Objective To study the therapeutic effect of combining vacuum seal ing drainage (VSD) with gluteus maximus myocutaneous flap on the repair of soft tissue defect caused by the resection of sacral tumors. Methods From June2007 to June 2008, 6 patients with skin and soft tissue necrosis in the sacrococcygeal region, deep infection, and formation of cavity at 3-6 weeks after sacral tumors resection were treated. There were 4 males and 2 females aged 17-51 years old. The size of skin and soft tissue defects ranged from 15 cm × 11 cm × 6 cm to 20 cm × 18 cm × 7 cm. Every patient underwent VSD treatment for 7-10 days, and the recombinant bovine bFGF was injected into the wound intermittently for 7-14 days (250-300 U/ cm2 once, twice daily). The wound was repaired by either the gluteus maximus myocutaneous flap (5 cases) or the lumbar-gluteus flap (1 case), and those flaps were 9 cm × 9 cm-20 cm × 18 cm in size. The donor site were sutured or repaired with spl itthickness skin graft. Results All the flaps survived uneventfully. The wound healed by first intention in 5 cases, but 1 case suffered from fat l iquefaction 2 weeks after operation and healed after drainage and dressing change. All the donor sites healed by first intention, and all the skin grafts survived uneventfully. All the patients were followed up for 6-10 months, there was no relapse of sacral tumor, and the flaps showed no obvious swell ing with good color and elasticity. Conclusion With fewer compl ications, the combination of VSD and gluteus maximus myocutaneous flap is a safe and rel iable operative method for repairing the skin and soft tissue defects caused by the resection of sacral tumors.
Objective To investigate the cl inical effect of vacuum seal ing drainage (VSD) on late-stage large skin avulsion injury with infection. Methods From May 2007 to August 2008, 9 patients with large-area skin avulsion injury and infection were treated. There were 1 male and 8 females aged 9-52 years old (median 27 years old). All patients suffered from closed skin avulsion injury involving the lower back, buttock, and part of the thigh. The injury area varied from 30 cm × 25 cm to92 cm × 38 cm. The time between injury and hospital admission was 15-23 days. The skin avulsion injury was compl icated with pelvis fracture, urethral injury, anal injury, sacrum exposure, and l imb fractures. The interval between hospital admission and operation was 3-23 hours. Free spl it-thickness skin graft was performed after the focus debridement and three VSD treatments (40-60 kPa). Results After three VSD treatments, no patient had general pyemia and severe local tissue necrosis or infection, the tissue edema in the skin avulsion area was alleviated obviously, and all the wound cavities were closed. All the wounds in the graft site healed after 28-45 days of treatment (average 39 days), and all the donor sites healed. Nine patients were followed up for 4-14 months (average 10 months). The appearance of the reparative area was good, and there was no occurrence of joint dysfunction in the injured area due to scar contracture. Conclusion VSD is effective in treating late-stage large skin avulsion injury with infection.
【摘要】 目的 探讨负压封闭吸引（vacuum sealing drainage，VSD）敷料在创伤性慢性骨髓炎治疗中的作用。 方法 2006年6月-2009年8月收治13例创伤后慢性骨髓炎有较多脓性渗出物患者，其中男9例，女4例；年龄8~56岁，平均34岁。车祸致胫骨开放性骨折9例；腓骨骨折1例；高处坠落致跟骨开放性骨折2例；股骨骨折1例，术后均合并慢性骨髓炎，病程11~35个月。于病灶清除后，先采用VSD治疗，待创面清洁、骨面有肉芽组织形成后，8例直接二期缝合伤口，4例通过带蒂肌皮瓣或皮瓣修复创面，1例采用背阔肌皮瓣游离移植修复创面。 结果 使用VSD平均吸引18 d，更换VSD平均2.1次。创面渗出物逐渐减少，创面面积减小，经二期缝合、皮瓣移植等方法封闭创面。13例患者经6~31个月随访，慢性创伤后骨髓炎均治愈，无复发。 结论 采用VSD治疗创伤性慢性骨髓炎具有引流充分、炎症控制快、创面肉芽组织生长快、骨髓炎复发率低的优点。【Abstract】 Objective To evaluate the clinical efficacy of vacuum sealing drainage (VSD) in managing traumatic chronic osteomyelitis. Methods Between June 2006 and August 2009, 13 patients with a lot of purulent exudates after traumatic chronic osteomyelitis were treated in our hospital. There were nine males and four females with their ages ranged from 8 to 56 years old, averaging at 34. Among these cases of traumatic chronic osteomyelitis, nine occurred after operation for open tibial fractures and one occurred after operation for open fibula fracture caused by traffic accident; two occurred after operation for open calcaneal fracture and one occurred after operation for femur fracture caused by falling. The course of the disease ranged from 11 to 35 months. After the focus of infection was debrided completely, they were treated with VSD. As soon as the wound surface was clear and the bone surface was covered with granulation tissue, eight patients were treated with secondary suture, four were treated with local skin flap transplantation or musculocutaneous flap transplantation, and one was treated with free latissimus dorsi musculo-cutaneous flap. Results The exudates in and the area of the wound were both decreased after VSD procedure on the wound for an average of 18 days and replacing the VSD for an average of 2.1 times. The wound was covered by second suture or flap transplantation. After a follow-up of 6-31 months, all 13 cases of traumatic chronic osteomyelitis were healed with no recurrence. Conclusion Application of VSD in treating traumatic chronic osteomyelitis can drain thoroughly, control inflammation faster, promote granulation tissue, and decrease the rate of recurrence.