Application Of Vacuum Sealing Drainage Research Articles

Surgical therapy and outcome of descending necrotizing mediastinitis in Chinese: a single-center series.

Descending Necrotizing Mediastinitis (DNM) is an acute and often fatal infection that affects the neck and mediastinum. DNM treatment consists of broad-spectrum antibiotics, early diagnosis, and surgical debridement with multidisciplinary cooperation. However, owing to the rarity and complexity of this disease, the mortality rate is high. This retrospective study analyzed a single-center experience of managing DNM in Chinese patients over the last 10 years. A single-center, retrospective, observational, and descriptive study was conducted on 31 patients with DNM at Peking Union Medical College Hospital from 2012 to 2022. Case report forms were used to collect data which were then analyzed with a focus on surgical management and outcomes. This study examined the outcomes of 31 patients diagnosed with DNM at our hospital. The most common comorbidities on admission were hypertension (48%) and diabetes mellitus (42%). The degree of diffusion of DNM according to Endo's classification was classified as follows: type I in 7 patients (22.6%), type IIA in 5 (16.1%), and type IIB in 19 patients (61.3%). Among these patients, 13 (41.9%) were found to have a single microbial infection, while 16 (51.6%) were found to have polymicrobial infections. In all cases, neck drainage was performed via cervicotomy, with multiple drains (64.5%) and vacuum sealing drainage (VSD) (35.5%). Mediastinal drainage was performed via a cervical mediastinotomy (51.6%), video-assisted thoracic surgery (VATS) (41.9%), or thoracotomy (6.5%). The 30-day mortality rate was 25.8% and 24.0 days of the average length of hospital stay. Early accurate diagnosis and timely intervention have been shown to be correlated with a positive prognosis. Cervicothoracic CT (computed tomography) is essential for the diagnosis, staging, and evaluation of the optimal surgical treatment. Cervicotomy and video-assisted thoracoscopic surgery with percutaneous drainage is effective, even in advanced cases. Additionally, the application of VSD in cervical incision did not improve prognosis but may shorten the length of ICU (intensive care unit) and hospital stays.

Clinical analysis of accelerated rehabilitation surgery for Gustilo type IIIA/B open tibio fibular fracture.

To investigate the clinical efficacy of accelerated rehabilitation surgery for the treatment of Gustilo type IIIA/B open tibiofibular fracture with emergency stage I debridement, internal fracture fixation, bone grafting, coverage of the wound surface with a muscle flap combined with vacuum sealing drainage (VSD), and internal and lateral leg reduction. A retrospective analysis was performed on the clinical data of 15 patients with Gustilo type IIIA/B open tibiofibular fracture who were admitted to the Affiliated Zhongshan Hospital of Dalian University from January 2015 to December 2018. There were 12 males and 3 females. The patients ranged in age from 20 to 62years, with an average of 39.5years. After admission, the patients underwent stage I emergency debridement (including exploration and repair of nerves and tendons), open reduction and internal fixation of the tibia and fibula, iliac bone grafting, muscle flap and VSD coverage of the bone defect, complete tensioning of the calf inside and outside, tibia-sparing incision before healing, and stage II free skin grafting. Patients were followed up periodically to observe muscle flap survival, fracture healing time, length of hospitalization, wound healing time, delayed union, bone nonunion, osteomyelitis and other complications. At the last follow-up, the Johner-Wruhs criteria were used to evaluate the rate of good functional recovery from tibial shaft fracture, fracture healing quality was evaluated by the Merchant score, and limb function was evaluated by the LEFS. All 15 cases were followed up for 12-32months, with an average of 22.8months. All the fractures healed; the range of healing time was 14-30weeks (mean 18.5weeks). The length of hospitalization was 25.1 ± 7.6days, and wound healing took 12.2 ± 2.0days. None of the patients had complications such as osteomyelitis infection. When the Johner-Wruhs evaluation criteria for functional recovery from tibial shaft fracture were applied at the last follow-up, the outcomes were as follows: excellent in 13 cases, good in 1 case and fair in 1 case, for an excellent and good rate of 93.3%. When fracture healing was evaluated according to the Merchant scoring standard, the outcomes were as follows: excellent in 12 cases, good in 1 case, fair in 1 case, and poor in 1 case, for an excellent and good rate of 86.7%. The mean LEFS score of the affected limb at the last follow-up was 70 (59-80). For Gustilotype IIIA/B open tibiofibular fractures, emergency stage I debridement, internal fixation of the fracture, bone grafting, coverage of the wound with a muscle flap, complete tensioning of the calf inside and outside, and application of VSD can improve the repair of leg soft-tissue defects, shorten hospitalization time, promote fracture healing, and effectively reduce infection and complications related to bone exposure. More importantly, this treatment protocol provides effective wound repair, guarantees the recovery of limb function, significantly speeds up recovery, and improve patients' quality of life.

Exploration on clinical treatment of incisional wound infection after orthopedic internal fixation for lower extremity joint injuries

Exploration on clinical treatment of incisional wound infection after orthopedic internal fixation for lower extremity joint injuries

Skin-stretching device promotes the treatment effect of vacuum sealing drainage technique on phases III and IV stress-induced injuries in aged patients with chronic critical illness: A retrospective study of 70 patients.

Stress-induced injury is a common complication associated with patients with chronic critical illness (CCI). Skin-stretching device (SSD) and vacuum sealing drainage (VSD) technique are 2 approaches that can facilitate wound healing.In the present study, the effect of the concatenated application of the 2 techniques on the phases III and IV stress-induced injuries in aged patients with CCI was assessed. About 70 patients with CCI with stress-induced injuries were selected from February 2015 to October 2017. The treatment outcomes of the combined method and VSD method were assessed by comparing their clinicopathologic parameters.The results showed that the combined treatment shortened the average healing duration of wounds. Moreover, the total area of pressure sores, incidence of bleeding, bacteria amount, 28-day cure rate, peripheral C-reactive protein (CRP) level, and the hospitalization duration were all significantly improved in patients treated with SSD and VSD. The overall effective rate (97.14%) of patients treated with VSD and SSD was significantly higher than that (77.14%) in patients treated with VSD.The present study showed that the combined application of VSD and SSD improved the treatment outcomes of phases III and IV stress-induced injuries in aged patients with CCI.

Application of vacuum sealing drainage in limb salvage of multiple trauma patients with Gustilo type III C open fracture

Objective To investigate the safety and effectiveness of vacuum sealing drainage treatment on limb salvage in multiple trauma patients combined with Gustilo type IIIC fracture. Methods A retrospective case control study was conducted to analyze the clinical data of 102 patients diagnosed with multiple trauma combined with Gustilo type III C fracture admitted to Tongji Hospital from October 2005 to October 2015. There were 66 males and 36 females, aged 17-65 years [(34.2±10.1)years]. The injury severity score (ISS) ranged from 18 to 26 points [(19.8±3.2)points]. There were 34 patients with femur fracture, 66 with tibia/fibula fracture, 35 with femur and tibia/fibula fracture. Among the patients, 58 were treated with VSD (VSD group) and 44 were treated with routine dressing change after emergency operation (routine group). The two groups were compared for active bleeding, re-vascular exploration, osteofascial compartment syndrome, wound infection and necrosis, gas gangrene, delayed amputation, systemic inflammatory response syndrome (SIRS), sepsis, deep venous thrombosis (DVT) incidence, per capita debridement times, length of stay, skin graft/skin flap rate, fracture fixation rate, incidence of refractory wounds, incidence of nonunion, incidence of complete nerve damage, British medical research council (BMRC) score, and amputation rate/salvage rate. Results All patients were followed up for 6-14 months [(8.4±2.1)months]. There was no significant difference in limb salvage rate between the two groups after operation (P>0.05). Among the indexes of limb salvage treatment after operation, no significant differences were found between the routine group and VSD group in active bleeding, gas gangrene, re-vascular exploration and delayed amputation (P>0.05); the wound infection and necrosis rates were 32% and 15% (P<0.05); the incidence rates of osteofascial compartment syndrome were 22% and 7% (P<0.05). During the hospital stay, there were no significant differences in DVT incidence and fracture internal fixation rate between the two groups; SIRS incidence rates of routine group and VSD group were 92% and 73% (P<0.05); the incidence rates of sepsis were 28% and 10% (P<0.05); the per capita debridement times in routine group and VSD group were 4.2 times and 3.2 times, respectively (P<0.05); hospitalization durations were 42.1 days and 30.2 days (P<0.05); skin graft/skin flap rates were 69% and 46% (P<0.05). In the follow-up results, there was no significant difference in the amputation rate/salvage rate between the two groups (P<0.05). The incidence of refractory wounds was 28% in routine group and 10% in VSD group (P<0.05); the incidence of nonunion was 22% and 6% (P<0.05); the incidence of complete neurological damage was 36% and 12% (P<0.05); the excellent and good rate of BMRC score was 83% and 96% (P<0.05). Conclusions VSD technology can promote wound healing after operation, prevent complications, reduce the number of debridement operations and shorten hospital stay, significantly improving the prognosis and limb function of patients. It is a relatively safe and effective method for the treatment of multiple trauma combined with Gustilo type III C fracture. Key words: Multiple trauma; Negative-pressure wound therapy; Fractures, open; Prognosis

Application of vacuum sealing drainage in the treatment of severe necrotizing fasciitis in extremities of patients

To study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients. Eight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence. VSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.

Vacuum sealing drainage facilitates the survival of slender narrow pedicle flap

Objective To probe into the application of vacuum sealing drainage (VSD) in flap with slender narrow pedicle and to observe the survival,the shaping of blood vessel,congested edema and the expression of CD34 in the flap,and to analyze the underlying mechanism of VSD on the flap survival.Methods 64 SD rats were randomly divided into 8 groups:4-hour group,8-hour group,1-day group,2-day group,3-day group,4-day group,and 6-day group.A flap was designed and put on either side of a rat's back.The both width and length of the flap were 0.8 cm and the pedicle sized in the diameter of 3.5 cm.Both sides of the flaps on the rats' backs were randomly arranged into control side and experimental side.VSD was fixed sideways to each group after the shaping of flaps.Each of the equipments was dismantled respectively in the corresponding time after the operation.Afterwards the color and swelling degree of the flaps were observed,a sample was cut and the flap survival area was measured altogether on the 7th day.Flap histology and the expression of CD34 were observed mainly through HE dyeing and immunohistochemistry.The statistical data were treated to figure out the flap survival rate and to determine whether statistical differences existed in the microvessel density (MVD).Results As the time of the negative pressure suction went on,the survival area of the experimental side flap was increasing day by day and came to the maximum on the third day (95±4)％,but no statistical difference was discerned between on the third day and on the sixth day (P＞0.05).As the time of the negative pressure suction went on,the MVD in the flap was also increasing.Statistical differences (P＜0.05) existed between the experimental side of the instant group,4-hour group and the 8-hour group and those of 3-day group,4-day group,and 6-day group.Conclusions The application of VSD can advance the survival of the flap,whose survival area can reach its maximum within 3 days under application.Besides,it can promote the increase of MVD in the flap. Key words: Vacuum sealing drainage (VSD) ; Narrow pedicle; CD34; Microvessel density

Application of vacuum sealing drainage in wave suction to repair severe defects with free dermatoplasty

Objective To discuss the application of vacuum sealing drainage in wave suction to prevent the complications in repairing severe defects with free dermatoplasty.Methods Necrotic tissues were debrided entirely,and the fresh defects received dermatoplasty with moderate thickness or full thickness free skin graft and VSD was equipped.VSD aspirated the effusion bellow free skin and lacouna around free skin on negative pressure initiatively and alternatively from 16.6～ 17.3 kPa (125-130 mmHg) (3 hours) to 40 kPa (300 mmHg) (0.5 hour).Vacuum sealing drainage was removed after 7 days.Results A total of 22 cases were treated,and the follow-up time was between 6 months and 18 months,and the result was ideal.A little necrosis of the dermatoplasty on tendon in one patient was seen after removal of VSD,the skin graft reactivated after applying VSD again and changing dressings,and the other free skin survived well without effusion and infection.Conclusions The application of vacuum sealing drainage in wave suction combined with free dermatoplasty to repair a part of patients with severe defects is a good choice.This method can aspirate the effusion to reduce the infection,promote the sealing between skin and recipient site.At the same time,it can prevent the necrosis of free skin and the tissue of skin around defects owing to heavy pressure in a long time. Key words: Vacuum sealing drainage; Wave suction; Severe defect; Dermatoplasty

Design of ARM-based pressure control system of vacuum sealing drainage device

Objective With the extensive application of vacuum sealing drainage (VSD),vacuum control mode needs to be developed and improved.The aim of this study was to develop ARM-based VSD system.Methods The system was composed of central processing unit,pressure sensing unit and pressure control units.32-bit LJD-e Win7000 was used as central processing unit.X-type silicon pressure sensor was used to sense the pressure.Real time feedback technology was applied to control the solenoid opening and closing in order to accurately control the negative pressure.Results VSD pressure control system was completed.Compared with the measured value,the system had relatively large error in low pressure.With the increase of pressure,the error decreased.Conclusion Through linear correction algorithm,the pressure control system can meet the requirements of VSD machine. Key words: Vacuum sealing drainage; ARM system; Pressure control

Clinical application of vacuum sealing drainage in treatment for the soft tissue defect in four limbs trauma

Objective To study the clinical efficacy of modified vacuum sealing drainage (VSD) technique for the treatment of extremities skin and soft tissue defect associated with trauma infection.Methods From May 2009 to September 2011,53 patients with complex traumatic defect were admitted in our hospital.Secondary trauma infection occurred in all cases.The defect was applied with VSD and irrigated with physiological saline for 7 to 14 days (mean of 10days).Once a smooth bed of granulation tissue was established,the defect was converged with either a skin graft (n=35)or flap (n=10).Results In this series,1 to 3 (mean,1.6) VSD applications were used before performance of reconstructive surgery,trauma healing was achieved in 52 cases and recurrence of infection was not observed,only 1 case was infected recurrence after trauma healing because of necrotic tissue.Conclusion The modified VSD technique can more effectively treat trauma with complex injury,help reduce the trauma infection rate,and it's beneficial for post-surgical trauma repair and reconstruction. Key words: Modified vacuum sealing drainage; Trauma; Soft tissue defect

Application of vacuum-sealing drainage for early infection in Gustilo III open fractures

Objective To study management of early infection in Gustilo Ⅲ open fractures and explore the effects of region- and layer-wise applications of Vacuum-Sealing Drainage (VSD). Methods Early in-fections in 46 cases of Gustilo Ⅲ open fracture were treated with VSD from December 2006 to January 2008. Of them, 11 cases were type Ⅲ A; 28 type Ⅲ B, and 7 type Ⅲ C. The area of infected wound surface or skin necrosis ranged from 3 cm × 2 cm to 50 cm×35 cm in all the patients who had previously undergone fixation and vessel repair. After they were treated with debridement, change of fracture fixation or position adjustment of outer fixation device, VSD was applied in a region- and layer-wise manner in the inter-muscular space, inter-joint space and the inter-fracture space of the infection region. The sequence and time of tube withdrawal were dependent on tube position and drainage pattern. After fresh granulation tissue grew, 12 cases underwent flap and muscle graft and 34 cases (36 lesions) underwent skin graft or suture to cover the wounds. Three to 6 months after wound healing, retention of former fixation or change to a permanent fracture fixation was de-termined according to the healing condition and the stability of the fixation. Results All the cases ob-tained fine fracture healing and effective control of infection after debridement and VSD. Forty-four cases of skin graft and tissue flap transplantation showed one-time full recovery, and 2 cases of free skin graft still had a small part of wound unhealed after first transplantation but fully recovered after re-transplantation. All pa-tients had normal body temperature and hemogram, no local fistula or pain. Fractures united within 5 to 12 months with fine limb functional recovery. Conclusions Early detection and timely treatment of early infection in Gustilo Ⅲ open fractures may result in preferable prognosis, and region- and layer-wise application of VSD is effective to control the infection. Key words: Fractures, open; Infection; Drainage; Occlusive dressings

Secondary characteristics and treatment of casualties evacuated from Wenchuan earthquake area

Objective To discuss the characteristics and treatment of the casualties evacuated from Wenchuan earthquake area. Methods An analysis was done on the 15 evacuated earthquake casualties who received secondary treatment in our hospital from May 22 to 24. Combined therapeutic protocols were used for the 15 cases, including psychological rehabilitation, wound excision, open reduction and internal fixation, application of vacuum sealing drainage, and dermatoplasty. Results The casualties were characterized by psychic trauma following earthquake (15 cases), infection after extremity amputation (4 cases), soft tissue defects (10 cases), and injury to extremity rather than to spine (only 1 case of spinal fracture). Infection was well controlled, wound surface healed, and fracture obtained stable fixation in all the patients. Conclusion The therapeutic protocols based on the secondary characteristics of earthquake casualties are effective. Key words: Earthquake; Evacuated casualties; Secondary characteristics