Ｔｏ ｆｉｎｄ ｏｕｔ ｔｈｅ ａｐｐｒｏｐｒｉａｔｅ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｆｏｒ ａｂｄｏｍｉｎａｌ ｄｒａｉｎａｇｅ ａｎｄ ａｐｐｌｙ ｉｔ ｔｏ ｔｈｅ ｐｏｓｔｏｐｅｒａｔｉｖｅ ａｂｄｏｍｉｎａｌ ｄｒａｉｎａｇｅ ｏｆ ｐａｔｉｅｎｔ ｗｉｔｈ ａｃｕｔｅ ｐａｎｃｒｅａｔｉｔｉｓ ａｒｅ ｒｅｐｏｒｔｅｄ．Ａｂｄｏｍｉｎａｌ ｔｕｂｅ ｗａｓ ｉｎｓｅｒｔｅｄ ｔｏ ｒａｂｂｉｔ ｆｏｒ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｄｒａｉｎａｇｅ ｍｏｎｉｔｏｒｉｎｇ ａｎｄ ａｎｏｔｈｅｒ ｔｕｂｅ ｗａｓ ｃｕｓｅｒｔｅｄ ｉｎｔｏ ｔｈｅ ａｂｄｏｍｅｎ ｆｏｒ ｃｏｎｔｉｎｕｏｕｓ ｎｏｒｍａｌ ｓａｌｉｎｅ ｉｎｓｔｉｌｌａｔｉｏｎ．Ｔｈｅ ｒｅｃｏｌｌｅｃｔｉｏｎｓ ｏｆ ｄｒａｉｎａｇｅ ｆｌｕｉｄ ｕｎｄｅｒ ｄｉｆｆｅｒｅｎｔ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｗｅｒｅ ｍｅａｓｕｒｅｄ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｆｌｕｉｄ ｄｅｐｌｅｔｉｏｎ ｒａｔｅ（７０％）ｏｆ ｔｈｅ ｌｏｗ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｇｒｏｕｐ（１．５ ｋＰａ）ｗａｓ ｈｉｇｅｈｅｒ ｔｈａｎ ｔｈａｔ ｏｔｈｅｒ ｉｎ ３ ｇｒｏｕｐｓ（ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ０ ｋＰａ，５ ｋＰａ ａｎｄ １５ ｋＰａ）（Ｐ＜０．０１）．Ｗｉｔｈ ｔｈｉｓ ｃｏｎｔｉｎｕｏｕｓ ｌｏｗ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｄｒａｉｎａｇｅ ｉｎ ２０ ｐａｔｉｅｎｔｓ ａｆｔｅｒ ｓｅｖｅｒｅ ｐａｎｃｒｅａｔｉｔｉｓ ｏｐｅｒａｔｉｏｎ，ｗｅ ｆｏｕｎｄ ｔｈａｔ ｔｈｉｓ ｍｅｔｈｏｄ ｈａｖｅ ｍｏｒｅ ａｄｖａｎｔａｇｅｓ ｏｆ ｒｅｄｕｃｉｎｇ ｃｏｍｐｌｉｃａｔｉｏｎ，ｐｒｏｍｏｔｉｎｇ ｒｅｃｏｖｅｒｙ ａｎｄ ｒｅｄｕｃｉｎｇ ｄｅａｔｈ ｒａｔｅ．
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.
目的 探讨可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面的临床效果及护理要点。 方法 对2008年5月－2011年5月收治的106例皮肤缺损伴感染创面患者，采用间歇负压引流治疗3～10 d，负压值设为50～120 mm Hg（1 mm Hg=0.133 kPa），创面达到Ⅱ期植皮条件时，采用大张、网状或邮票状皮片覆盖创面，继续采用持续负压引流治疗3～12 d，负压值设为50～60 mm Hg，同时进行患者心理和可调节负压引流技术创面等护理。 结果 56例大张皮片植皮中，2例皮片出现0.5 cm×1 cm～0.8 cm×1.2 cm皮片坏死；21例邮票状植皮者，1例出现皮片移动皱缩。除5例骨外露，先通过植皮创面缩小后行皮瓣转移，101例创面愈合时间7～25 d，平均14 d，无因所植皮片未成活需再次植皮和因感染死亡或截肢。 结论 可调节负压引流技术结合植皮治疗皮肤缺损伴感染创面，可有效控制感染，减轻患者换药痛苦，减少医务人员换药和护理工作量，加快植皮创面愈合，缩短创面治愈时间。
Objective Gunshot wound spreads to the surrounding tissues and organs, it is difficult to debride and easy to infect. The conventional treatment is thorough, extensive debridement, fully open drainage, which often causes normal tissue damage and compl ications. To evaluate the effectiveness of vacuum seal ing drainage (VSD) treating thepenetrating wound in porcine extremity by MRI and pathological methods so as to provide theoretical basis for future cl inical use. Methods Eight healthy adult pigs, weighing (45 ± 5) kg, were selected. Eight pairs of hind l imb penetrating wounds (16 wounds) were made by using Chinese-made 95-type rifle at 25 meters distance, which were randomly divided into experimental group (left side, n=8) and the control group (right side, n=8). After debriding and disinfecting the penetrating wounds at 6 hours after injury, wounds were treated with VSD in experimental group. The ball istics exports of the wounds were covered with single-layer gauze and imports were directly sutured and covered with sterile gauze in control group. The trajectory and the general condition of the adjacent skin were observed. MRI and histological observation were taken at 5, 24, 48, and 72 hours after injury, bacterial counting analysis was done at 0, 12, 24, 48, and 72 hours after injury. Results The aperture of the trajectory exit and entry were (5.00 ± 2.50) cm and (0.30 ± 0.15) cm immediately after injury. The wound surface was clean, rosy without leakage and swell ing after 72 hours in experimental group; wound and adjacent tissue were swell ing obviously, pus, muscle necrosis and exfol iative tissue was observed, and deep defect cavity at the trajectory exit could be seen in control group. MRI showed that pairs of l inear low signal in T1WI and T2WI was seen in trajector of experimental group at 5 hours after injury, and signal in T1WI gradually increased at disrupted area and tissue deformation area at 24, 48, and 72 hours; in control group, low signal in T1WI was observed at 5 hours after injury, and signal in T2WI gradually increased and a clear boundari between edema and surrounding tissue, and the increase of signal in T1WI was not obvious at 24, 48, and 72 hours. The histological observation showed that wound was dominated by effusion at 5 hours after injury, granulation tissue gradually increased, muscle tissue dissolved and inflammatory cell infiltration was not obvious at 24, 48, and 72 hours in experimental group; in control group, the gradual dissolution of muscle fibers and inflammatory cell infiltration were observed at 5, 24, and 48 hours, muscle tissue became swell ing, dissolving and degeneration and a large number of inflammatory cell infiltration gathered into the bacteria group at 72 hours. There was no significant difference in the number of bacteria per gram of tissue (P gt; 0.05) between experimental group and control group at 0 hour after injury; the numbers of bacteria in control group were significantly higher than those in experimental group at 12, 24, 48, and 72 hours (P lt; 0.05). Conclusion MRI combined with pathology show diagnostic meaning in treatment of gunshot wound with VSD. MRI can accurately reflect the scope of l imb gunshot wound 72 hours after injury. VSD may be an approach to delay infective time, shorten wound heal ing time, and promote the growth of healthy granulation tissue.
ObjectiveTo investigate the clinical characteristics of motorcycle spoke heel injury and the effectiveness of sequential therapy of vacuum sealing drainage (VSD) and pedicled flap transplantation for treating motorcycle spoke heel injury in children. MethodsBetween January 2010 and January 2014, 15 children (aged from 3 to 8 years, 5.7 years on average) with motorcycle spoke heel injury received sequential therapy of VSD and pedicled flap transplantation. The interval from injury to admission was 3-7 days, with an average of 4.9 days. The locations were the heel in 8 cases, the heel and lateral malleolus in 2 cases, and the medial malleolus and medial heel in 4 cases, and the medial and lateral malleolus and heel in 1 case. The patients had different degrees of defects of the skin, tendon, and bone. The skin defect size ranged from 3 cm×3 cm to 13 cm×6 cm. VSD was applied for twice in 13 cases and three times in 2 cases. Reversed flow sural flap was applied in 8 cases, lateral supramalleolar flap in 2 cases, medial supramalleolar perforator-based flaps in 4 cases, and posterior tibial artery flap in 1 case. Eight pedicled flaps with neuroanastomosis were selected according to the wound characteristics. The flap size ranged from 4 cm×4 cm to 14 cm×7 cm. ResultsOf 15 cases, 13 flaps survived well except that two had partial skin necrosis at the distal site. Primary healing was obtained, and skin graft at donor site survived. The patients were followed up 9-21 months (mean, 13 months). Mild and moderate bulky flaps were observed in 9 cases and 6 cases respectively. Of 15 cases, 13 could walk with weight loading, and 2 had slight limping. Superficial sensation recovered to S3 in 8 patients undergoing neuroanastomosis, and recovered to S2 in 7 patients not undergoing neuroanastomosis at 6 months after operation. According to AOFAS evaluation system for Ankle-Hindfoot, the results were excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100% at 8 months after operation. ConclusionThe main characteristic of motorcycle spoke heel injury lies in a combination of high energy damage and thermal damage. Sequential therapy of VSD and pedicled flap transplantation can be regarded as a reliable option to obtain good outcome of wound healing and satisfactory functional recovery for the management of motorcycle spoke heel injury.
【摘要】 目的 探讨封闭负压引流（vacuum sealing drainage，VSD）装置用于全厚皮移植术后加压固定对全厚皮片移植成活的影响。 方法 新西兰大白兔24只，在脊柱两侧2个术区建立全厚皮片移植模型。每只兔2个术区分别采用VSD（A组）、传统缝合打包加压包扎（B组），做自身对照。第3、5、7天各随机处死8只兔，观察皮片成活情况，做移植皮片中央及边缘（指打包固定的缝线处）的外观质量评价（由1名研究者做主观评价），计算皮片成活率，并在移植皮片上取材，HE染色处理后，应用光学显微镜观察组织形态学特征。采用免疫组织化学检测各组创面血管内皮生长因子（vascular endothelial growth factor，VEGF）表达情况。 结果 两组比较，移植皮片边缘的外观质量评价显著提高（Plt;0.05），皮片中央差异无统计学意义（Pgt;0.05）；皮片移植成活率差异无统计学意义（Pgt;0.05）。HE染色结果显示，A组较B组皮片边缘的细胞层次清晰、结构完整，皮片中央无差异。免疫组织化学检测显示，A组皮片边缘VEGF阳性染色部位的累积吸光度值显著高于B组（Plt;0.05），皮片中央差异无统计学意义（Pgt;0.05）。 结论 VSD用于全厚皮移植术后加压固定可提高皮片边缘的外观质量，促进创面修复和血管生成，可能减轻边缘瘢痕增生。【Abstract】 Objective To explore the influence of vacuum sealing drainage (VSD) on compression bandage of full-thickness skin grafting. Methods A model of full-thickness skin grafting in 2 operation zones was established in the two sides of spinal column of 24 New Zealand white rabbits. The wounds were deal with by VSD (group A) and conventional suture and compression bandage (group B) randomly. About 3, 5, and 7 days after operation, the assessment of the center and edge area (suture area) of skin grafting was performed by a single observer blinded to the randomization. The survival rate was calculated. Samples were selected from skin grafting and observed under a light microscope after HE staining. The expression of vascular endothelial growth factor (VEGF) was detected by immunohistochemistry method. Results The assessment of the edge area of skin grafting in group A was significantly better than that in group B (Plt;0.05); the difference in the center area was not significant (Pgt;0.05). HE staining showed that in the edge area of skin grafting, the cell layer and structure were better in group A than that in group B, the difference in the center area was not significant (Pgt;0.05). Immunohistochemistry method showed that in the edge area of skin grafting, integrated optical density of VEGF was significantly higher in group A than in group B (Plt;0.05), it was not significantly in the center area (Pgt;0.05). Conclusions VSD utilized on compression bandage of full-thickness skin grafting can significantly improve the qualitative appearance of grafting, promote wound healing and vascularization. VSD may possibly reduce scar hyperplasia.
To investigate the method of using vacuum seal ing drainage (VSD) technique to repair the wound of the injured in Wenchuan earthquake and its therapeutic effect. Methods From May 12, 2008 to June 12, 2008, 52 injured persons (83 wounds) were treated, including 27 males and 25 females aged 11-83 years old (average 42 years old). There were 22 cases of crush injury, 9 cases of contusion and laceration injury, 17 cases of compression injury receiving incision decompression of fascia compartment and 4 cases of open amputation. And 37 wounds were on the leg, 13 woundson the thigh, 17 wounds on the forearm, 11 wounds on the upper arm and 5 wounds on the trunk. The wound ranged from3 cm × 2 cm to 30 cm × 15 cm, and the time from injury to undergoing VSD treatment was 12 hours-18 days. After complete debridement, the wound was covered by VSD dressing, and antibiotics were given according to the result of drug sensitive test. When wound infection was under control and granulation tissues grew well, the method of either direct suture or skin grafting or flap transposition was used to repair the wounds. Results In 21 cases (40.4%), wound secretion smear was positive, and multiple species of bacteria were detected, such as staphylococcus aureus, escherichia col i, proteus and klebsiella pneumoniae. After initial operation, 7 injured persons were transferred to the hospital outside of Sichuan province for further treatment. VSD treatment was performed on 33 cases (45 wounds) once, 6 cases (10 wounds) twice, 2 cases (3 wounds) three times and 1 case (1 wound) four times, resulting in the control of wound infection and the growth of granulation tissue. Then the wounds were repaired by either direct suture or skin grafting or flap transposition. Three cases (4 wounds) underwent VSD treatment ten times, leading to the control of infection and the stabil ity of condition. Conclusion VSD treatment can cover the wound promptly, el iminate contamination, prevent secondary infection and benefit late-stage wound repair. During the process of treatment, no medical necessity for frequent change of dressing can rel ieve the pain suffered by the injured and decrease theworkload of medical stuff, thus facil itating the rescue work.