Vacuum Sealing Drainage Therapy Research Articles

Acute compartment syndrome secondary to anterolateral thigh flap harvesting in a pediatric patient

Introduction:The anterolateral thigh (ALT) flap is the most popularly used flap for major soft tissue reconstruction. Although it is widely used, acute compartment syndrome (ACS) in pediatric patients has rarely been reported in the literature. We herein reported a case of ACS in a 6-year-old girl after ALT flap harvest with direct closure of the donor site.Patient concerns:A 6-year-old girl was admitted to the Second Hospital of Jilin University with crush injury on the palmar aspect of the right hand and wrist.Diagnosis:Examination showed soft tissue defect of the hand and wrist, damage on the thenar muscles, lightly crushed flexor tendons, crushed median nerve, and ulnar artery thrombosis.Interventions:The defect was closed with an ipsilateral ALT flap measuring 9 cm in length by 6 cm in width.Outcomes:After debridement was performed 3 times, the majority of the rectus femoris and lateral femoris were removed. Secondary closure by skin grafting was performed 2 weeks later. Three days after the procedure, necrotic tissues were noted on the edges of the wound. The diagnosis of ACS of the right was made. A second exploration was decided, and an extensive anterior compartment fasciotomy was performed. After 6 weeks of vacuum sealing drainage therapy, the defect was closed with a free latissimus dorsi musculocutaneous flap. At 4 months of follow-up, the right thigh wound had healed. At 6 months of follow-up, quadriceps muscle weakness remained. At 1 year of follow-up, the patient's mobility had been significantly improved, but diminished sensation remained on the lateral aspect of the thigh.Conclusion:ACS can occur after ALT flap harvesting in pediatric patients and should be recognized as early as possible to avoid devastating complications.

Microfluidic Printing of Slippery Textiles for Medical Drainage around Wounds.

Surface materials with specific wettability play significant roles in existing fields from environmental protection to biomedicine. Here, a 3D droplet transport microfiber textile with slippery liquid‐infused porous surface is presented for medical drainage around wounds. The textile is fabricated by using a simple capillary microfluidic printing method to continuously spin polyurethane microfibers with liquid paraffin‐infused porous surface and print them into a 3D‐structure. Benefiting from the specific surface porous structure and oil encapsulation of the microfibers, aqueous droplets could be nondestructively and rapidly transported not only in simple single, double or multiple microfiber systems, but also in the microfibers composed stereoscopic textile through the microfluidic 3D printing. Based on this feature, it is demonstrated that the 3D slippery microfiber textile coupled with a vacuum sealing drainage therapy could significantly enhance the wound exudation drainage efficiency, reduce tissue injury, and prolong the effective service life in versatile wounds management. Thus, it is believed that the slippery microfiber textiles have potential for clinical applications.

Comparison of clinical efficacy of the new type of irrigation and aspiration therapy and vacuum sealing drainage in the treatment of high perianal abscess

Objective To compare the clinical efficacy of the new type of irrigation and aspiration therapy and vacuum sealing drainage in the treatment of high perianal abscess. Methods 72 consecutive patients with high perianal abscess accepted to our department were randomized into the observation group and the control group, 36 cases in each group. The observation group underwent new type of irrigation and aspiration therapy and the control group underwent vacuum sealing drainage therapy. Preoperative, intraoperative and post-operative patient characteristics were evaluated. Results Compared with control group, the incision length of observation group was significantly shorter [ (15.2±3.6) mm vs. (33.2±8.4) mm, t=-11.818, P=0.000], the operation time was significantly shorter too [ (14.2±2.6) min vs. (16.8±3.2) min, t=3.784, P=0.000], and the postoperative pain score was significantly lower [ (3.5±1.1) vs. (5.3±1.6), t=5.562, P=0.000], the wound healing time was significantly shorter [ (14.3±3.2) d vs. (18.2±4.8) d, t=-4.056, P=0.000]. While in wound healing rate (69.44% vs. 66.67%, χ2=0.064, P=0.800), fistula formation rate (22.22% vs. 25.00%, χ2=0.077, P=0.781), and abscess recurrence rate (5.56% vs. 8.33%, χ2=0.215, P=0.643), there were no significant differences between the two groups. Conclusion The new type of irrigation and aspiration therapy can reduce the surgical trauma, shorten the operative time, reduce the postoperative pain and shorten the wound healing time. The new type of irrigation and aspiration therapy is an effective method for minimally invasive treatment of high perianal abscess. Key words: Irrigation and aspiration therapy; Vacuum sealing irrigation and aspiration device; High perianal abscess; Vacuum sealing drainage

Vacuum Sealing Drainage Therapy for Refractory Infectious Wound on 16 Renal Transplant Recipients

BackgroundRefractory infectious wounds on renal transplantation (RT) recipients significantly prolong hospital stay, increase medical costs, and threaten allograft survival. Vacuum sealing drainage (VSD) therapy is a new technique for managing wounds based on the principle of application of controlled negative pressure. The aim of this study was to summarize the efficacy and safety of VSD therapy in the management of refractory infectious wounds following RT. Materials and methodsThis is a retrospective study of a cohort of 661 consecutive patients who received renal transplants over a period of 3 years in which the data were collected and analyzed retrospectively. ResultsOut of the 661 patients, 16 (2.4%) developed refractory wound infection following RT. Nineteen organisms were identified by culture from all patients, including 10 patients infected with 1 or more bacteria, 2 patients with fungal infection, and 4 patients with both. Specifically, mucormycosis was demonstrated in 4 patients, pan-resistant Klebsiella pneumoniae in 2 patients, and Acinetobacter baumannii in 2 patients. All 16 patients were treated with VSD therapy for a median of 37 days (range, 6–111 days). The number of VSD sets used ranged from 4 to 28 sets (mean, 11.1 sets). A combination of antibiotics, debridement, and VSD therapy lead to 100% (16 of 16) wound healing. No VSD-relevant adverse events were observed. ConclusionsVSD therapy is an effective and safe adjunct to conventional treatment modalities for the management of refractory wound infection following RT.

Application of vacuum sealing drainage in oral and maxillofacial surgery

This study aimed to evaluate the clinical significance of Vacuum Sealing Drainage (VSD) therapy in oral and maxillofacial surgery patients with serious maxillofacial abscesses, trauma wounds, or flap necrosis, and to summarize the advantages of VSD. We retrospectively analysed 28 patients who received VSD therapy in our ward since 2013, including 13 patients with trauma wounds, 8 patients with abscesses, and 7 patients suffering from postoperative flap necrosis. We then compared their treatment time and pain scores with those of 22 patients who received traditional therapy. All the data were statistically analysed using SPSS software. The VSD device was safe, and the 28 serious wounds were effectively resolved after VSD therapy. The use of VSD significantly shortened the time required for healing by 54.5% (P<0.01) and reduced the pain scores by 48.8% (P<0.01) as compared to traditional treatment. VSD has more advantages than traditional therapy in the treatment of various serious maxillofacial wounds, and leads to greater patient satisfaction. VSD has many useful applications in oral and maxillofacial clinical practice.

Mechanism of vacuum sealing drainage therapy attenuating ischemia-reperfusion injury of skeletal muscle in rabbit

To investigate the mechanism of how vacuum sealing drainage (VSD) ameliorating ischemia reperfusion (I/R) injury in skeletal muscle I/R model. Thirty New Zealand white rabbits were divided into three groups: control (sham operation) group, I/R group, VSD+ I/R group.The ischemia of the left hind limb of the animal was induced by clamping the common femoral artery and vein. After 4 hours of ischemia, the clamp was removed and the hind limp underwent 6 hours reperfusion. VSD treated animals received the treatment at the beginning of reperfusion. The concentrations of myeloperoxidase (MPO), malondialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT) and glutathione (GSH) in muscular tissues were assayed. HE stained pathological section was used to evaluate the degree of edema of muscular tissues, and the immunohistochemistry was used to detect the percentage of positive cells expressing high mobility group protein B1 (HMGB1). Q-RT-PCR and Western Blot were used to detect the mRNA levels and protein expression of HMGB1 in myocyte respectively. The experimental data was tested using variance analysis. The levels of inflammatory factors and antioxidant factors in muscular tissues were significantly different in the I/R group compared to the VSD group and control group (the levels of MPO in I/R group, I/R+ VSD group and control group were 0.91±0.22, 0.53±0.08, 0.31±0.10, respectively, F=26.48, P=0.000; MDA were 2.04±0.92, 1.65±1.02, 1.01±0.12, F=4.250, P=0.040; SOD were 35.97±9.23, 55.99±18.97, 61.83±14.91, F=5.240, P=0.020; CAT were 31.42±16.27, 48.50±17.86, 75.95±13.09, F=9.720, P=0.002; GSH were 1.48±0.90, 3.54±1.88, 3.84±2.08, F=5.240, P=0.020). HE staining showed an increased intercellular space ratio in the I/R group (F=16.47, P<0.05). Immunohistochemistry staining showed that percentage of HMGB1 positive myocytes in control, I/R and I/R+ VSD group are 1.94%, 18.63% and 61.36%, respectively. There was significant difference among groups (F=853.886, P<0.01). A significantly inhibited HMGB1 expression by VSD therapy was also validated by the results of Q-RT-PCR (F=50.653, P<0.01) and Western blot (F=963.489, P<0.01). The results from the present research suggest that VSD may attenuate skeletal muscles I/R injury by increasing the cellular antioxidative stress reaction and inhibiting the reactive oxygen species as well as the inflammatory mediators.

Use of vacuum sealing drainage therapy in the closure of a radial forearm flap donor site defect with a full-thickness skin graft

ObjectiveThe donor site defect of a radial forearm free flap is typically repaired with a full-thickness or split-thickness skin graft. Reports of vacuum sealing drainage (VSD) therapy for the closure of a radial forearm flap donor site defect with a full-thickness skin graft are rarely presented. This clinical study evaluated the efficacy and safety of VSD therapy for the closure of radial forearm flap donor site defects with full-thickness skin grafts. MethodsThis study reviewed the cases of 28 patients (including eight patients with type 2 diabetes) who had undergone reconstruction of soft tissue defects resulting from resection of oral squamous cell carcinoma with radial forearm free flaps. VSD dressings were applied on the radial forearm flap donor sites in all patients. ResultsComplete coverage of the donor site defect with full-thickness skin graft was evident in (n=27) 96% of patients. Only one patient (4%) exhibited a partial loss of the graft at its edge. No tendon exposure was noted. The long-term functional and esthetic results were excellent over 4–12 months of follow-up. ConclusionsVSD therapy is a safe, effective, and simple technique for closing a radial forearm flap donor site defect with a full-thickness skin graft.

A study on revascularization after the treatment of vacuum sealing drainage technology combined bone graft for bone and soft tissue composite defect

Objective To study the feasibility and efficiency of vacuum sealing drainage (VSD) technology combined with bone graft and its influence on revascularization.Methods Twenty-four rabbits with bone and soft tissue defects were randomly divided into experimental group (VSD therapy with open bone graft) and control group (only open bone graft).The curative efficacy was assessed by wound conditions and wound healing time,X-ray examination,immunohistochemistry,and real-time quantitative polymerase chain reaction (Real-time PCR).Results Wounds and bone defects in experimental group tended to have shorter healing time and healthier wound conditions.Hematoxylin and eosin (HE) staining showed that the graft in experimental group produced plentiful micrangium.The expression of vascular endothelial growth factor (VEGF) via immunohistochemistry and Real-time PCR was significantly higher in experimental group than in control group.Conclusion The VSD therapy combined with open bone graft can be used as a feasible and valuable method to treat composite bone and soft tissue defect,and it may promote revascularization of the graft through up-regulating the expression of VEGF. Key words: Vacuum sealing drainage; Open bone graft; Bone defect; Revascularization

Clinical application of the reversed saphenous fasciocutaneous island flap combined with the vacuum sealing drainage therapy in plate exposure of the distal tibia

Objective To evaluate the clinical effect of the reversed saphenous fasciocutaneous island flap combined with the VSD therapy in plate exposure of the distal tibia.Methods From January 2008 to July 2010,seven patients with hardware exposure following internal fixation of the distal tibia fracture were treated by VSD therapy and reversed saphenous fasciocutaneous island flap reconstruction.The VSD therapy was performed from 7 to 26 days after hardware exposure,and the flap transfer was performed 7 to 14 days after the VSD therapy.The size of the soft-tissue defect ranged from 4 cm × 2 cm to 13 cm × 4 cm.The mean follow-up was 10.6 months after the fracture (range,8-14 months).Results The average times of the VSD therapy was 1.3.After VSD was removed,the exposed hardware was covered by healthy granulation tissue in all cases.All flaps were successfully transplanted,and the size of flap ranged from 6 cm × 3 cm to 15 cm × 6 cm.Six of 7 flaps survived completely without further procedures.The necrosis of the distal margin of the flap occurred in 1 patient.A solid bony union was confirmed by the X-ray in all patients after 4-6 months postoperatively.No skin defects or fistulae were observed.Conclusion The combination of the reversed saphenous fasciocutaneous island flap and VSD therapy could save the exposed hardware and cover the soft tissue defects in the distal tibia. Key words: Saphenous fasciocutaneous island flap; Vacuum sealing drainage; Hardware exposure; Tibia

The influence of oxygen partial pressure change and vascularization of rabbit wound through negative pressure wound therapy

To investigate the effect of vacuum sealing drainage (VSD) on variation of oxygen partial pressure (PtO2) and vascularization. The 12 cases of rabbit's wound models were undergoing the VSD (vacuum group, n = 6) or conventional therapy (conventional group, n = 6). Variation of PtO2 was measured by oxygen partial pressure admeasuring apparatus, expression of hypoxia inducible factor 1α (HIF-1α) mRNA was measured by real-time fluorescent quantitative PCR, content of vascular endothelial growth factor (VEGF) was measured by ELISA after tissue homogenate in 7 days. Vascular endothelial cell (VEC) and new blood capillary (NBC) of hematoxylin-eosin slice of tissue were counted by using light microscope. Average value of PtO2 of vacuum group was significant lower than conventional group (t = -99.780 to -5.305, P < 0.01). Expression of HIF-1α (30 minutes, 1, 6, 12 hours were 3.11 ± 0.07, 3.68 ± 0.26, 4.16 ± 0.13 and 3.91 ± 0.26 respectively) and content of VEGF (30 minutes, 1, 6, 12 hours were 103.3 ± 2.4, 134.2 ± 9.0, 167.8 ± 3.8 and 232.1 ± 9.5 respectively) of vacuum group were increased after 30 minutes and significant lower than conventional group (t = 13.038 - 80.208, P < 0.01), and both of them were reduced after 24 hours (P < 0.05). Counting numbers of VEC (2.47 ± 0.45 to 4.70 ± 0.38) and NBC (1.33 ± 0.49 to 4.33 ± 0.68) of vacuum group were increased at the same time-point and significant higher than conventional group (t = -0.670 to 16.500, P < 0.05). PtO2 of wound surface could be reduced significantly by VSD. Expression of HIF-1α and content of VEGF were increased by VSD for enhancing differentiated state of VEC and construction of NBC, which were better for vascularization and wound healing.

Vacuum sealing drainage therapy for complex infective extremity wounds following an earthquake

Objective To evaluate the vacuum sealing drainage (VSD) therapy for management of complex infective extremity wounds following an earthquake. Methods From May 2008, we treated 10 complex infective extremity wounds in 8 cases (6 males and 2 females) following an earthquake. Their mean age was 35.8 years (range, 20 to 62 years). Two-stage operations, preparative VSD therapy followed by closure surgery, were performed for every patient. Preoperative bacterial cultures were conducted at each stage. Results The follow-up persisted till one month after every wound healed completely and none had evidence of infection recurrence. The mean operative duration was 20 days (range, 7 to 32 days) from the preparative VSD therapy to the closure surgery and each patient underwent 3.5 times (range, 2 to 5 times) of operations averagely. Nine out of the 10 bacterial cultures were positive before the first surgical debridement and none before the closure surgery. Four wounds were closed by direct suture, 5 by free-skin grafting and one by local flap transplantation. Conclusion Since the VSD therapy can promote the growth of granulation tissues and help eradicate infection, it is safe and effective for management of complex infective extremity wounds. Key words: Extremities; Wound and injuryies; Infection; Vacuum sealing drainage