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.
Objective To investigate the method and effectiveness of vacuum seal ing drainage (VSD) combined with debridement for treatment of deep infection after hip or knee replacement. Methods Between September 2006 and May 2010, 13 cases of deep infection after joint replacement surgery were treated, including 5 males and 8 females with an average ageof 62.5 years (range, 56-78 years). Infection occurred at 7 days to 1 year and 2 months (median, 14 days) after joint replacement surgery. The time from infection to admission was 8 days to 4 years and 6 months (median, 21 days). Purulent secretion with or without blood were observed in all patients; sinus formed in 5 cases; and unhealing of incision or drainage opening disunion were observed in 8 cases. The size of skin defect at secretion drainage or sinus opening site was 5 mm × 3 mm to 36 mm × 6 mm; the depth of drainage tunnel or sinus was 21-60 mm. The histopathological examination in 11 patients showed acute infection or chronic infection with acute onset in 10 cases, and tuberculosis in 1 case. In 6 cases of secretion culture, Staphylococcus aureus was isolated from 5 cases. After thorough debridement, wound irrigation was performed during the day and VSD during the night in 10 cases. VSD was merely performed in 3 cases. Results In 1 case after revision total hip arthroplasty, the wound bled profusely with VSD, then VSD stopped and associated with compression bandage, VSD proceeded again 3 days later with no heavy bleeding. All the patient were followed up 1 year to 4 years and 5 months (mean, 2 years and 11 months). Infection were controlled 7-75 days (mean, 43 days) after VSD in 10 cases. In these cases, prosthesis were reserved, no recurrent infection was observed, wound were healed, limb function were reserved. VSD was refused in 1 case because of hypersensitive of the pain at the vacuum site, infection control was failed and amputation at the thigh was proceeded. The effect was not evident in 1 case with tuberculosis infection, then the prosthesis was removed and arthrodesis was proceeded followed by complete union. In 1 case, infection was cured with VSD, recurrent infection happened after 9 months, antibiotic-impregnated cement spacer was used at end, and no recurrence was observed 1 year and 4 months later. Conclusion VSD combined with debridement can drainage deep infection sufficiently, promote wound healing, reduce recurrent infection rate, maximize the possibil ity of prosthesis preservation.
ObjectiveTo preliminary explore the effect of decellularized adipose tissue (DAT) combined with vacuum sealing drainage (VSD) on wound inflammation in pigs.MethodsThe DAT was prepared through the process of freeze-thaw, enzymatic digestion, organic solvent extraction, and vacuum freeze-drying. The appearance of DAT was observed before and after freeze-drying. HE staining was used to observe its structure and acellular effect. Eighteen male Bama minipigs were recruited, and four dorsal skin soft tissue wounds in diameter of 4 cm were made on each pig and randomly divided into 4 groups for different treatments. The wounds were treated with DAT combined with VSD in DAT/VSD group, DAT in DAT group, VSD in VSD group, and sterile gauze dressing in control group. HE staining was performed at 3, 7, 10, and 14 days after treatment. Moreover, the expressions of inflammatory factors [interleukin 1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α)], as well as the phenotypes of M1 and M2 macrophage phenotypic markers [inducible nitric oxide synthase (iNOS) and arginase 1 (ARG-1)] were detected by real-time fluorescence quantitative PCR (qRT-PCR). ELISA was used to determine the content of iNOS and ARG-1.ResultsGeneral observation and HE staining showed that DAT obtained in this study had a loose porous structure without cells. The neutrophils of wounds were significantly less in DAT/VSD group than in control group and DAT group (P<0.05) at 3 days after treatment, and the difference was not significant (P>0.05) between DAT/VSD group and VSD group. And the neutrophils were significantly less in DAT/VSD group than in other three groups (P<0.05) at 7, 10, and 14 days. The mRNA expressions of IL-1β, IL-6, TNF-α, and iNOS were significantly lower in DAT/VSD group than in other three groups at 3, 7, 10, and 14 days (P<0.05), while the mRNA expression of ARG-1 was significantly higher in DAT/VSD group than in other three groups (P<0.05). ELISA showed that the content of iNOS was significantly lower in DAT/VSD group than in other three groups at 3, 7, 10, and 14 days (P<0.05), while the content of ARG-1 was significantly higher in DAT/VSD group than in other three groups (P<0.05).ConclusionDAT combined with VSD can significantly reduce inflammatory cell infiltration during wound healing, regulate the expressions of inflammatory factors and macrophage phenotype, and the effect is better than single use of each and conventional dressing change.
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.
目的 探讨自制封闭式负压引流冲洗治疗四肢难愈性创面的护理要点。 方法 对2011年8月－2012年9月收治的38例使用自制封闭式负压引流冲洗+Ⅰ期植皮修复四肢难愈性创面的患者进行护理观察。 结果 34例四肢难愈性创面Ⅰ期成功修复创面，减轻了患者住院期间痛苦，缩短患者治疗时间，住院费用明显下降，4例创面因感染植皮大部分融解，经2次冲洗引流，培养肉芽后再植皮痊愈，无护理并发症发生。 结论 术后患者维持在适应的体位、间歇式冲洗，持续恒定的负压吸引、密切的护理观察和引流管的管理是护理的关键环节。
Objective To investigate the curative effect of facility negative pressure closed drainage on wounds in earthquake. Methods We retrospectively analyzed the data of 35 patients treated by facility negative pressure closed drainage after debridement in earthquake. The same category patients treated by conventional therapy as the control group. Results Time of facility negative pressure closed drainage was 6-12 days, average 7.5±1.8 days. The woundswere all cured. The wounds closure were performed with skin grafting in 24, with secondary suturing in 4, with regionalflap transposition in 5, and with cross leg flap in 2. There were significant differences in time of secondary closure, timesof dressing and the total time of hospitalization between two groups (Plt;0.01). And there was a significant difference incurative effect of skin grafting between two groups (Plt;0.05). Conclusion Facility negative pressure closed drainage on treating wounds in earthquake is a simple, safe method, and has significant curative effect.