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Vacuum Sealing Drainage for Patients with Wound Infection after Cardiac Surgery

Objective　To evaluate outcomes of vacuum sealing drainage（VSD）for the treatment of wound infection　after cardiac surgery.?Methods?We retrospectively analyzed clinical data of 70 patients（with valvular heart disease，congenital heart disease or coronary heart disease）who underwent cardiac surgery via mid-sternotomy and had postoperative wound infection from Jan. 2008 to Jan. 2012 in General Military Hospital of Guangzhou Command. According to different treatment strategy for wound infection, all the patients with wound infection （incision longer than 5 cm） were randomly divided into VSD group （n=35） and control group（n=35） by random number table，while VSD treatment was used for patients in VSD group and routine treatment was used for patients in control group. Treatment outcome，duration of wound infection, duration of antibiotic treatment and treatment cost were compared between the two groups.?Results?There was no in-hospital death in both groups. Wound exudate significantly decreased and fresh granulation tissue grew well in the wound in most VSD group patients after VSD treatment. The cure rate of VSD group was significantly higher than that of control group （94.3% vs. 60.0%，P＜0.05）. Duration of wound infection （12.9±3.4 d vs. 14.8±4.1 d；t=-2.094，P=0.040）and duration of antibiotic treatment （7.0±1.5 d vs. 8.3±1.9 d；t=-2.920，P=0.005） of VSD group were　significantly shorter than those of control group. There was no statistical difference in treatment cost between the two groups. Fifteen patients in VSD group were followed up （42.9%） for 3 months with good wound healing, and 20 patients in VSD group were lost in follow-up.?Conclusion?VSD is effective for the treatment of wound infection after cardiac surgery with shortened treatment duration and similar treatment cost compared with routine treatment.

Study on the Role of the Coated VICRYL Plus Antibacterial Suture in the Prevention of Infection of Appendectomy Incision

摘要:目的: 探討在闌尾切除術中應用抗菌薇喬縫線以減少闌尾切口感染的可能性。 方法 : 將我院2007年4月至2009年3月所有闌尾切除術病例1425例隨機分為抗菌薇喬縫線組和絲線組,比較其切口感染發生率。 結果 : 統計中按闌尾未穿孔、闌尾穿孔以及總計分別計算切口感染率,在抗菌微喬線組感染率分別為017%、072%、028%,絲線組分別為154%、781%、267%,兩組間分別予以X2檢驗,其〖WTBX〗P 值均小于001,具有顯著性差異。 結論 : 縫線是輔助產生切口感染的一個危險因素,在闌尾切除術中使用抗菌薇喬縫線可以顯著降低切口感染率。Abstract: Objective: To investigate the application of Coated VICRYL Plus Antibacterial suture in order to reduce the possibility of infection of appendectomy incision. Methods : Hospital from April 2007 to March 2009 appendectomy patients in all 1425 cases were randomly divided into Coated VICRYL Plus Antibacterial suture group and silk group,compared to the incidence of incision infection. Results : The statistics are not in accordance with perforated appendicitis, perforated appendicitis, as well as calculation of the total, respectively, incision infection, the infection rate in the Coated VICRYL Plus Antibacterial suture group were 017%, 072%, 028%, silk group were 154%, 781%, 267% between the two groups separately X2 test, the P value of less than 001, with a significant difference. Conclusion : The suture is to assist the incision produced a risk factor for infection in appendectomy,Coated VICRYL Plus Antibacterial suture can be used in a significant reduction in incision infection rates.

Clinical Observation of Adjustable Negative Pressure Wound Therapy plus Regional Oxygen Therapy in the Treatment of Abdomen Incision Infection Wound

目的　觀察可調節負壓引流技術聯合局部氧療治療腹部切口感染創面的臨床效果。 方法　對2009年5月－2012年9月28例腹部切口感染創面患者使用可調節負壓引流技術聯合局部氧療治療，創口內填入負壓吸附墊，持續輸氧0.5～1 L/min，可調節負壓采用連續工作模式，使密閉創面保持60～120 mm Hg（1 mm Hg=0.133 kPa）的負壓狀態，3～7 d更換負壓吸附墊和引流管。 結果　28例切口創面感染得到控制。8例經一次治療創面愈合，15例經2～4次治療創面愈合，2例行Ⅱ期縫合，3例患者對貼膜過敏，治療一次后改為換藥治療。28例患者創面愈合時間4～28 d，平均14 d，隨訪1～18個月無切口裂開，7例有凹陷瘢痕，余瘢痕平整。 結論　可調節負壓引流技術聯合局部氧療治療腹部切口感染創面，具有操作簡便、安全可靠、療效明顯的優點，可加快創面愈合，縮短住院時間，提高切口的愈合質量，減輕患者痛苦及醫務人員的工作量。

醫護合作處理腎移植術后造口旁復雜傷口一例

Risk Factors for Incision Infection in Gastrointestinal Surgery and Its Preventive Measures

目的　分析胃腸外科手術切口感染的影響因素，為醫院感染的防治提供理論依據。 方法　回顧性分析2010年12月－2012年12月764例行胃腸外科手術患者的臨床資料，并用單因素χ2檢驗統計分析患者醫院感染的危險因素。 結果　共有65例患者發生手術切口感染，其感染率為8.5%，且分離培養出合格菌株48株，陽性率73.8%，其中G?菌32株，占66.7%，G+菌16株，占33.3%。G?菌主要以大腸桿菌、變形桿菌、克雷伯桿菌和腸桿菌為主，分別占29.2%、18.8%、12.5%和6.2%；G+菌以腸球菌和表皮葡萄球菌為主，分別占22.9%和10.4%。單因素χ2檢驗顯示年齡＞60歲、手術時間＞120 min、術中有輸血、且有腫瘤病變的患者具有較高的切口感染發生率（P＜0.05）。 結論　胃腸外科手術切口感染的主要致病菌是G?桿菌，患者的年齡、手術時間、術中輸血情況和疾病良惡性質是術后切口感染的高危因素，積極采取相應的預防措施有望減低其感染的發生率。

Efficacy of Triclosan-Coated Polyglactin 910 Suture in Reducing Surgical Wound Infection for Patients Undergoing Gastrointestinal Emergency Operation

ObjectiveTo evaluate the role of triclosan-coated polyglactin 910 suture in reducing wound infections of emergency gastrointestinal surgeries. MethodsThis was a prospective, randomized, controlled, single center study. From May 2009 to August 2010, 412 patients underwent emergency gastrointestinal operations in our department, 198 of them were chose randomly as experimental group using triclosancoated polyglactin 910 suture for abdominal wall closure， 214 using traditional braiding suture were taken as control. The risk factors for wound healing were analyzed, and wound infection rate was compared between two groups. ResultsThere were no significant differences of gender, age, body mass index, combined diabetes, use of immunosuppressant, and glucocorticoid steroid, type of incision, intraoperative bleeding volume, and operation time between two groups (Pgt;0.05). Wound infection rate of experimental group 〔3.0% (6/198）〕 was significantly lower than that of control group 〔11.7% (25/214), Plt;0.001〕. Especially in subgroup of type Ⅲ incision and operative time more than 120 min, wound infection rate was significantly different between experimental group and control group 〔3.5%(5/141) versus 14.3%(22/154); 3.3%(2/60) versus 21.2%(11/52) respectively, Plt;0.001〕. ConclusionTriclosancoated polyglactin 910 suture can reduce wound infection rate of gastrointestinal emergency operations, especially with type Ⅲ incision and operation time ≥120 min.

腹腔鏡手術對中低位直腸癌患者免疫功能和切口感染的影響

目的探討腹腔鏡手術對中低位直腸癌患者免疫功能和切口感染的影響。 方法前瞻性納入筆者所在醫院科室2008年9月至2013年3月期間收治的中低位直腸癌患者，根據納入及排除標準共有128例納入研究，采用數字表法將納入研究患者隨機分為腹腔鏡手術組與開腹手術組，2組各64例。檢測2組患者術前1 d及術后3 d的免疫功能指標，并統計切口感染率。 結果術前1 d，2組患者外周血CD3+、CD4+、CD8+及CD4+/CD8+的差異均無統計學意義（P＞0.05）；術后3 d，開腹手術組的CD3+及CD4+/CD8+較術前均有明顯降低（P＜0.05），而腹腔鏡手術組術后3 d的CD3+及CD4+/CD8+下降不明顯，并高于開腹手術組（P＜0.05）。開腹手術組術后3 d血清IgG、IgA、IgM及IgE水平較術前均明顯降低（P＜0.05），而腹腔鏡手術組術后3 d血清IgG、IgA、IgM及IgE水平與術前比較變化不明顯（P＞0.05），且均高于開腹手術組（P＜0.05）。術后切口感染發生率開腹手術組為17.2%（11/64），腹腔鏡手術組為7.8%（5/64），后者低于前者（P＜0.05）。 結論腹腔鏡手術治療中低位直腸癌對患者免疫功能影響小，切口感染率低。

Reasons analysis on unplanned reoperation of degenerative lumbar spine diseases

ObjectiveTo review the research on the reasons of unplanned reoperation (URP) for degenerative lumbar spine diseases, and to provide new ideas for improving the quality of surgery for degenerative lumbar spine diseases. Methods The literature about the URP of degenerative lumbar spine diseases at home and abroad in recent years was reviewed and analyzed. Results At present, the reasons for URP include surgical site infection (SSI), hematoma formation, cerebrospinal fluid leakage (CSFL), poor results of surgery, and implant complications. SSI and hematoma formation are the most common causes of URP, which happen in a short time after surgery; CSFL also occurs shortly after surgery but is relatively rare. Poor surgical results and implant complications occurred for a long time after surgery. Factors such as primary disease and surgical procedures have an important impact on the incidence of URP. ConclusionThe main reasons for URP are different in various periods after lumbar spine surgery. Interventions should be given to patients with high-risk URP, which thus can reduce the incidence of URP and improve the surgery quality and patients’ satisfaction.

INTRAABDOMINAL DRAINS AFTER APPENDECTOMYINCREASE RISK OF WOUND INFECTION

目的探討闌尾切除術后腹腔引流放置與否對切口感染的影響。方法回顧性分析1 719例闌尾手術的引流情況和切口感染情況。結果引流組切口感染率為50.93%，未引流組為3.17%(Plt;0.005)。其中單純性闌尾炎引流組感染率為33.33%，未引流組為1.66%； 化膿性闌尾炎引流組感染率為46.43%，未引流組為3.12%； 壞疽性闌尾炎引流組感染率為56.25%，未引流組為20.00%； 穿孔性闌尾炎引流組感染率為54.95%，未引流組為23.08%。結論無論何種類型闌尾炎，術后放置腹腔內引流均可能增加切口感染。

Surgical treatment of 655 patients with deep chest wall infection: A single-center retrospective analysis

ObjectiveTo explore the surgical treatment of deep chest wall infection, improve the cure rate and reduce the recurrence rate.MethodsThe clinical data of 655 patients with deep chest wall infection treated in Yanda Hospital and Beijing Royal Integrative Medicine Hospital from June 2015 to June 2020 were retrospectively analyzed. There were 450 males and 205 females, aged 55.6±12.8 years. There were 8 patients with chest wall infection after tumor necrosis, 15 patients after radiotherapy and 632 patients after thoracotomy (612 patients after cardiovascular surgery and 20 patients after general thoracic surgery). Among them, 649 patients underwent debridement and reconstruction of chest wall defect with muscle flap.ResultsThe average operation time was 95±65 min, the average intraoperative blood loss was 180±100 mL, and the average postoperative hospital stay was 13±6 d. Of the 649 patients who underwent muscle flap reconstruction after debridement, 597 patients recovered within 2 weeks, and the primary wound healing rate was 94.4%. Twenty-three (3.5%) patients died. The median follow-up time was 25 (2-40) months. Among the remaining 632 patients, 20 recurred, with a recurrence rate of 3.1% (20/632).ConclusionPedicled muscle flap after thorough debridement of deep chest wall infection is one of the best methods to repair chest wall defect with pedicled muscle flap.