Continuous suction and intermittent irrigation for septic coxitis

This prospective study was undertaken on 42 children with septic arthritis of the hip diagnosed within 5 days of onset of symptoms. The mode of treatment used was continuous catheter suction and intermittent saline irrigation of the hip joint together with parenteral antibiotics. All but 4 children responded to this treatment; 2 of these were less than 3 years old. We conclude that continuous suction-irrigation is effective in children older than 3 years very early in the course of the disease; the majority need not undergo arthrotomy.     

Continuous suction and intermittent irrigation for septic coxitis

This prospective study was undertaken on 42 children with septic arthritis of the hip diagnosed within 5 days of onset of symptoms. The mode of treatment used was continuous catheter suction and intermittent saline irrigation of the hip joint together with parenteral antibiotics. All but 4 children responded to this treatment; 2 of these were less than 3 years old. We conclude that continuous suction-irrigation is effective in children older than 3 years very early in the course of the disease; the majority need not undergo arthrotomy.     

A venturi based suction drainage system used in facelifts.

A method of drainage using the Venturi suction system has been used in 3124 facelifts over an 18 year period. It has proven to be effective and safe and has reduced the degree of postoperative bruising and swelling in these patients. There have been no complications relating to the technique.     

Successful salvage of an infected breast prothesis by changing from continuous to intermittent suction under continuous irrigation

IntroductionImplant-based breast reconstruction is a widely performed procedure. However, prostheses are susceptible to infection and there are currently no established guidelines on treatment. In the present case, a prosthesis was salvaged by changing from continuous irrigation and suction to continuous irrigation and intermittent suction. This case report has been reported in line with the SCARE criteria [1].Presentation of caseA 50-year-old female patient underwent implant-based breast reconstruction following surgery for breast cancer. One month later, the left breast prosthesis was infected with abscesses. Surgical treatment and continuous irrigation were performed as postoperative therapy. However, recurrent infection was detected a few days after surgery. Continuous irrigation was changed to continuous irrigation with intermittent aspiration, which successfully controlled the infection.DiscussionFactors that limit the effectiveness of continuous irrigation and aspiration have not yet been identified. Inflow/discharge shunt routes may be established in continuous aspiration, and, thus, sufficient cleaning may not be possible. On the other hand, the storage of water throughout the wound in intermittent aspiration may facilitate cleaning.ConclusionIntermittent suction worked well in this patient and, thus, warrants further study.     

Outcome of arthroscopic drainage and debridement with continuous suction irrigation technique in acute septic arthritis

Purpose

The purpose of this study was to determine the clinical course and functional outcome of acute septic arthritis treated by arthroscopic drainage and debridement with continuous suction irrigation.

Methods

Eighteen subsequent cases of acute septic arthritis of hip and knee were included in this study. Complete hemogram, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), blood sugar, liver and kidney function test was done. Plain radiographs and ultrasound of affected joints were done. Joint aspirate was analyzed for gram staining, AFB staining, culture/sensitivity, biochemistry and cytology. Quantitative CRP was repeated every third day till normal CRP level was noted. Intravenous cloxacillin 25–50 mg/kg was started according to WHO protocol and was later changed to specific antibiotics after culture reports. Arthroscopic drainage and debridement of joints was done through standard portals and two tubes were placed in each joint for continuous suction and irrigation. Continuous suction irrigation was used till the effluent saline from the joint was clear. Functional outcome was documented as per Harris hip score for hips and Lysholm score for knee joint. Scoring was done before surgery, at one month and at three months. The duration of intravenous antibiotics and hospitalization was recorded.

Results

Out of eighteen cases 83.33% were males and 14.67% females. The mean age was 22 years (±12.01). The mean duration of symptoms was 4.33 days (±1.41). According to Gachter classification 88.88% of cases were stage 2 infection and 11.12% cases in stage 1 at the time of arthroscopy. The mean duration of hospital stay was 14.61 days (±4.01). Intravenous antibiotics were given for a mean period of 9.33 days (±2.16). The mean pre-operative Harris score was 13.6 (±2.07) which improved to 98 (±1.87) at 3 months and all the cases had painless normal range of movements. Mean pre-operative Lysholm score was 38.38 (±4.29) and it improved to 98.84 (±2.19) at 3 months. There were no sequelae of septic arthritis in any case.

Conclusion

Early arthroscopic decompression and debridement of septic arthritis with continuous suction irrigation can eradicate the infection. The duration of intravenous antibiotics and the hospital stay required is shorter. The functional outcome of joints is satisfactory.     

A new instrument for surface suction and removal of irrigation fluid during surgery

A new instrument for removal of intraocular/extraocular irrigating solutions during eye surgery, based on modification of a miniature otologic suction device, is now commercially available.     

皮下引流持续冲洗负压吸引术在肠造口还纳术后预防切口感染的前瞻性研究

目的探讨皮下引流持续冲洗负压吸引术在结直肠癌手术并肠造口患者行还纳术后预防切口感染的应用价值。 方法前瞻性选择2017年2月至2018年12月佛山市第一人民医院收治的100例肠造口患者,按照随机数字表法分成两组,在肠造口还纳术中关闭切口时采用不同措施,每组50例,试验组采用皮下引流持续冲洗负压吸引装置,对照组采用传统关闭切口方法。比较两组患者的围手术期资料以及术后切口感染率。 结果两组患者均采取开腹手术,无一例围手术期死亡。两组造口类型、初次造口时机、造口时间、手术时间、术中出血量比较,差异均无统计学意义。试验组患者术后住院时间为（7.0±5.7）d,术后切口感染率为2.0%（1/50）,显著低于对照组的（9.5±5.6）d、16.0%（8/50）,差异有统计学意义（t=-2.193,P=0.031;χ²=4.396,P=0.036）。 结论皮下引流持续冲洗负压吸引术能有效降低结直肠癌肠造口还纳术患者的切口感染发生率,缩短住院时间,临床应用价值较高。     

Comparison between intermittent (spring-loaded) and continuous closed suction drainage of orthopedic wounds: a controlled clinical trial

A randomized prospective trial of a continuous vacuum system (VariDyne) and an intermittent spring type system (Hemovac) was conducted in 126 consecutive orthopedic surgical wounds between February 1988 and October 1988 in which postoperative suction drainage was required. Comparison between the two groups showed a statistically significant difference among total drainage removed by the vacuum units and wound drainage into the dressing following drain removal. Hip and knee arthroplasty patients receiving continuous vacuum suction experienced a greater average drainage volume and better wound healing than those receiving the spring-loaded device. Overall, all wounds which utilized continuous vacuum drained less serosanguinous or serous fluid than those wounds utilizing the intermittent system following drain removal. A clear advantage to using a continuous vacuum suction device over an intermittent spring-loaded device is seen with respect to hematoma evacuation, wound drainage, wound healing, and possible complications.     

氨甲环酸和间断负压引流对腰椎术后引流量的影响

[目的]探讨联合局部应用氨甲环酸(TXA)和间断负压引流对腰椎后路椎间融合术后出血量的影响。[方法]按照前瞻性对照方法收集2016年02月～2019年03月行开放性单或双节段腰椎后路椎间融合手术患者214例,随机分为使用TXA和持续负压引流者52例(A组)、未使用TXA和间断负压引流者54例(B组),使用TXA和间断负压引流者55例(C组),未使用TXA和持续负压引流者53例(D组)。对四组性别、年龄、手术节段、术中出血量、术后引流量、术后隐性失血量、引流管留置时间、术后输血人数以及并发症等进行分析。[结果]四组患者年龄、性别、手术节段方面差异无统计学意义(P>0.05);四组患者在术中出血量、术后隐性失血量、术后输血人数以及并发症发生率方面差异无统计学意义(P>0.05)。术后引流量与总出血量统计得出了一致的结果,即A组与B组的差异无统计学意义(P>0.05),但均显著少于D组,差异有统计学意义(P>0.05);C组显著少于A组、B组和D组,差异有统计学意义(P<0.05)。在术后拔管时间方面,C组最早,与其他各组相比差异具有统计学意义(P<0.05);其次是A组和B组,而D组与其他三组相比明显延长,差异具有统计学意义(P<0.05)。[结论]对于开放性单节段或双节段腰椎融合手术,联合局部使用TXA和间断负压引流可以明显减少术后引流量和总出血量,缩短引流管留置时间。     

Active wound dressing with artificial capillaries for temporary wound irrigation and skin cell supply

Medical treatment of burns and chronic wounds remains a challenge. We discussed a therapy concept that combines skin cell spray transplantation with a novel wound dressing based on artificial hollow fiber membrane capillaries. In skin cell-based therapy development, autologous skin progenitor cells are isolated from a healthy skin area and sprayed onto the wound. A medical device was introduced that uses perfused capillaries, known from clinical plasma separation, as a temporarily applied extracorporeal wound capillary bed. The functions of the dressing are comparable with those of dialysis; the capillaries, however, are applied externally onto the wound. Perfusion with a clinical peripheral nutrition and buffer solution can provide wound irrigation, wound debris removal, cell nutrition, pH regulation, and electrolyte balance while potentially serving to address delivery of regenerative factors and antibiosis. An innovative active skin wound dressing that provides cell support and stimulates regeneration by wound irrigation is discussed.     

持续双侧脑室引流间断腰池引流治疗重症脑室出血

重症脑室出血起病急、进展快、死亡率高。本院从1991年10月至2000年9月,用双侧侧脑室持续引流,脑室内注入尿激酶,并且间断腰池引流灌洗治疗92例重症脑室出血,取得较好疗效。报道如下。1临床资料1.1一般资料:90例病人,其中男性54例,女性38例;年龄40～75岁,平均为63.5岁;高血压病史68例。1.2临床表现:起病时主要表现为剧烈头痛,恶心呕吐,迅速出现意识障碍。入院GCS评分:3分23例,4～6分53例,7～8分16例。呼吸不规则14例,双瞳孔缩小31例、大小不等11例,去脑强直8例。1.3CT表现:均为全脑室系统出血、脑室扩张。环池积血51例,原发性脑室出血21例…     

Iglesias resectoscope with continuous irrigation, suction and low intravesical pressure.

A resectoscope with continuous irrigation, suction and low intravesical pressure is described. Advantages of this instrument include: no interruption, better endoscopic vision by a continuous clear inflow of more than 600 ml per min, a constant intravesical pressure less than 10mm Hg during the resection, shorter operating time, less bleeding, easier teaching and no more wet floor and wet surgeon. Since the entire amount of irrigating fluid is collected, blood loss can be calculated and the amount of absorption determined.     

延长引流时间并间断夹闭引流管治疗脊柱术后脑脊液漏的疗效观察

目的:评价延长切口引流时间并间断夹闭引流管治疗脊柱手术后脑脊液漏的效果。方法:1999年12月~2009年12月我科行脊柱手术1400例,术后出现脑脊液漏31例,其中男19例,女12例,年龄22~70岁,平均48.5岁。15例采用常规术后3d拔除切口引流管及更换切口敷料治疗(A组),16例采用延长切口引流时间并间断夹闭引流管治疗(B组),两组在切口愈合前均应用抗生素预防感染。观察两组脑脊液漏消失和切口愈合时间及相关并发症情况。结果:A组脑脊液漏消失时间为20.0±3.8d,切口愈合时间为24.0±4.3d,其中8例初期治疗切口愈合,术后平均20d脑脊液漏消失;7例初期治疗失败,其中2例1周内脑脊液漏无减少趋势均行单纯硬膜修补,修补术后15d脑脊液漏消失;2例合并假性硬膜囊肿,行囊肿壁切除、硬膜修补常规术区放置引流管,术后15d复查MRI未见硬膜外脑脊液潴留;3例合并切口感染行切口切开彻底清创、对口置管冲洗引流及静脉应用抗生素,术后平均15d切口愈合。B组脑脊液漏的引流及消失时间为9.0±1.6d,切口均Ⅰ期愈合,愈合时间为14.0±2.5d,未出现假性硬膜囊肿及切口感染等并发症。B组脑脊液漏消失时间和切口愈合时间明显短于A组(P0.05)。结论:采用延长切口引流时间并间断夹闭引流管的方法治疗脊柱手术后脑脊液漏有效,效果优于常规术后3d拔除引流管并更换切口敷料的治疗方法。     

A simple method for irrigation and drainage in neurosurgery

Summary A simple, inexpensive method for drainage of neurosurgical wounds, coupled with continuous irrigation, is described. Obstruction of the drain is effectively prevented with this method.     

腰大池置管持续引流治疗脊柱术后脑脊液漏的疗效分析

目的:探讨腰大池置管持续引流治疗脊柱术后脑脊液漏的疗效。方法:2003年3月~2010年7月在我科行脊柱手术的患者共982例,术后出现脑脊液漏45例,其中26例行腰大池置管持续引流。23例为单纯脑脊液漏,采用腰大池置管持续引流;2例脑脊液漏合并颅内感染,行腰大池置管持续引流加鞘内注射抗生素;1例脑脊液漏合并颅内感染及伤口深部感染,行腰大池置管持续引流加鞘内注射抗生素,同时行伤口深部病灶清除冲洗引流。结果:26例患者均痊愈出院,腰大池置管时间平均为7.2d。无一例出现脑脊液漏复发、颅内感染和伤口感染等并发症。23例单纯脑脊液漏患者中,22例在行腰大池引流2d后脑脊液漏停止,1例在引流5d后脑脊液漏停止,腰大池置管时间平均为6.7d;2例脑脊液漏合并颅内感染患者,均在引流2d后脑脊液漏停止,腰大池置管时间均为9d;1例脑脊液漏合并颅内感染及伤口深部感染患者,经腰大池置管持续引流、鞘内注射抗生素及伤口深部病灶清除冲洗引流综合治疗14d后痊愈。结论:腰大池置管持续引流治疗脊柱术后脑脊液漏安全、有效。     

Closed suction drainage for hip and knee arthroplasty. A meta-analysis

BACKGROUND: The use of closed-suction drainage systems after total joint replacement is a common practice. The theoretical advantages for the use of drains is a reduction in the occurrence of wound hematomas and infection. The aim of this meta-analysis was to determine, on the basis of the evidence from randomized controlled trials, the advantages and adverse effects of surgical drains. METHODS: All randomized trials, as far as we know, that compared patients managed with closed-suction drainage systems and those managed without a drain following elective hip and knee arthroplasty were considered. The trials were identified with use of searches of the Cochrane Collaboration with no restriction on languages or source. Two authors independently extracted the data, and the methods of all identified trials were assessed. RESULTS: Eighteen studies involving 3495 patients with 3689 wounds were included in the analysis. The pooled results indicated that there was no significant difference between the wounds treated with a drain and those treated without a drain with respect to the occurrence of wound infection (relative risk, 0.73; 95% confidence interval, 0.47 to 1.14), wound hematoma (relative risk, 1.73; 95% confidence interval, 0.74 to 4.07), or reoperations for wound complications (relative risk, 0.52; 95% confidence interval, 0.13 to 1.99). A drained wound was associated with a significantly greater need for transfusion (relative risk, 1.43; 95% confidence interval, 1.19 to 1.72). Reinforcement of wound dressings was required more frequently in the group managed without drains. No difference between the groups was seen with respect to limb-swelling, venous thrombosis, or hospital stay. CONCLUSIONS: Studies to date have indicated that closed suction drainage increases the transfusion requirements after elective hip and knee arthroplasty and has no major benefits. Further randomized trials with use of larger numbers of patients with full reporting of outcomes are indicated before the absence of any benefit, particularly for the outcome of wound infection, can be proved.     

Intravesical pressure during transurethral resection using Iglesias resectoscope with continuous irrigation and suction.

Intravesical pressure was studied in 20 patients during transurethral resection (TUR) of the prostate using the Iglesias resectoscope with continuous irrigation and suction. The suction pressure (50 cm H20) was considerably lower than that suggested by Iglesias. The amount of irrigant was thereby appreciably diminished and blocking of the outlet system was avoided. The intravesical pressure averaged 35 cm H20 during resection, which is less than in conventional resection, and 15 cm during evacuation of tissue chips. Signs of TUR syndrome were not seen. We consider the new resectoscope to be a considerable improvement for TUR.