followed up 10-18 months (mean, 13.5 months). In 11 cases of segmental bone sclerosis, the infection control time was 7-14 days (mean, 8.8 days); the bone healing time was 32-40 weeks (mean, 34.4 weeks); and the frequency of VSD was 3-6 times (mean, 4.5 times). In 12 cases of partial bone sclerosis, the infection control time was 7-12 days (mean, 8.3 days); the bone healing time was 24-31 weeks (mean, 27.3 weeks); and the frequency of VSD was 3-5 times (mean, 3.6 times). Infection recurred in 1 case, and the patient gave up the therapy. No infection recurrence was observed in the other patients. ConclusionThe VSD combined with open bone graft is an effective method for the treatment of tibial traumatic osteomyelitis.

封闭式负压引流技术在下肢毁损伤中的应用

目的 总结封闭式负压引流（vacuum sealing drainage，VSD）技术在下肢毁损伤早期治疗中的应用效果。 方法 2008 年7 月－ 12 月，收治13 例下肢毁损伤患者。男10 例，女3 例；年龄4 ～ 40 岁，中位年龄37.3 岁。致伤原因：机器损伤5 例，交通事故伤8 例。软组织缺损范围35 cm × 10 cm ～ 40 cm × 20 cm。下肢损伤程度采用四肢损伤分级标准评分平均10.7 分。伴膝关节周围骨折9 例，股骨中段骨折2 例，胫、腓骨中段骨折2 例。受伤至入院时间为6 ～ 20 h，平均10 h。采用VSD 治疗后，4 例保肢失败，截肢术后创面直接缝合；9 例保肢成功，其中8 例游离植皮修复，1 例采用腓肠神经营养血管蒂皮瓣修复，供区游离植皮修复。 结果 患者应用VSD 治疗 1 ～ 3 次。术后植皮及皮瓣均顺利成活，创面均Ⅰ期愈合。供区切口Ⅰ期愈合，植皮成活。患者均获随访，随访时间10 ～ 17 个月，平均14 个月。植皮创面均愈合良好，未出现破溃、感染。皮瓣色泽正常，无臃肿。X 线片检查示骨折均愈合，愈合时间7 ～ 12 个月。 结 论 VSD 技术可降低下肢毁损伤创面感染几率，促进创面内肉芽生长，为植皮及皮瓣移位修复提供良好的组织条件。

Clinical Observation of Sequential Vacuum-assisted Closure and Free Lateral Thigh Muscle Flaps for Soft Tissue Defects in Extremities

目的　探讨游离股外侧肌瓣联合封闭式负压吸引技术（VSD）修复四肢软组织缺损的临床效果。 方法　2009年6月－2011年6月，对25例四肢软组织缺损患者采用游离股外侧肌瓣联合VSD治疗对创面经彻底清创后，先行VSD覆盖，5～9 d后去除VSD负压膜。再次清创受区，切取股外侧肌瓣修复创面，处理血管危象，二期植皮。 结果　25例均获得随访，时间6～12个月。经负压封闭引流后，局部创面无明显感染，肌腱及骨外露区周围肉芽组织生长良好。出现血管危象3例，经及时处理后3例肌瓣均恢复血液循环。感染控制良好，无窦道形成，患肢功能恢复满意。 结论　对于严重创伤后的肢体软组织缺损，经彻底清创后，应用封闭式负压引流及游离股外侧肌瓣修复，可明显缩短治疗周期，提高手术成功率，最大限度恢复患肢的功能。

封闭式负压引流技术联合腓肠神经营养血管逆行岛状皮瓣修复下肢皮肤软组织大面积缺损

目的 总结封闭式负压引流技术（vacuum sealing drainage，VSD）联合腓肠神经营养血管逆行岛状皮瓣修复下肢皮肤软组织大面积缺损的临床疗效。 方法 2008 年1 月－ 7 月，收治25 例下肢皮肤软组织大面积缺损患者。男13 例，女12 例；年龄15 ～ 54 岁，平均34.4 岁。机器绞伤15 例，交通伤9 例，爆炸伤1 例。损伤部位：小腿中下段8 例，踝部4 例，足背部5 例，足跟部及跟腱部8 例。创面范围为9 cm × 4 cm ～ 12 cm × 9 cm。受伤至手术时间为1 ～ 12 h，平均6.2 h。先行VSD 治疗待创面肉芽组织新鲜、感染控制后，采用大小为10 cm × 7 cm ～ 13 cm × 11 cm 的腓肠神经营养血管逆行岛状皮瓣修复创面。供区直接缝合或游离植皮修复。 结果 皮瓣修复术后2 例出现皮瓣切口远端皮缘坏死，1 例静脉危象，经对症处理后成活；其余皮瓣均顺利成活，创面Ⅰ期愈合。供区切口均Ⅰ期愈合，游离植皮成活。25 例均获随访，随访时间11 ～ 14 个月，平均13 个月。皮瓣与周围皮肤色泽相似，无臃肿，质地佳；皮瓣受力处无破溃。 结论 VSD 治疗能降低创面感染几率，为皮瓣修复提供良好组织床。腓肠神经营养血管逆行岛状皮瓣是修复下肢及远端足跟部皮肤软组织缺损的有效方法之一。

中厚皮片和真皮下血管网皮瓣联合封闭式负压引流技术修复四肢大面积皮肤撕脱伤

目的 总结中厚皮片和真皮下血管网皮瓣联合封闭式负压引流技术（vacuum sealing drainage，VSD）修复四肢大面积皮肤撕脱伤的疗效。 方法 2008 年1 月－ 2009 年2 月，采用中厚皮片和真皮下血管网皮瓣联合VSD修复12 例四肢大面积皮肤撕脱伤。男9 例，女3 例；年龄17 ～ 65 岁。交通伤7 例，机器轧伤3 例，其他伤2 例。损伤部位：上肢2 例，小腿8 例，足踝及足背2 例。创面范围为9 cm × 7 cm ～ 38 cm × 24 cm。受伤至入院时间3 ～ 11 h，平均 5 h。 结果 10 例经5 ～ 7 d VSD 治疗后，95% 以上撕脱皮肤成活；2 例创面缩小50% 及60%，直接拉拢缝合后于大腿外侧取中厚皮片修复残余创面，同时联合VSD 治疗5 ～ 7 d 后移植皮片成活。患者术后均获随访，随访时间6 ～ 12 个月。创面无明显瘢痕增生，关节功能恢复满意。 结论 中厚皮片和真皮下血管网皮瓣联合VSD 修复四肢大面积皮肤撕脱伤具有早期封闭创面、减轻水肿、降低感染几率、促进撕脱皮肤成活等优点。