持续灌洗负压引流治疗肾周脓肿

我院 1 995年 2月～ 2 0 0 1年 9月 ,对 3 4例肾周脓肿的病例 ,采用第 1 2肋下斜切口行脓肿切开、脓腔抗生素液持续灌洗、负压引流进行治疗 ,收到较好效果。现报告如下。1　资料与方法1 .1 　 临床资料本组 3 4例 ,男 3 2例 ,女 2例 ,年龄 1 2～ 70岁 ,平均 42岁。右侧 1 8例 ,左侧 1 6例。典型症状 :畏寒 ,发热 ,腰腹疼痛 ,患侧肋脊角叩痛 ,腰肌紧张 ,皮肤红肿 ,患侧肾区可触及肿块 ,患侧下肢屈伸及躯干侧弯均引起剧痛。 3 2例穿刺有脓液流出 ,2例未抽到脓液。经保守治疗症状、体征及Ｂ超检查均无好转 ,且并发患侧肺部炎症。引流脓液量 40…     

封闭负压引流技术在糖尿病足治疗中的应用体会

糖尿病足是糖尿病患者由于神经病变及各种不同程度末梢血管病变而导致的下肢感染、溃疡形成和/或深部组织的破坏.糖尿病足治疗难度大、时间长,如不能及时控制感染修复创面,有截肢的风险,严重影响患者的生存质量.我科在积极治疗原发病基础上,采用封闭负压引流技术(vacuum ealing drainage,VSD),积极有效地控制糖尿病足创面感染的发展,促进创面新鲜肉芽组织的生长,运用植皮和局部皮瓣转移,修复破溃创面,有效地降低了致残率.     

负压封闭引流在软组织损伤修复中的应用

2009年2月～11月,我院收治15例软组织缺损患者,均早期应用负压封闭引流（VSD）治疗,取得了满意的效果。1材料与方法1.1病例资料本组15例,男10例,女5例,年龄13～65（34.5±6.7）岁。均为创伤后致软组织缺损或皮肤坏死,创面5 cm×5 cm～20 cm×40 cm大小,伴肌腱、血管、神经、肌腱外露9例,软组织损伤伴骨折并骨质外露6例。     

负压创面引流技术在糖尿病足治疗中的作用

目的 分析应用负压创面引流技术和常规敷料治疗糖尿病足溃疡创面的疗效.方法 回顾性分析2008年5月至2010年5月在我院治疗的35例Wagner 3～5级糖尿病足患者资料.20例接受常规敷料治疗;15例接受负压创面治疗.通过创面愈合时间及截肢率评价疗效.结果 负压创面组平均创面愈合时间为(28.21±4.34)d,常规敷料组为(57.35±5.23)d.常规敷料组18例截肢,截肢率为90.00%,2例(10%)接受常规敷料治疗患者保肢成功,而负压创面组5例截肢,截肢率为33.33%,10例(86.67%)患者保留患肢功能.结论 负压创面治疗技术结合清创及适当的抗炎治疗,可以有效的降低糖尿病足患者的截肢率.     

持续负压封闭引流在四肢感染伤口中的应用

目的：探讨持续负压封闭引流治疗感染创面的疗效。方法：使用Vacuseal（威克伤）材料和生物透性薄膜（美国3M）对9例感染严重的创伤部位行持续负压封闭引流。结果：5例病人持续负压引流5—7天后,创面经植皮或直接缝合愈合;4例每5-10天更换Vacuseal材料2-4次后,创面经植皮或转移皮辨后愈合。结论：持续负压封闭引流不仅具有引流通畅、不易堵塞管腔的优点,而且还能及时清除引流区渗出物和坏死组织,改善局部微循环和促进组织水肿消退,刺激肉芽组织生长,加速创面愈合。     

持续负压灌洗引流技术在轴型皮瓣修复慢性感染创面中的应用

目的:总结持续负压灌洗引流技术应用于轴型皮瓣修复慢性感染创面中的临床经验。方法:慢性感染创面共25例,实施轴型皮瓣修复,皮瓣下留置负压引流管进行持续负压灌洗引流7～14天,停止灌洗后维持负压吸引3～5天,拔除引流管,观察创面愈合情况。结果:所有皮瓣均存活,感染控制,创面及时修复。结论:持续负压灌洗引流有利于控制感染,促进皮瓣存活及创面修复。     

封闭式负压引流在伤口应用中的护理

<正>封闭式负压引流(vacuum sealing drainage,VSD)是利用低压力吸引体液流量的控制真空原理[1],由泡沫敷料接引流管将压力平均分布在伤口上,并利用泡沫敷料提供一保护性屏障覆盖在伤口上,将开放性伤口变成受控制密闭式环境,该技术可以     

持续冲洗加肠造口袋负压引流治疗脓肿13例报告

脓肿是外科常见病,临床处理有一定的困难。切开引流是基本的治疗措施,常规引流和换药处理耗时长、效果差。我们采用肠造口袋和自制双腔引流管持续灌洗负压引流治疗各类脓肿13例,临床效果满意,现报告如下。1资料和方法1.1一般资料本组13例,男9例,女4例。年龄最大69岁,最小26岁,平均52岁。乳腺深部脓肿3例,腹腔脓肿2例,肛周脓肿3例,臀部深部脓肿2例,腹壁脓肿1例,足部脓肿2例。1.2方法取康乐保(Coloplast)肠造口袋一个,医用橡胶引流管或粗肛管一根,再取普通输液管一根。粗管子前端剪2～4个侧孔,输液管剪侧孔后和粗管并排绑在一起。根据脓肿切…     

经乳晕切口负压引流治疗乳腺脓肿

目的：探讨经乳晕切口负压引流治疗乳腺脓肿的应用效果。方法：将48例经乳晕切口负压引流乳腺脓肿患者（观察组）与42例采用脓肿切开开放引流患者（对照组）进行回顾性分析,观察两组的临床效果并比较。结果：观察组治愈时间、手术瘢痕及乳房变形明显少于对照组,二组比较差异有显著性意义（P〈0.01）。结论：乳晕切口负压引流治疗乳腺脓肿的方法,痛苦小,美容效果好,缩短住院时间,值得临床推广运用。     

中药灌洗负压治疗糖尿病足创面的疗效观察

目的:观察中药灌洗负压治疗糖足创面的临床疗效。方法:将60例糖尿病足住院患者随机分为观察组30例和对照组30例。观察组给予常规基础及中药灌洗负压技术治疗,对照组给予常规基础及盐水灌洗负压治疗,疗程为21 d,观察两组患者全血白细胞计数、C反应蛋白、创面面积变化、创面缩小率、换药次数及创面局部各症状积分的变化情况。结果:近期疗效结果表明观察组总有效率96.67%,明显高于对照组的90%(P0.05)。两组患者创面局部各症状积分治疗前后对比,差异有统计学意义(P0.05)。治疗后,观察组WBC、CRP、创面面积及换药次数等观察指标分别为(5.86±1.37)×109/L、(4.59±1.10) mg/L、(5.81±2.01) cm~2、(5.33±0.92)次,均明显低于对照组,治疗后创面缩小率(25.06±5.91)%明显高于对照组。结论:临床上应用中药灌洗负压技术治疗糖尿病足创面,可以明显缩短创面愈合时间,提高愈合率,减少换药次数,减轻患者换药痛苦和医护人员工作量。在治疗上具有自己的特色和优势,值得临床进一步推广应用。     

负压创面治疗联合高压氧治疗糖尿病足的临床疗效

目的 探讨负压创面治疗联合高压氧治疗糖尿病足的临床疗效.方法 采用回顾性病例对照研究分析江苏大学附属人民医院整形烧伤科自2013年2月至2017年12月收治的46例糖尿病足患者的临床资料,根据治疗方法分为对照组(24例)和联合治疗组(22例).糖尿病足创面按Wagner分级为3～5级;共46足.对照组采用控制血糖、抗感...     

A case history of multimodal therapy in healing a complicated diabetic foot wound: negative pressure, dermal replacement and pulsed radio frequency energy therapies

Advanced multimodal therapies are being used with increasing frequency in the management of difficult or complex wounds. Although the primary goal remains to expedite complete healing, secondary goals include avoidance of superimposed infection, repeated hospitalisations and subsequent amputations. We describe a case involving a limb- and life-threatening necrotising infection in a diabetic patient in which we successfully applied negative pressure wound therapy, dermal replacement therapy and pulsed radio frequency energy to achieve definitive healing. Further study is warranted to elucidate the most effective combinations of such therapies to promote healing of similarly complex wounds.     

Management of negative pressure wound therapy in the treatment of diabetic foot ulcers

Diabetic foot (DF) is a common complication of diabetes and the first cause of hospital admission in diabetic patients. In recent years several guidelines have been proposed to reinforce the the management of DF with a notable increase in diabetes knowledge and an overall reduction of amputations. Significant improvements have been reached in the treatment of diabetic foot ulcers (DFUs) and nowadays clinicians have several advanced medications to apply for the best local therapy. Among these, negative pressure wound therapy (NPWT) is a useful adjunct in the management of chronic and complex wounds to promote healing and wound bed preparation for surgical procedures such as skin grafts and flap surgery. NPWT has shown remarkable results although its mechanisms of action are not completely understood. In this paper, we offer a complete overview of this medication and its implication in the clinical setting. We have examined literature related to NPWT concerning human, animal and in vitro studies, and we have summarized why, when and how we can use NPWT to treat DFUs. Further we have associated our clinical experience to scientific evidence in the field of diabetic foot to identify a defined strategy that could guide clinician in the use of NPWT approaching to DFUs.     

糖尿病足部溃疡外科保肢治疗进展

糖尿病足部溃疡是糖尿病的一个严重并发症,占非创伤性截肢的第1位。糖尿病足发病涉及足踝外科、血管外科、内分泌科.、感染控制,治疗方案需多学科联合诊治。清创术是治疗糖尿病足部溃疡的基础,清创过程中须注意维持足部正常解剖结构;负压封闭引流技术以及抗生素骨水泥在外科感染控制、溃烂创面愈合方面优势明显,疗效满意;肌腱延长术可缓解足底部应力集中导致的溃疡发生、进展等,其适应证广泛,优势在于既可预防足部溃疡形成也可治疗溃疡;皮瓣移植虽可以解决创口愈合问题,但是需要考虑移植皮瓣能否承担与足底组织相同的功能;胫骨骨搬运是一项较新的技术,具体机制还不清楚,但从临床疗效看具有一定的应用前景。     

Effect of ultrasound-supported wound debridement in subjects with diabetic foot ulcers: A meta-analysis

A meta-analysis study to assess the effect of ultrasound-supported wound debridement (USSD) in subjects with diabetic foot ulcer (DFU). A comprehensive literature examination till January 2023 was implemented and 1873 linked studies were appraised. The picked studies contained 577 subjects with DFUs in the studies' baseline, 282 of them were using USSD, 204 were using standard care, and 91 were using a placebo. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of USSD in subjects with DFUs by the dichotomous styles and a fixed or random effect model. The USSD applied to DFU caused a significantly higher wound healing rate compared with the standard care (OR, 3.08; 95% CI, 1.94–4.88, P < .001) with no heterogeneity (I² = 0%) and the placebo (OR, 7.61; 95% CI, 3.11–18.63, P = .02) with no heterogeneity (I² = 0%). The USSD applied to DFUs caused a significantly higher wound healing rate compared with the standard care and the placebo. Though precautions should be taken when commerce with the consequences as all of the picked studies for this meta-analysis was with low sample sizes.     

A comparison of diabetic foot ulcer outcomes using negative pressure wound therapy versus historical standard of care

Diabetic foot ulcers (DFUs) are a leading cause of morbidity and hospitalisation among patients with diabetes. We analysed claims data for Medicare part B diabetic foot ulcer patients treated with Negative Pressure Wound Therapy at home (N = 1135) and diabetic foot ulcer patients from a published meta-analysis of randomised controlled wet-to-moist therapy. The expected costs of care for the two treatments were also compared. A significantly greater proportion of wounds treated with NPWT achieved a successful treatment endpoint compared with wet-to-moist therapy at both 12 weeks (39.5% versus 23.9%; P < 0.001) and 20 weeks (46.3% versus 32.8%; P < 0.001). NPWT-treated patients reached a successful wound treatment endpoint more rapidly, and the benefit was apparent in all wound sizes. Expected 20-week treatment costs for NPWT were similar to those for wet-to-moist therapy if one nursing visit per day for the latter is assumed but 42% less if two nursing visits per day are made. Thus, NPWT may improve the proportion of DFUs that attain a successful wound treatment endpoint and decrease resource utilisation by a given health care system compared with standard wet-to-moist therapy.     

Histomorphological observation of surgical debridement combined with negativepressure therapy in treatment of diabetic foot

Purpose: To further study the mechanism of epithelization on the fascia side of the flap after surgical incision and the treatment of the negative pressure therapy. Methods: With the patients'' informed consent, parts of tissue samples were obtained from a 51-year-old diabetic patient who was suffering lower extremity ulcers. The samples were processed with hematoxylin and eosin (HE) staining and Masson trichrome staining. The keratin 19, keratin 15 and carcinoembryonic antigen (CEA) were immunohistochemically detected. Results: The results of HE staining showed that the specimen was divided into two regions, newborn area and original epithelial area. There were more inflammatory cells infiltrating in the dermis in the newborn epithelial area, compared with the original epithelial area. Cells in newborn epithelial area were more active and many dinuclear and polynuclear cells were observed in newborn epithelial area. But there were more cuticular layers and obvious rete pegs in original epithelial area. In addition, the cells with keratin 19 and CEA positive were found around hair follicle, while keratin 15 was negative. Masson trichrome staining showed that there was a lot of de novo collagen in newborn epithelial area. Conclusion: Epidermal cells on the fascia side of the flap could be derived from the stem cells. Negative pressure wound therapy would attract not only cells but also other elements such as growth factors, cytokines, some nutrients and extracellular matrix. With the formation of the appropriate microenvironment after debridement, the migrated cells can grow, differentiate and spread, eventually leading to the epithelization on the fascia side of the flap in diabetic foot.     

封闭负压引流在手足创伤中的应用

2010年4月～2012年4月,我科采用封闭负压引流技术(VSD)治疗26例手足创伤患者,疗效满意,报道如下。1材料与方法1.1病例资料本组26例,男19例女7例,年龄4～66岁。手部创伤9例足部创伤17例。损伤原因:搅拌机叶轮绞挫伤5例,传动带绞轧伤4例,交通事故碾压伤16例,鞭炮炸伤1例。     

自制皮下引流管持续冲洗负压吸引预防腹部切口感染的双中心随机对照研究

目的探讨自制皮下引流管持续冲洗负压吸引预防腹部Ⅳ类切口感染的价值。 方法将2012年1月至2017年1月在佛山市第一人民医院普外科和伽师县人民医院普外科行Ⅳ类切口开腹手术的220例患者随机分为试验组和对照组。试验组患者关腹时放置自制皮下引流管,术后持续负压冲洗3 d后拔除;对照组采用传统不放置皮下引流管的关腹方法。观察并比较两组患者术后伤口恢复情况及围手术期临床资料。 结果试验组平均术后住院时间、术后治疗费用、总治疗费用显著低于对照组,差异均有统计学意义（P<0.01）。两组腹腔液细菌培养结果差异无统计学意义（χ²=0.017,P=0.992）,试验组的切口愈合程度显著优于对照组（χ²=8.208,P=0.017）,切口感染发生率显著低于对照组（χ²=8.206,P=0.004）。多因素分析结果显示,是否放置皮下引流管（P=0.008）、原发疾病部位（P=0.004）、术前降钙素原水平（P=0.008）、合并糖尿病（P=0.006）是术后伤口感染的危险因素。 结论Ⅳ类切口手术放置自制皮下引流管持续冲洗和负压吸引,能有效预防术后切口感染,减少住院时间,降低住院费用。