封闭负压引流技术在心脏手术后切口感染治疗中的应用

目的探讨封闭负压引流技术对心脏手术后胸骨正中切口感染的治疗效果。方法回顾性分析2008年1月至2012年1月广州军区总医院70例心脏病(包括心瓣膜病、冠心病、先天性心脏病等)行心脏手术后发生胸骨正中切口感染患者的临床资料,术后按对感染切口的处理方法不同,将70例切口感染(切口长度>5 cm)患者用随机数字表法分为两组,封闭负压引流组:35例,使用封闭负压引流(vacuum sealing drainage)技术治疗胸骨正中切口感染;对照组:35例,采用常规治疗方法处理感染切口。比较两组的治疗效果、切口感染持续时间、抗生素使用时间和治疗费用等。结果两组无死亡。封闭负压引流组大多数患者经封闭负压引流技术治疗后,感染切口渗出物明显减少,肉芽填充良好;治愈率明显高于对照组(94.3%vs.60.0%,P<0.05)。封闭负压引流组患者切口感染持续时间[(12.9±3.4)d vs.(14.8±4.1)d;t=-2.094,P=0.040)],抗生素使用时间[(7.0±1.5)d vs.(8.3±1.9)d;t=-2.920,P=0.005)]均短于对照组,治疗费用与对照组比较差异无统计学意义(P>0.05)。封闭负压引流组术后随访15例(42.9%),随访时间3个月,伤口愈合良好;失访20例。结论采用封闭负压引流技术治疗胸骨正中切口感染,效果好、治疗时间短、治疗费用与常规治疗方法接近。     

早期清创闭合负压引流治疗颈椎后路术后切口感染的疗效观察

目的观察早期清创闭合负压引流术治疗颈椎后路术后切口感染的临床疗效。方法对本院2006年5月至2012年5月,共收治的9例颈椎后路手术后切口感染患者早期行清创术,术中使用闭合负压引流术保持切口密闭状态,接负压引流冲洗6～8天,拆除装置后予切口缝合,切口内留置真空负压引流管,外接真空负压引流瓶,2～3天后拔除,9～12天后拆线。结果 9例患者切口均完全愈合,随访6～18个月,颈部切口愈合,无窦道形成。结论早期清创闭合负压引流术治疗颈椎后路术后切口感染有效,值得临床推广。     

封闭引流强负压吸引治疗腹部手术切口脂肪液化的护理体会

目的　探讨封闭引流强负压吸引治疗腹部手术切口脂肪液化的疗效及护理。方法　采用威通公司的一次性使用负压封闭引流护创材料,应用封闭引流强负压吸引治疗腹部手术切口脂肪液化27例。结果　27例切口均痊愈,切口水肿减轻无渗液,出现新鲜肉芽组织时间为3~12 d,平均7.9 d。其中20例切口自然愈合,7例经二次缝合愈合。结论　封闭引流强负压吸引治疗可引流切口渗液,促进肉芽生长,操作简单,疗效可靠,减少换药次数,减轻患者痛苦,缩短伤口治愈时间。     

背阔肌皮瓣修复胸骨切口感染裂开创面

目的 介绍背阔肌皮瓣在心脏直视术后胸骨切口感染裂开的手术修复中的应用及体会.方法 对于心脏直视术后胸骨切口感染裂开的创面,经伤口扩创、坏死软组织及坏死胸骨、肋骨清除后,创口3 cm×10 cm～5 cm×15 cm,平均4 cm×12 cm,选取背阔肌皮瓣转移修复前胸伤口,消灭创面,临床处理6例患者.结果 经术后平均1年随访,所有伤口一期愈合,皮瓣全部成活,伤口无炎症表现,呼吸正常,上肢功能正常.结论 背阔肌皮瓣移植修复胸骨切口感染裂开创面,能保证有足够的组织覆盖创面,是一简单有效的手术处理方法.     

经胸骨正中切口心脏手术后并发乳糜胸的治疗

目的 探讨经胸骨正中切口心脏直视手术后发生乳糜胸的可能机制和治疗经验,以减少术后乳糜胸的发生. 方法 回顾分析1996年10月至2006年1月收治的18例经胸骨正中切口径路行心脏直视手术后发生乳糜胸患者的临床资料,其中男12例,女6例;年龄2个月～79岁,平均年龄14.4岁.所有患者均采用在禁食基础上的保守治疗,包括胸腔闭式引流、静脉高营养、强心、利尿等综合措施. 结果 住院时间7～130 d,胸腔引流时间4～35 d.全组死亡2例,其中死于心律失常、心搏骤停1例;因肺部感染、再次插管,死于多器官功能衰竭1例.随访14例,随访时间2～10年,失访2例.随访期间无乳糜胸复发或需二次手术者. 结论 经胸骨正中切口径路行心脏直视手术后发生乳糜胸可能与手术时损伤较小的淋巴侧枝有关,采用禁食、胸腔闭式引流、静脉高营养等保守治疗效果满意.     

VSD治疗胸腰椎后路内固定术后切口深部感染的应用

目的通过比较封闭负压引流装置(VSD)和常规闭式引流治疗胸腰椎后路内固定术后切口深部感染的效果。观察VSD治疗胸腰椎后路内固定术后切口深部感染的可行性。方法回顾性分析郑州大学第一附属医院骨一科2014-06—2017-06间收治的53例胸腰椎后路融合术后切口深部感染患者资料,均经保守治疗无效后行清创冲洗引流。根据引流方式不同分为2组,将行常规闭式引流的25例纳入对照组,将行VSD负压引流的28例纳入观察组。比较2组患者的清创次数及切口愈合时间,并观察血常规、血沉(ESR)、C反应蛋白(CRP)及微生物培养结果。结果单因素分析结果表明,2组患者首次清创术前性别、年龄、体质指数(BMI)、合并症、ASA评分、ESR、CRP等基线资料无显著性差异(P0.05)。所有患者切口最终均完全愈合。观察组患者清创次数及切口愈合时间均少(短)于对照组,差异有统计学意义(P0.05)。观察组中无患者因VSD使用出现脑脊液漏等相关并发症。细菌培养结果革兰氏阳性球菌者43例(包含7例多重耐药菌),革兰氏阴性杆菌者10例。经过早期清创、彻底引流及全身应用敏感抗生素后均获得满意治疗效果,且随访期间无感染复发病例。结论 VSD应用于切口深部感染可显著降低患者住院时间,减少治疗期间清创次数和抗生素应用周期,加速切口愈合。对于切口感染严重的患者将VSD埋入切口深部进行引流,取得了满意的临床效果。     

医用皮肤表面缝合器在胸部正中切口裂开中的应用

目的:评价医用皮肤表面缝合器在胸部正中切口裂开治疗中的效果。方法:2017年以来收治的胸部正中切口裂开的15例患者,在对其伤口清创处理后,应用医用皮肤表面缝合器来缝合固定伤口,防止裂开扩大,并不断调节缝合力,逐步缩小腔隙,促其快速愈合。结果:应用后患者感觉伤口疼痛减轻,裂口未再扩大,均痊愈,愈合后未再发生裂开、窦道、脓肿等并发症,无明显瘢痕增生。结论:医用皮肤表面缝合器用于治疗胸部正中切口裂开,使用方便,能减轻患者痛苦,加快伤口愈合,缩短治疗时间,值得在临床上推广。     

三切口经胸骨后颈部胃食管吻合治疗食管癌

目的 探讨食管癌经三切口的手术方法及疗效。方法 自2003年4月至2005年10月。我院收治15例食管癌接受三切口行肿瘤切除及经胸骨后颈部胃食管吻合术进行回顾性分析。结果 15例中，8例行根治性切除，其余7例为姑息性切除；术后2例发生吻合瘘，但均经恰当引流而治愈，无心肺并发症发生。术后随访2～29月，肿瘤复发死亡1例。结论 三切口经胸骨后颈部胃食管吻合术治疗食管癌是一个安全有效的治疗方法。     

冠状动脉搭桥术后胸骨切口感染裂开的修复

目的介绍冠状动脉搭桥术后,胸骨切口感染裂开的手术修复方法。方法2002年2月~2004年10月,冠状动脉搭桥术后胸骨切口感染裂开患者10例,男7例,女3例。年龄68~76岁。创口范围3cm×5cm~5cm×15cm。经伤口扩创,坏死软组织及坏死胸骨、肋骨、肋软骨清除后,切取腹直肌肌皮瓣、胸大肌肌皮瓣、背阔肌肌皮瓣移位修复前胸伤口或单纯胸大肌肌瓣移位填塞死腔,消除创面,切取皮瓣范围3cm×5cm~5cm×16cm。结果术后10例患者伤口均期愈合。随访3~11个月,平均6个月,伤口无炎性表现,呼吸正常,无腹壁疝发生,上肢功能正常。无其他并发症出现,供区伤口愈合良好,临床效果满意。结论根据不同病程、局部炎性情况以及术中扩创后情况,分别选用不同的手术方式修复创面,可获得满意的治疗效果。     

心脏术后胸骨正中切口感染的治疗策略

目的 探讨心脏手术后胸骨正中切口感染的分类与治疗方法,以期更好的提高临床治疗效果.方法 采用回顾性调查的方法,对2007年1月至2009年5月我院治疗的胸骨切口感染患者的相关因素及治疗结果进行分析.结果 本组患者76例,其中29例在术后1个月内,7例为术后1～2个月,超过2个月以上39例.1例胸骨完全坏死,心脏外露,拟手术前1 d死亡.76例患者中1例接受4次清创手术,13例清创2次,6l例接受1次清创手术,一次修复成功率80.26%.14例深部感染患者采用伤口持续负压吸引(VAC)的方法辅助创面准备.乳腺组织瓣转移1例,59例行肌肉组织瓣转移,其中胸大肌肌瓣转移52例,腹直肌瓣转移7例.结论 根据感染发生的时间和累及的深度,选用恰当的治疗方法可以取得良好的治疗效果.     

Management of abdominal wound dehiscence using vacuum assisted closure in patients with compromised healing

BACKGROUND: Restoration of the abdominal wall's integrity after postoperative wound dehiscence is frequently performed in a delayed fashion, necessitating a temporary dressing of the dehisced wound. METHODS: The Vacuum Assisted Closure (VAC) system (Kinetic Concepts, Inc., San Antonio, TX) was used in 21 patients with postoperative abdominal wound dehiscences that could not be closed immediately and who were at high risk for healing complications. The VAC device was used in conjunction with sharp debridement and it was maintained on a continuous mode with a negative pressure of -75 to -125 mm Hg. The dressing was changed every 2 days. VAC therapy was continued until the integrity of the abdominal wall was reestablished by surgical procedures or secondary healing. RESULTS: Thirteen patients had fascial dehiscence, and 9 of them had frank bowel exposure. Definitive fascial closure was performed in 9 of 13 patients with fascial dehiscence. Stable cutaneous coverage was subsequently achieved in all patients by local abdominal skin flap advancement (6), skin grafting (9), or secondary intention healing (6). Seven patients had part of their VAC therapy as outpatients. The complications included a low-output small bowel enterocutaneous fistula in 2 patients and partial skin graft loss in 1 patient. The fistulae resolved after operative treatment (1) or conservative treatment (1). CONCLUSION: Integration of the VAC system in the management of post-laparotomy wound dehiscence in patients with compromised wound healing appears to be successful and should be considered in such patients to provide a stable, healed wound.     

Vacuum‐Assisted Closure for Mediastinitis in Pediatric Cardiac Surgery: A Single‐Center Experience

Vacuum‐assisted closure (VAC) has been widely used to treat mediastinitis after congenital cardiac surgery, which is associated with a high risk of morbidity and mortality. The aim in this study is to review our 14 cases of mediastinitis treated with VAC therapy after congenital cardiac surgery. We retrospectively reviewed the medical records of 14 congenital heart patients with mediastinitis from January 2012 to March 2017. Patients with fever, wound discharge, sternal dehiscence, a positive wound culture or abscess diagnosed with computed tomography are accepted as mediastinitis. A VAC was applied to all our patients without irrigation or dressing the wound because of sterility concerns. The vacuuming of the wound was either 50 mm Hg or 75 mm Hg according to the sternal intactness. We gradually decreased the pressures and changed the VAC systems once every three days, after wound healing was seen and a negative culture was obtained and VAC was terminated. There were 14 patients (8 male and 6 female) with mediastinitis and all of them were treated using VAC. The mean age of the patients was 6.96 months (ranging from 0.5‐26 months). The mean weight was 5.16 kg (2.8‐12 kg). Three patients needed extracorporeal membrane oxygenation after the surgery. Mean onset of mediastinitis was 25.3 days. The wound cultures showed methicillin resistant coagulase negative streptococcus and methicillin‐sensitive staphylococcus aureus in most cases. Acinetobacter, serratia, pseudomonas, and klebsiella were the other bacterial species seen in cultures. Two patients had mediastinitis symptoms, but their cultures were negative. VAC systems were changed 3.85 times on average. Mean duration of hospital stay was 49.9 days (21‐104 days). One patient needed a muscle flap to close the thoracic cavity after mediastinitis. Two patients did not survive. Mediastinitis is a serious postoperative condition in pediatric cardiac surgery patients. Classical wound dressing and irrigation methods are not suitable in mediastinitis for the pediatric age group. Therefore, VAC therapy can be an effective way to successfully treat the situation.     

Treatment of a large defect of the chest wall in a child using a negative pressure wound dressing.

Vacuum-assisted closure(VAC) is a simple wound healing tool in plastic surgery. We report a large thoracic defect in a child, in which the VAC was used to cover an exposed polytetrafluoroethylene prosthesis. The VAC saved the prosthesis and induced complete granulation of the wound, which healed completely in five weeks.     

感染性股动脉假性动脉瘤手术治疗及伤口处理：附16例分析

目的:探讨感染性股动脉假性动脉瘤治疗的手术方式,以及评估封闭负压辅助闭合(VAC)装置在治疗感染伤口的作用和应用价值。方法:回顾性分析2015年7月—2018年4月行手术治疗的16例感染性股动脉假性动脉瘤患者的临床资料。结果:16例患者术中破损动脉直接缝合破口5例,自体静脉修补6例,自体静脉置换3例,2例行动脉瘤切除局部旷置。患者手术伤口术后均经VAC装置引流治疗;伤口二期直接缝合12例,行皮瓣移植4例,伤口愈合时间平均34.2 d。术后13例患者获随访6个月,除1例伤口再次破溃接受清创治疗之外,其余12例患者伤口均无再次感染或破溃,所有随访患者动脉瘤均未复发。结论:感染性股动脉假性动脉瘤应尽早手术清创治疗;VAC装置治疗感染性伤口安全、有效。     

Vacuum-assisted closure combined with a closed suction irrigation system for treating postoperative wound infections following posterior spinal internal fixation

Background

Wound infections after posterior spinal surgery are a troublesome complication; patients are occasionally forced to remove the internal fixation device, which can lead to instability of the spine and injury to the spinal cord. The purpose of this study was to evaluate the efficacy of modified vacuum-assisted closure (VAC) for treating an early postoperative spinal wound infection.

Methods

We conducted a retrospective study of 18 patients with wound infections after posterior spinal surgery from 2014 to 2017 at a single tertiary center. All patients included in the study received modified VAC treatment (VAC combined with a closed suction irrigation system, CSIS) until the wound satisfied the secondary closure conditions. Detailed information was obtained from the medical records.

Results

Wound size decreased significantly after 1?week of the modified VAC treatment. Three patients were treated with VAC three times and one patient received the VAC treatment four times; the remaining patients received the VAC treatment twice. The patients had excellent wound beds after an average of 8?days. The wound healed completely after an average of 17?days, and the average hospital stay was 33?days. There was no recurrence of infection at the 1-year follow-up.

Conclusions

This study demonstrates that VAC combined with a CSIS is a safe, reliable, and effective method to treat a wound infection after spinal surgery. This improved VAC procedure provides an excellent wound bed to facilitate wound healing and shorten the hospital stay.

     

Use of VAC therapy and sternal plating in the treatment of sternotomy wound dehiscence

Sternal dehiscence has a high morbidity and mortality. Many treatment modalities have evolved. Early wound management and closure has a positive outcome. Vacuum-assisted closure (VAC) therapy has proven to be effective, and recently the closure of the sternum with internal plate fixation appears to be beneficial. We present a small series with their combined usage. We retrospectively reviewed eight cases of sternal wound dehiscence or sepsis referred to our unit for further management for the period January 2006 to December 2007. The subjects consisted of five males and three females with their ages ranging from 47 to 74 years (mean = 63 years). All patients had a premorbid history of hypertension and hyperlipidemia and five of diabetes. The patients were managed with a combination of serial debridement, VAC therapy, and sternal internal plate fixation and bilateral pectoralis major advancement flap. In three patients, final closure was obtained after sternal plating. Two patients achieved final closure by VAC therapy only. Three patients died of multiple-organ failure while undergoing wound bed preparation. We believe the use of VAC therapy and definitive wound closure using sternal plating, as part of a staged treatment, is an effective method for managing sternotomy wound dehiscence.     

Vacuum-assisted closure for wound management in the pediatric population

Background/Purpose

Wound management in children has traditionally consisted of daily dressings. Although vacuum-assisted closure (VAC) is well described in the adult literature, there are few reports about children. We reviewed our experience with VAC.

Methods

A retrospective review from 2003 to 2005 revealed that 16 children underwent VAC. Variables analyzed included demographics, diagnosis, duration and characteristics of VAC, wound closure, recurrence, complications, and cost analysis.

Results

Sixteen children received VAC therapy at an average age of 12.1 years (range, 1 month-18 years). Indications included tissue loss after pilonidal sinus excision (n = 8, primary = 5, recurrent = 3) after wound dehiscence of the abdomen (3), the sternum (2), the back (1), the leg (1), and after chronic postoperative perineal fistula. Average length of VAC use was 23 days, with an average pressure of 104 mm Hg. Wound closure occurred in 15 of 16 patients. Patients with primary pilonidal disease obtained wound closure by 45 days, whereas those with recurrent disease required 72 days. Children with wound dehiscence healed by 28 days. Recurrent sinuses developed in all 3 patients with known recurrent pilonidal disease. Pain in 1 patient required cessation of VAC therapy after 7 days. Follow-up after wound closure averaged 8 months.

Conclusions

Vacuum-assisted closure is well tolerated in our pediatric population and offers many advantages including fewer dressing changes and an earlier return to daily activities.     

Managing the open abdomen with vacuum-assisted closure therapy: retrospective evaluation of 22 patients

BACKGROUND: The authors reviewed their experience in the management of "open abdomen" using the vacuum-assisted closure device (VAC), in order to assess its morbidity particularly in terms of fistula, and the outcome of abdominal wall integrity. METHODS: Between January 2003 and October 2006, 22 patients required management with an "open abdomen" technique (18 patients were managed with the VAC abdominal dressing device with application of a specific sheet and 4 other patients simply required a dressing with the polyurethane sponge). The mean age was 55 years, and M/F sex ratio was 2.67. Indications were abdominal compartment syndrome in 7 patients, initial "abdominal closure" after trauma in one patient, severe abdominal sepsis in 7 patients, and abdominal wound dehiscence where closure was impossible in 7 patients. RESULTS: There were no enteric fistulae. Two infections were seen--a chronic suppuration which resolved with antibiotic therapy and a deep abscess which was drained with radiologic guidance. Of the 18 cases of "open abdomen" managed with the VAC, 15 were alive. Six (40%) underwent a delayed primary closure at a mean interval of 9 days; the others underwent secondary healing by granulation, and 10 eventually underwent split thickness skin grafting at a mean interval of 50 days. With VAC closure of the "open abdomen", the development of ventral hernia is an anticipated outcome; in four cases, patients underwent abdominal wall reconstruction at an interval of one year. CONCLUSION: Laparostomy or "open abdomen" using the VAC dressing system should be considered an established and well-defined technique which provides temporary abdominal coverage with limited morbidity.     

Treatment of postoperative mediastinitis using an omental pedicle flap]

Four patients with postoperative mediastinitis who were treated by omentopexy at the Fukuoka University Hospital between 1989 and 1990. Three of the 4 patients healed successfully, another one died of multiple organ failure 83 days after surgery. All patients were received coronary artery bypass surgery harvesting a left internal thoracic artery for ischemic heart disease. Three patients had diabetes mellitus, one patient had renal failure preoperatively. Recognition of mediastinitis was made by sternal wound purulent discharge and sternal dehiscence. Culture of the discharge fluid yielded methicillin-resistant Staphylococcus aureus in three, and Enterococcus cloacae in one. Irrigation with popidone-iodine or blonopol were ineffective. Thus, the wound was treated with debridement and omentopexy with an omental pedicle flap, respectively. Postoperative course after omentopexy were excellent, had no complications. We conclude that the omentopexy is useful in the treatment of postoperative refractory anterior mediastinitis.     

Vacuum-assisted closure for deep infection after spinal instrumentation for scoliosis

Our aim was to review the efficacy of the wound vacuum-assisted closure (VAC) system in the treatment of deep infection after extensive instrumentation and fusion for spinal deformity in children and adolescents. A total of 14 patients with early deep spinal infection were treated using this technique. Of these, 12 had neuromuscular or syndromic problems. Clinical and laboratory data were reviewed. The mean follow-up was 44 months (24 to 72). All wounds healed. Two patients required plastic surgery to speed up the process. In no patient was the hardware removed and there was no loss of correction or recurrent infection. We believe that the wound VAC system is a useful tool in the armamentarium of the spinal surgeon dealing with patients susceptible to wound infections, especially those with neuromuscular diseases. It allows for the retention of the instrumentation and the maintenance of spinal correction. It is reliable and easy to use.