ObjectiveTo summarize the nursing experience of vacuum-assisted closure (VAC) technology for deficiency of skin and soft tissue in "4·20" earthquake damage.
MethodsWe used VAC to treat 20 patients suffering from deficiency of skin and soft tissue who were injured in "4·20" earthquake (35 wounds) from April 21st to 28th, 2013; and we observed closely the results of nursing for pain and psychological care.
ResultsA total of 35 wounds were all cleaned after 5 to 7 days; 20 wounds were healed after VAC treatment; 15 wounds recovered well by covering autogenous split-thickness skin; 20 patients had stable emotion and all left the hospital with the recovery.
ConclusionVAC for deficiency of skin and soft tissue caused by "4·20" earthquake damage may obviously decrease the time of wound healing, relieve the pain caused by changing fresh dressing, and reduce the length of stay in the hospital.
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 effect of vacuum sealing(VS) technique and emergency internal fixation on the management of limbs open fracture and soft tissue dirty defects. METHODS: Fourteen patients (18 limbs) with open fracture and soft tissue dirty defects were treated by the VS technique and internal fixation after debridement and 14 patients managed by traditional method as control group. Wound surface were covered with polyvinyl alcohol foams with embedded drainage tubes connected with vacuum bottle (negative pressure of 50 to 60 kPa) after wound surface were debrided and fracture were fixed. Wound closure was performed with secondary suturing, or free flap, or loco-regional flap and mesh-grafts after 5 to 7 days. RESULTS: All wound surface healed completely. No complications (systemic and local) were found. After 4-6 months follow-up on average, the fracture healed well. There was significant difference in time of treatment, total cost of treatment and complication rate between 2 groups (P lt; 0.01). CONCLUSION: The VS procedure can drain the wound surface completely, decrease infection rate and stimulate the proliferation of granulation tissue. A combination of VS with emergency internal fixation is a simple and effective method in treatment of limbs open fracture and soft tissue dirty defects.
ObjectiveTo explore the effectiveness of open reduction and internal fixation through anterior and posterior approaches in treatment of open Tile type C pelvic fractures at early stage.
MethodsBetween January 2009 and April 2012, 12 patients with open Tile C pelvic fractures were treated. There were 7 males and 5 females, aged 6-53 years (median, 31 years). Of 12 cases, 4 were classified as Tile type C1, 6 as Tile type C2, and 2 as Tile type C3; 5 were rated as Gustilo type Ⅱ and 7 as Gustilo type Ⅲ. The injury severity score was 18-57 (mean, 37.2). The interval of injury and admission ranged from 15 minutes to 3 days (median, 50 minutes). The debridement and external fixation were performed at first stage; then open reduction and internal fixation were used through anterior approach (reconstruction plate) and posterior approach (cannulated lag screws). The vacuum sealing drainage was performed during treatment until the wounds healed.
ResultsDelayed healing of incison was obtained in 12 cases because of wound infection. Anatomical reduction or approximate anatomical reduction was achieved in all 12 cases. The patients were followed up 3-39 months (median, 18 months). No loosening of internal fixation or fracture displacement was observed during follow-up. The fracture healing time was 7-13 weeks (mean, 9.7 weeks). At last follow-up, according to the Matta standard, the outcome was excellent in 10 cases and good in 2 cases; according to Majeed score, the results were excellent in 9 cases, good in 1, and poor in 2.
ConclusionEarly internal fixation operation of open Tile type C pelvic fractures can effectively restore the pelvic anatomical structure and stability, reduce the complication, and achieve satisfactory effectiveness.
ObjectiveTo explore the leakage management and skin care by improved homemade portable vacuum sealing drainage device used for enterocutaneous fistula, in order to solve such confusing problems as leakage collection and nursing for patients with inconvenient activity.
MethodsThe homemade portable vacuum sealing drainage device was made by using hydrophilic fiber of silver ion antimicrobial dressings, leak-proof strings, skin protective film, transparent patches, sputum suction tube, bottle of portable infusion, and negative pressure drainage bottle. Between January 2011 and September 2013, patients with enterocutaneous fistula admitted into our hospital were divided into traditional treatment group and portable vacuum sealing treatment group according to the admission time, and traditional center negative pressure suction treatment and portable negative pressure drainage method were used respectively for the two groups of patients. We verified the effect of the mobile vacuum sealing drainage device through comparing these two groups in terms of wound healing time, redness, burst and impregnation of the skin.
ResultsThe wound healing time was significantly shorter for patients in the portable vacuum sealing drainage treatment group (P<0.05), and patients in this group also had a lower occurrence of skin redness, impregnation and burst.
ConclusionHomemade portable negative pressure drainage device for enterocutaneous fistula patients can reduce the incidence of skin complications such as redness, impregnation and burst, promote patients' activity, and reduce the patients' pain.
ObjectiveTo investigate the effects of intermittent irrigation of insulin solution combined with continuous drainage of vacuum sealing drainage (VSD) in chronic diabetic lower limb ulcers.
MethodsBetween January 2012 and December 2014, 45 patients with diabetic lower limb ulcer were treated with VSD (group A, n=15), with VSD combining irrigation of normal saline (group B, n=15), and with VSD combining irrigation of insulin solution (group C, n=15) after debridement. There was no significant difference in gender, age, course of ulcers, area and depth of wound, glycosylated hemoglobin, and Wagner grade among 3 groups (P>0.05), and the data were comparable. The levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose were determined everyday during treatment. The contents of insulin growth factor 1 (IGF-1), tumor growth factor α (TNF-α), and nitric oxide (NO) in necrotic tissue after drainage were determined. The coverage rate and thickness of granulation tissue and clearance rate of bacteria in wound were calculated, the granulation tissue in the center of the wound was harvested for pathological observation with HE staining after 6 days of treatment. The second stage operation was performed according to the condition of wounds, and the time to the second stage operation and the method of the second stage operation were recorded and the survival rate of grafted skin or flap was calculated.
ResultsThe pathological staining showed that there were a few new microvessels and fibroblasts in group A after treatment;more new microvessels and fibroblasts were observed in group B;and many new microvessels and fibroblasts were found in group C. There was no significant difference in levels of fasting blood glucose, 2-hour postprandial blood glucose, and random blood glucose among 3 groups during treatment (P>0.05). The coverage rate and thickness of granulation tissue and clearance rate of bacteria in group C were significantly higher than those in groups A and B after treatment (P<0.05). The contents of IGF-1 and NO were significantly increased and TNF-α was significantly decreased in group C when compared with those in group A (P<0.05). Compared with group B, IGF-1 and NO contents were significantly increased at 3-6 days and at 2-6 days respectively, and TNF-α content was significantly decreased at 3-6 days in group C (P<0.05). The method of the second stage operation showed no significant difference among 3 groups (χ2=2.920, P=0.230), but the time to the second stage operation in group C was significantly shorter than that in groups A and B (P<0.05), and the survival rate of grafted skin or flap in group C was significantly higher than that in groups A and B (P<0.05).
ConclusionThe treatment of diabetic lower limb ulcers with intermittent irrigation of insulin solution combined with continuous drainage of VSD can reduce inflammatory reaction effectively, promote development of granulation tissue, improve recovery function of tissue, increase the rate and speed of wound healing obviously, but it has no effect on blood glucose levels.
ObjectiveTo analyze the curative effect of vacuum sealing drainage for early deep infection after posterior spinal internal fixation.
MethodsFrom March 2009 to March 2012, 9 patients with early deep infection after posterior spinal internal fixation, including 5 males and 4 females aged between 21 and 64 years, averaging at 44.6, underwent debridement and vacuum sealing drainage (VSD). Original fixtures in all the patients were not taken out.
ResultsThe patients were treated by VSD for once to three times with an average of 2.1 times, and VSD continued for 3 to 7 days every time. Two patients underwent one time of VSD, 4 underwent twice, and 3 underwent three times. In these patients, 6 achieved wound healing after VSD, one changed to ordinary dressing and wound suturing two weeks later due to hemorrhage of VSD, one changed to ordinary dressing and wound suturing wound three weeks later due to impeded drainage, one accepted skin-grafting after three times of VSD. All the patients were followed up for 6 to 38 months (18 months on average) and all of them were cured. There was no obvious back pain or signs of incision infection. The X-ray films showed that there were no bone destruction and the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein significantly decreased to normal after surgery.
ConclusionOne-stage debridement and vacuum sealing drainage therapy is an effective method for treating early deep infection after posterior spinal internal fixation.
ObjectiveTo investigate the methods and effectiveness of one-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage (VSD).
MethodsBetween June 2008 and October 2012, 15 cases of pelvis and acetabular fractures combined with Morel-Lavallée injury were treated. There were 5 males and 10 females, aged from 18 to 67 years (mean, 36.8 years). Fractures were caused by traffic accident in 11 cases and crashing injury of heavy object in 4 cases. The time from injury to hospitalization was 3 hours to 9 days (mean, 5.4 days). Morel-Lavallée injury located in the above posterior superior iliac spine in 4 cases, greater trochanter in 7 cases, and anterior proximal thigh in 4 cases. In 10 cases complicated by pelvic fracture, there were 1 case of anteroposterior compression type, 3 cases of lateral compression type, 5 cases of vertical shear type, and 1 case of compound injury type; in 5 cases complicated by acetabular fracture, there were 1 case of transverse fracture, 1 case of posterior wall and posterior column fracture, 1 case of transverse acetabulum plus posterior wall fracture, and 2 cases of both columns fracture. Open reduction and internal fixation were used to treat pelvic and acetabular fractures, and VSD to treat Morel-Lavallée injury. When the drainage volume was less than 20 mL/d, interrupted wound suture or free skin grafting was performed.
ResultsThe hospitalization time was 16-31 days (mean, 20.8 days). Thirteen cases were followed up 4-16 months (mean, 7.8 months). The healing time of Morel-Lavallée injury was 16-36 days after operation (mean, 21.3 days). All the wounds had primary healing, and no infection occurred. The X-ray films showed that all fractures healed, with a mean healing time of 13.6 weeks (range, 11-18 weeks). At 6.5 months after operation, according to Majeed function scoring system in 8 cases of pelvic fracture, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case; according to Harris hip scoring in 4 cases of acetabular fracture, the results were excellent in 2 cases, good in 1 case, and fair in 1 case.
ConclusionTo pelvis-acetabular fractures combined with Morel-Lavallée injury, internal fixation treatment for fracture and VSD for Morel-Lavallée injury not only can cure merge Morel-Lavallée injury effectively, but also can guarantee the operation timing and incision safty of the pelvis-acetabular fractures.
Objective To evaluate the efficacy of percutaneous kyphoplasty (PKP) in hyperextension position for the treatment of osteoporotic vertebral compression fracture (OVCF) with vacuum phenomenon. Methods Between April 2004and August 2009, 35 patients who suffered from OVCF with vacuum phenomenon were treated with PKP in hyperextension position, 8 patients were excluded because of lost follow-up. In 27 follow-up cases, there were 9 males and 18 females with an average age of 75 years (range, 58-90 years) and with an average disease duration of 9.8 months (range, 2-17 months). One vertebral body was involved in 26 cases and 2 vertebral bodies were involved in 1 case. According to the imaging examination and Krauss et al. criterion, all patients were diagnosed as having vertebral vacuum phenomenon. Refer to the lateral X-ray views, the height and the kyphotic angle of the involved vertebral body were measured pre- and postoperatively. The surgical outcomes were evaluated by using visual analogue scale (VAS) and Oswestry disabil ity index (ODI) system. Results All operations were performed successfully with no severe compl ication. The mean follow-up of 27 patients was 32 months (range, 24-58 months). The mean cl inical heal ing time of OVCF was 4 months (range, 3-6 months). The VAS score, ODI system, anterior and medial height of involved vertebral body, kyphotic angle of involved vertebral body were improved significantly at 1 week after operation and at last follow-up (P lt; 0.05); there was no significant difference between at 1 week after operation and at last follow-up (P gt; 0.05). There was no significant difference in the posterior height of involved vertebral body among different postoperative time-points (P gt; 0.05). Asymptomatic cement leakage occurred in 3 patients. Adjacent vertebral fracture occurred in 1 patient at 7 months. Intravertebral vacuums showed a compact and sol id cement fill ing pattern. Conclusion PKP in hyperextension position can significantly rel ieve back pain, restore vertebral height, and correct local kyphosis in the treatment of OVCF with vacuum phenomenon.
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.
