负压封闭引流技术在胸部深部感染性创腔创面治疗中的应用

目的:探讨负压封闭引流技术(vaeuum assisted closure,VAC)用于肺部术后胸部深部感染性创腔创面的治疗效果。方法:入选因行肺叶切除术后遗留感染性创腔创面共10例,清创后安装VAC装置,采用100~125mm Hg负压及持续吸引模式治疗,有手术指征者转整形外科治疗至愈合。观察治疗后伤口肉芽覆盖和治愈情况。结果:负压封闭引流技术(VAC)治疗后伤口治愈率80%(8/10),平均愈合时间(18±3.2)d,其中1例转整形外科手术治愈,1例行清创缝合出院。结论:VAC治疗对胸部深部创腔创面治疗有效,促进创腔的封闭、肉芽组织生长和伤口愈合。     

应用封闭负压引流技术治疗四肢地震创伤的临床疗效分析

[目的]探讨应用封闭负压引流技术治疗四肢地震创伤的临床疗效。[方法]四川地震伤员99人,合并四肢开放性损伤21人23处,均在首次伤口换药时采取创面分泌物做细菌培养及药敏试验,创面彻底行清创后应用一次性封闭负压引流敷料覆盖创面,根据药敏结果选用敏感抗生素抗感染治疗,待创面清洁肉芽组织新鲜后采用直接缝合、游离植皮、邻位皮瓣和带蒂皮瓣转移闭合创面。[结果]本组伤员21人经治疗后创面全部愈合。[结论]地震后四肢开放伤损伤应用封闭负压引流技术可以促进炎症消退及伤口肉芽组织生长,为Ⅱ期闭合伤口提供良好的软组织条件,可加速创面闭合,缩短肢体功能恢复时间。     

手部油漆高压注射伤的治疗

目的：探讨手部高压注射伤急诊清创及二期修复闭合创面的方法。方法对6例手部油漆高压注射伤患者,急诊于显微镜下行彻底清创手术,若不能一期清除干净,则将伤口敞开,二次清创闭合创口。结果本组4例一期愈合,2例经二期手术扩创后愈合。术后功能恢复优5例,良1例,6例患者均重返工作岗位。结论对于手部油漆高压注射伤的治疗,早期清创,开放伤口,必要时重复清创及二期闭合创面,可以获得较好的治疗效果。     

黄金微针射频治疗腋臭术后感染继发溃疡的处理分析

目的:以黄金微针射频术治疗腋臭后感染并继发多处溃疡的伤口处理为例,介绍笔者科室伤口处理过程中根据伤口基底情况的演变选用不同功能敷料促进伤口愈合的经验。方法:运用"TIME"原则,对患者双腋下超过50处的散在溃疡面进行机械清创,联合使用不同功能的敷料进行伤口管理,并在创面愈合后就使用抗瘢痕增生的药物积极预防瘢痕形成。结果:通过14d机械清创联合自溶清创,双腋下创面从25%黑色坏死组织,75%黄色组织逐渐转变为100%红色新鲜肉芽组织,加之合理使用银离子敷料控制感染、水凝胶促肉芽生长、泡沫敷料管理渗液及促进上皮移行,经过约50d的伤口处理,患者双腋下散在50多处溃疡面完全愈合。患肢功能正常,瘢痕小,患者满意。结论:银离子敷料、水凝胶及各种泡沫敷料联合治疗对光电术后伤口的愈合有明显促进作用,对不良反应的改善和恢复也大有益处。     

封闭式负压引流促进创面愈合的机制

封闭式负压引流（vacuum-assisted closure，VAC）疗法也称负压伤口（topical negative pressure wound，TNP）疗法，是将吸引装置与特殊的伤口敷料连接后，使伤口保持在负压状态，达到治疗目的。1993年，Fleischmann等^[1]首次将负压应用于创面感染的预防，并发现所有创面清洁迅速，水肿消退增快，     

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。     

清创后负压辅助肢体创面闭合与常规治疗的比较

[目的]评价清创联合负压辅助创面闭合在治疗肢体创面的临床效果。[方法]回顾性分析2017年10月—2019年11月本院收治的骨科肢体创面64例患者的临床资料。依据术前医患沟通结果，32例采用清创联合负压辅助创面闭合治疗（VAC组），32例采用清创联合常规创面换药治疗（常规组）。比较两组围手术期、随访与检验结果。[结果]两组均顺利完成二期手术，术中无严重并发症。VAC组初次手术时间长于常规组，但差异无统计学意义（P>0.05）,VAC组换药次数、渗出评级、肉芽评级、两次手术间隔时间、二次手术时间、创面愈合情况、住院时间等均显著优于常规组（P<0.05）。VAC组的完全负重活动时间显著早于常规组（P<0.05）。随时间推移，两组VAS评分、局部瘢痕情况、邻近关节功能均显著改善（P<0.05）。术后3个月VAC组上述指标显著优于常规组（P<0.05）。术后6、12个月两组上述指标的差异均无统计学意义（P>0.05）。实验室检查方面，随时间推移，两组WBC、NEU、CRP和ESR均显著下降（P<0.05）。二次术前VAC组上述指标均显著优于常规组（P&...     

手部油漆高压注射伤的治疗

我科自2006年3月～12月共收治油漆高压注射伤6例,根据患者不同的伤情分别采取急诊彻底清创一期闭合创面、置管持续冲洗或彻底清创后敞开伤口引流、二期重复清创闭合创面。合并皮肤缺损者同时予以皮瓣修复等治疗[3],取得了较为满意的治疗效果,现总结如下。1资料与方法     

负压创面治疗技术的研究进展

负乐创面治疗技术（negative pressure wound therapy，NPWT）又称真空辅助闭合疗法（vacuum assisted closure）、吸引创面闭合疗法（suclion wound closure therapy）．是近几年来兴起的一种促进创面愈合的前沿技术。该技术足将吸引装置与特殊的伤口敷料连接后，使伤口保持在负压状态，可以改善创面微循环．促进创面肉芽生长，减少细菌定植和繁殖，保持伤口环境湿润，从而达到治疗创面的目的。国内外学者将负压创面治疗技术应用于多种急、慢性创面的治疗或促进移植皮肤、皮瓣的成活，均取得了良好的效果。     

美盐敷料用于感染性伤口换药

目的探讨美盐敷料在感染性伤口换药中的疗效。方法将80例感染性伤口患者随机分为观察组和对照组各40例,常规清创消毒后,观察组用美盐敷料填敷创面,对照组用优锁尔填敷创面。观察两组的愈合时间、换药次数以及疼痛情况并记录。结果观察组治疗效果显著优于对照组,愈合时间显著缩短,换药次数显著减少,患者疼痛明显减轻(均P0.01)。结论美盐敷料用于感染伤口换药效果较好。     

Diabetic foot and foot debridement technique

Surgical foot debridement is widely practised in diabetic foot care. Although minor debridement could be done at the bedside with or without local anaesthesia, more extensive debridement would require regional or general anaesthesia in operating theatres. Delayed surgery could increase the risk of limb loss and mortality. The International Working Group of the Diabetic Foot (IWGDF) or the Infectious Diseases Society of America classifications could be used to assist management of the diabetic foot sepsis. A detailed knowledge of the anatomy of the foot is required to achieve the best outcome. Complications of diabetes and any amputation further disrupts the biomechanics of the diabetic foot and increases the risk of transfer ulceration. Foot biomechanics should be considered while debridement and reconstructive techniques employed, although adequate debridement shouldn't be compromised.     

Diabetic foot and foot debridement technique

Surgical foot debridement is widely practised in diabetic foot care. Although minor debridement could be done at the bedside with or without local anaesthesia, more extensive debridement would require regional or general anaesthesia in operating theatres. Delayed surgery could increase the risk of limb loss and mortality. The International Working Group of the Diabetic Foot (IWGDF) or the Infectious Diseases Society of America classifications could be used to assist management of the diabetic foot sepsis. A detailed knowledge of the anatomy of the foot is required to achieve the best outcome. Complications of diabetes and any amputation further disrupts the biomechanics of the diabetic foot and increases the risk of transfer ulceration. Foot biomechanics should be considered while debridement and reconstructive techniques employed, although adequate debridement should not be compromised.     

Charcot's foot

Charcot's foot used to be considered an unusual complication of diabetic peripheral neuropathy. With the current appreciation that approximately 25% of adult diabetics have an appreciable peripheral neuropathy, it is understandable that Charcot's neuro-osteoarthropathy has become recognized as a major problem for clinicians caring for diabetics. Differentiation from acute diabetic foot infection is the first challenge. Once Charcot's foot is identified, treatment generally involves immobilization during the acute inflammatory stage. When deformity develops, the orthopedic foot and ankle surgeon must decide whether accommodative care with a combination of inlay depth shoes, accommodative foot orthoses, and ankle-foot orthoses is adequate. If a plantigrade weight-bearing surface cannot be achieved, surgical stabilization or reconstruction requires rigid stabilization in a poor biomechanical environment using tools that are not designed for structures as small as the foot. The controversies presented to clinicians charged with care of this difficult patient population are as follows: 1. When to allow weight bearing in the acute phase of the disease process. 2. Whether prefabricated devices are as successful as the total contact cast in the acute phase. 3. Early surgical stabilization versus accommodation when deformity first develops. 4. Late reconstruction versus accommodation or amputation in the deformed late stages.     

Madura foot

Madura foot is the most frequent clinical form of mycetoma, which is a tumor-like destructive fistulized infection of the foot, caused by fungi. The only effective treatment is complete resection of the lesions. Leg amputation is frequently required.     

Madura foot

Summary Two cases of Madura foot which originated in the Middle East are described. This so-called maduramycosis is a chronic progressive infection caused by thread fungi or actinomycetes. The diagnosis is confirmed when the grains of mycetoplaits are demonstrated in the discharge from a sinus. Clinical findings and treatment are discussed. Medical treatment may be needed for several months, but operation is indicated for infections caused by the true fungi (eumycetoma).

---

Résumé Présentation de deux cas de pied de Madura originaires du Moyen-Orient. Cette maduramycose est une infection chronique progressive due à des filaments mycéliens ou actinomycètes. Le diagnostic peut être affirmé lorsqu'on met en évidence dans l'écoulement s'évacuant par les fistules des grains constitués d'amas de filaments mycéliens. Les constatations cliniques et le traitement sont discutés. Le traitement médical doit parfois être poursuivi plusieurs mois, mais une intervention chirurgicale peut être indiquée en présence d'infections dues à de véritables mycoses (ou eumycétomes).

     

Club foot

This review article examines the aetiology of congenital talipes equinovarus deformity, and the pathological difference between postural and structural club foot. The early assessment and management, the various surgical options, and the need for critical long-term audit are described.