Vacuum Sealing Drainage Treatment Research Articles

Vacuum Sealing Drainage against Surgical Site Infection after Intracranial Neurosurgery.

Background: Surgical site infections (SSIs) remain a conundrum for neurosurgeons. This study examines the efficacy and outcome of vacuum sealing drainage (VSD) in the treatment of pyogenic SSIs following intracranial neurosurgery. Methods: Twenty patients with SSIs, who received surgical intervention, were treated retrospectively with VSD during the past five years. Primary surgical procedure types, SSI types, VSD replacements, pathogenic germs, antibiotic therapy, and infection control were reviewed and discussed. Results: Of the 20 infections, 13 (65%) were extradural and 7 (35%) were extradural SSIs combined with intracranial infections (including 5 meningitis, 1 subdural abscess, and 1 brain abscess). All the patients consented to medical device implantation (including 5 titanium webs, 6 bone flap fixation devices, and 12 duraplasties), most of which were removed during debridement. The median duration from primary surgical procedure to an SSI diagnosis was 19 days (range: 7 to 365 d). All the patients also agreed to debridement and VSD treatment; VSD was replaced 0 to 5 times (median, one time) every 4 to 7 days and kept for 4 to 35 days (median, 14 d). Seven (35%) patients had defined bacterial infections, with Staphylococcus aureus being the dominant infection. The deployed standard VSD and antibiotic treatment ensured full recovery from SSIs, including from intracranial infections: 14 (70%) patients had recovered fully by follow-up, and no infection-associated death was registered; 6 (30%) patients died of severe primary affections. Conclusion: VSD-assisted therapy is safe and effective against SSIs after intracranial neurosurgery.

Clinical evaluation of continuous irrigation with Bikerui combined with negative pressure closed drainage and platelet-rich plasma technique for treatment of stage III-IV pressure ulcer.

As a catastrophic complication of bedridden and elderly patients, pressure ulcer usually continuously affects patients' health and quality of life, so the daily care of wounds is attached great importance in clinic. This work investigated the effect of Bikerui disinfectant + vacuum sealing drainage (VSD) + platelet-rich plasma (PRP) therapy on patients with stage III ~ IV pressure sore. In this work, 110 patients with pressure ulcer (PU) treated in our hospital were enrolled and were randomly divided into an experimental group (Exp group) and a control group (Ctrl group) by a blind selection method, with 55 cases in each group. Patients in the Ctrl group received surgical debridement + VSD for treatment, while those in the Exp group were treated with Bikerui disinfectant + VSD + PRP. Inflammatory response (IR) score, PU healing (PUH) score, healing time, dressing change frequency (DCF), dressing interval time (DIT), and scar recovery (SR) score of patients in different groups were compared. The results revealed that the positive rate of bacterial culture in wound secretions in the Exp group was greatly lower than that in the Ctrl group 1 or 2 weeks after treatment (p < 0.05). The IR score in the Exp group was much lower at week 1 and 2 after treatment (p < 0.05). The total effective rate (TER) in the Exp group was obviously higher than that in the Ctrl group (94.55% vs. 76.36%). The results suggested that Bikerui disinfectant + VSD + PRP therapy could effectively improve the inflammatory degree of PU patients, promote the wound repair and scar recovery of patients, and greatly improve the clinical efficacy of PU patients.

Laparoscopic harvest and free transplantation of great omentum flap for extensive tissue defects in complex wounds

IntroductionThe repair of extensive tissue defects remains a challenge, although great progress has been made in reconstructive surgery. The transplantation of a single huge flap or several flaps in combination will inevitably result in donor-site morbidity. Here we report our experience in the repair of these wounds with laparoscopically harvested great omentum flaps. MethodsTwelve patients with extensive tissue defects caused by deep burn injury, avulsion injury, and open fracture underwent free omental flap transplantation and split-thickness skin grafting. The patient demographics, wound characteristics, and complications postsurgical operation were recorded. Prior to omentum flap transplantation, these patients underwent debridement, vacuum sealing drainage treatment, and/or fixation of fractures. All omentum flaps harvested using laparoscopic technique were anastomosed to recipient vessels, and split-thickness skin grafting was performed 14 days after omental flap transplantation. ResultsThe mean defect size was 471 cm2 and the mean omental flap size was 751.1 cm2. Among all 12 cases, the omental flaps survived well except for distal partial necrosis in one case. Skin grafting was also achieved in all cases, and all patients achieved complete wound coverage. All donor sites achieved primary healing without major complications. The mean follow-up time was 30 months with satisfactory appearance and functional outcome. ConclusionFor the reconstruction of extensive tissue defects in complex wounds, the free transfer of an omental flap may be an ideal option because of its well-vascularized and pliable tissue with reliable vascular anatomy, as well as minimized donor-site morbidity.

Discussion on the Application Effect of Simplified Vacuum Sealing Drainage (VSD) in the Treatment of Chronic Refractory Wounds

Objective: To analyze the effect of simplified vacuum sealing drainage (VSD) in the treatment of chronic&#x0D; refractory wounds. Methods: A total of 90 patients with chronic refractory wounds treated from May 2022 to May 2023 were randomly divided into groups. The simplified VSD treatment was employed in group A, and conventional treatment was employed in group B, and the wound healing of both groups were compared. Results: Group A showed better wound healing compared to group B, P &lt; 0.05; the wound healing rate, wound healing duration, visual analog scale (VAS) score, wound dressing times and other indicators in group A were better than those in group B, P &lt; 0.05. The SF-36 score of group A was higher than that of group B, P &lt; 0.05; the complication rate of chronic refractory wounds in group A was no different from that in group B, P &gt; 0.05. Conclusion: Simplified VSD treatment is effective in treating patients with chronic refractory wounds, and it reduces the number of wound dressing changes and promote wound healing.

Management strategy of femoral artery pseudoaneurysm combined with infectious wounds

Objective: To investigate the surgical treatment methods of femoral artery pseudoaneurysm combined with infectious wounds and to evaluate the clinical effects. Methods: The retrospective observational research method was used. Twelve patients with femoral artery pseudoaneurysm combined with infectious wounds who met the inclusion criteria were admitted to Nanjing University of Chinese Medicine Wuxi Integrated Traditional Chinese and Western Medicine Hospital (Affiliated Hospital of Jiangnan University) from October 2014 to September 2022, including 6 males and 6 females, aged from 46 to 78 years. In the primary operation, debridement, tumor resection, and artery suture/venous grafting to repair the artery/artery ligation were performed, and the wound area after tumor resection ranged from 4.0 cm×1.5 cm to 12.0 cm×6.5 cm. Wounds that could be sutured were treated with tension reduction suture and extracutaneous continuous vacuum sealing drainage (VSD), while large wounds that could not be sutured were treated with VSD to control infection. In the secondary operation, tension reduction suture was performed to repair the wounds that could be sutured; large wounds were repaired with adjacent translocated flaps with area of 9.0 cm×5.0 cm to 15.0 cm×7.0 cm. Additionally, when the length of the exposed femoral artery was equal to or over 3.0 cm, the wounds were repaired with additional rectus femoris muscle flap with length of 15.0 to 18.0 cm. The donor areas of the flaps were directly sutured. The wound with artery ligation was treated with stamp skin grafting and continuous VSD. The bacterial culture results of the wound exudate samples on admission were recorded. The intraoperative blood loss, the location of femoral artery rupture, the artery treatment method, and the wound repair method in the primary operation were recorded, and the durations of catheter lavage, catheter drainage, and VSD treatment, and the drainage volume after the operation were recorded. The repair method of wounds in the secondary operation, the durations of catheter drainage and VSD treatment, and the total drainage volume after the operation were recorded. The survivals of flap/muscle flap/stamp skin grafts were observed, and the wound healing time was recorded. Follow-up after discharge was performed to evaluate the quality of wound healing and the walking function and to check whether the pulsatile mass disappeared. B-ultrasound or computed tomography angiography (CTA) was performed again to observe potential pseudoaneurysm recurrence and evaluate the patency of blood flow of the femoral artery. Results: The bacterial culture results of wound exudate samples of all the patients were positive on admission. The blood loss was 150 to 750 mL in the primary operation. The arterial ruptures were located in the femoral artery in 8 cases, in the external iliac artery in 2 cases, and in the femoral arteriovenous fistula in 2 cases. Six cases received direct artery suture, 4 cases received autologous great saphenous vein grafting to repair the artery, 1 case received autologous great saphenous vein bypass surgery, and 1 case received artery ligation. The primary wound suture was performed in 4 cases, along with catheter lavage for 3 to 5 days, catheter drainage for 4 to 6 days, VSD treatment for 5 to 7 days, and a total drainage volume of 80 to 450 mL after the surgery. In the secondary operation, the wounds were sutured directly in 3 cases along with catheter drainage for 2 to 3 days, the wound was repaired with scalp stamp skin graft and VSD treatment for 5 days in 1 case, the wounds were repaired with adjacent translocated flaps in 2 cases with catheter drainage for 2 to 3 days, and the wounds were repaired with rectus femoris muscle flaps+adjacent translocated flaps in 2 cases with catheter drainage for 3 to 5 days . The total drainage volume after the secondary operation ranged from 150 to 400 mL. All the skin flaps/muscle flaps/skin grafts survived after operation. The wound healing time ranged from 15 to 36 days after the primary operation. Follow-up of 2 to 8 months after discharge showed that the wounds of all patients healed well. One patient who underwent femoral artery ligation had calf amputation due to foot ischemic necrosis, and the rest of the patients regained normal walking ability. The pulsatile mass disappeared in inguinal region of all patients. B-ultrasound or CTA re-examination in 6 patients showed that the blood flow of femoral artery had good patency, and there was no pseudoaneurysm recurrence. Conclusions: Early debridement, tumor resection, and individualized artery treatment should be performed in patients with femoral artery pseudoaneurysm combined with infected wounds. Besides, proper drainage and personalized repair strategy should be conducted according to the wound condition to achieve a good outcome.

Vacuum Sealing Drainage for Primary Thoracolumbar Spondylodiscitis: A Technical Note.

Primary spinal infection is a challenge for neurosurgeons. Here, for the first time, we introduced the vacuum sealing drainage (VSD) sponge into the intervertebral space for the primary thoracolumbar infection treatment. This study included 6 bedridden patients with thoracolumbar spondylodiscitis without deformity formation. All 6 patients were treated with the VSD in our hospital from June 30, 2018, to August 31, 2019. All 6 cases of thoracolumbar infection achieved clinical cure at 3-month follow-up, and no surgical-related mortalities occurred in our series. One patient died of acute cerebral infarction 5 months after surgery, and the remaining 5 patients completed a 12-month follow-up without recurrence. The JOA score of all 6 cases improved significantly after VSD treatment. VSD is feasible for safe and effective treatment for primary thoracolumbar infection. The short-term follow-up effect is definite.

Effect Evaluation of Platelet-Rich Plasma Combined with Vacuum Sealing Drainage on Serum Inflammatory Factors in Patients with Pressure Ulcer by Intelligent Algorithm-Based CT Image.

This work was to explore the efficacy of intelligent algorithm-based computed tomography (CT) to evaluate platelet-rich plasma (PRP) combined with vacuum sealing drainage (VSD) in the treatment of patients with pressure ulcers. Based on the u-net network structure, an image denoising algorithm based on double residual convolution neural network (Dr-CNN) was proposed to denoise the CT images. A total of 84 patients who were hospitalized in hospital were randomly divided into group A (without any intervention), group B (PRP treatment), group C (VSD treatment), and group D (PRP+VSD treatment). Procalcitonin (PCT) was detected by enzyme-linked immunosorbent assay (ELISA) combined with immunofluorescence method, C-reactive protein (CRP) was detected by rate reflectance turbidimetry (RRT), and interleukin-6 (IL-6) was detected by electrochemiluminescence method. The results showed that after treatment, 44 cases (52.38%) of pressure ulcers patients recovered, 24 cases (28.57%) had no change in stage, and 16 cases (19.04%) developed pressure ulcers. The pain scores of group D at 1 week (3.35 ± 0.56 points) and 2 weeks (2.76 ± 0.55 points) after treatment were significantly lower than those in group C (7.77 ± 0.58 points and 6.34 ± 0.44 points, respectively). The time of complete wound healing in group D (24.5 ± 2.32) was obviously lower in contrast to that in groups A, B, and C (35.54 ± 3.22 days, 30.23 ± 2 days, and 29.34 ± 2.15 days, respectively). In addition, the medical satisfaction of group D (8.74 ± 0.69) was significantly higher than that of groups A, B, and C (4.69 ± 0.85, 5.22 ± 0.31, and 5.18 ± 0.59, respectively). The levels of IL-6 and PCT in group D were lower than those in groups A, B, and C, and the differences were statistically significant (P < 0.01). The average values of peak signal to noise ratio (PSNR) and structural similarity index measure (SSIM) of the Dr-CNN network model were 37.21 ± 1.09 dB and 0.925 ± 0.01, respectively, which were higher than other algorithms. The mean values of root mean square error (MSE) and normalized mean absolute distance (NMAD) of the Dr-CNN network model were 0.022 ± 0.002 and 0.126 ± 0.012, respectively, which were significantly lower than other algorithms (P < 0.05). The experimental results showed that PrP combined with VSD could significantly reduce the inflammatory response of patients with pressure ulcers. PRP combined with VSD could significantly reduce the pain of dressing change for patients. Moreover, the performance model of image denoising algorithm based on double residual convolutional neural network was better than other algorithms.

Application of free anterolateral thigh flap with fascia lata for diabetic foot ulcers with bone exposure

To investigate the effectiveness of free anterolateral thigh flap (ALTF) with fascia lata in repairing diabetic foot ulcers (DFUs) with bone exposure. Between January 2019 and January 2021, 20 patients with DFUs with bone exposure were admitted. There were 17 males and 3 females with a median age of 57.5 years (range, 48-76 years). There were 10 cases of Wagner grade 3 and 10 cases of grade 4. The DFUs formed 1 to 14 months, with a median time of 3 months. The patients underwent CT angiography, which showed extensive atherosclerosis in both lower limbs; 6 of them were severely narrowed or occluded and underwent percutaneous transluminal angioplasty. The size of wound ranged from 7 cm×6 cm to 27 cm×10 cm after applied first-stage debridement combined with vacuum sealing drainage treatment. In the second-stage, free ALTF with fascia lata was used to repair wounds and partial defects of tendons. The size of flap ranged from 8 cm×5 cm to 28 cm×11 cm. The wound of the donor site was sutured directly. The survival of the flap, the healing time of the wound, and the complications were recorded. The laser speckle blood flow imaging system was used to detect the blood perfusion of the flap and the skin around the flap at 2 weeks and 6 months after operation. The foot function was evaluated by American Orthopaedic Foot and Ankle Society (AOFAS) score at 6 months after operation. After operation, effusion under the flap happened in 6 cases, which cured after symptomatic treatment. Flaps survived completely in 14 cases. The tissue necrosis at the edges of the flaps occurred in 3 cases and healed after dressing changes. Venous crisis of flaps occurred in 3 cases, of which 1 case was completely necrotic after exploration, and the other 2 cases were partially alive. The wounds of 3 cases were repaired with skin grafts after debridement and dressing. The flap survival rate was 95.0%, and the limb salvage rate was 100%. The wound healing time after flap transplantation was 14-30 days, with an average of 19.1 days. Two patients had recurrence of peripheral skin ulcers of the flaps within 1 month after healing, which healed after conservative dressing changes. Eighteen cases of incisions at donor site healed by first intention, 2 cases had local skin necrosis and healed by debridement and suture. All patients were followed up 6-30 months, with a median time of 11 months. The texture, appearance, and elasticity of the flaps were good. All patients could walk alone without pain. At 6 months after operation, the AOFAS score was 75.9±11.9, which was significantly different from that (44.7±18.4) before operation ( t=-7.025, P=0.000). The blood perfusion value increased from (38.1±7.8) PU at 2 weeks to (42.7±10.3) PU, and the difference was significant ( t=-4.680, P=0.001). Free ALTF with fascia lata has a rich blood supply and a high survival rate. It can be used to repair DFUs with bone exposure. After the free skin flap healed, it can promote revascularization of the affected foot, reduce the probability of ulcer recurrence, and avoid amputation.

Outcomes of Covered Stents With Vacuum Sealing Drainage For Treatment of Infected Femoral Pseudoaneurysms in Intravenous Drug Addicts

For treatment of infected femoral artery pseudoaneurysms (IFAPs) with the covered stent, debridement technique is important but frequently ignored. Our study aims to review our experience and outcomes of patients undergoing covered stents placement and debridement with vacuum sealing drainage (VSD). This study retrospectively analyzed 41 intravenous drug addicts with IFAP who received covered stent implantation and debridement with VSD from January 2015 to December 2020. The diagnosis was based on the previous history of local injection and the presence of pulsatile mass at the injection site. All cases were confirmed by CT angiography (CTA), ultrasound, or digital subtraction angiography (DSA). Technical success, time of wound care, and clinical outcomes were evaluated. Technical success was achieved in all patients. The interval from diagnosis to treatment was 26 ± 11 hours. The time of continuous drainage with VSD was 18.79 ± 6.56 days. 38 patients (92.68%) with fresh granulation tissue were sutured and discharged from the hospital. Stents in 31(91.18%) of 34 cases were patent during follow-ups. Three patients had stent occlusion caused by thrombosis, and two of them were complicated with stent infection. The two infectious stents were removed and the femoral arteries were ligated. One of them received open-surgical reconstruction with the great saphenous because of claudication. Two patients were admitted to the hospital for rebleeding caused by drug abuse relapse. Covered stents placement is convenient and rapid to control massive hemorrhage in IFAPs of intravenous drug abuse. Early debridement of infected tissue with continued VSD may shorten the time of wound care and make the incidence of stent infection relatively low. Meanwhile, the patency in a short time follow-up is acceptable. These results indicate that covered stents implantation with VSD may be a safe, effective, and feasible measure for the treatment of IFAPs.

Clinical effects of autologous platelet rich plasma gel combined with vacuum sealing drainage techno-logy in repairing refractory wounds

Objective: To investigate the clinical effects of autologous platelet rich plasma (PRP) gel in combination with vacuum sealing drainage (VSD) technology in repairing refractory wounds. Methods: From March 2011 to January 2015, 44 patients with refractory wounds meeting the inclusion criteria were recruited into VSD alone group, who were admitted to the Department of Burns and Plastic Surgery of the Yidu Central Hospital of Weifang and received intermittent VSD treatment. From February 2015 to September 2019, 43 patients with refractory wounds meeting the inclusion criteria were recruited into PRP+ VSD group, who were admitted to the same unit as above-mentioned and received PRP combined with intermittent VSD treatment. The retrospective cohort study was conducted. There were 24 males and 20 females with age of (37.5±2.2) years in VSD alone group, and there were 25 males and 18 females with age of (37.0±2.5) years in PRP+ VSD group. The wound exudate of patients in the two groups before and 7 and 14 d after the first treatment were collected for bacterial culture, and the positive rate of bacterial culture was calculated. The wound healing of patients in the two groups was observed on 7, 14, and 21 d after the first treatment, and the wound healing rate was calculated. The complete wound healing time of patients in the two groups was recorded. The degree of wound pain of patients in the two groups was evaluated by the Visual Analog Scale (VAS) before and 14 d after the first treatment. The scar hyperplasia of patients in the two groups was evaluated by the Vancouver Scar Scale (VSS) in 1 and 2 months after the wound healed completely. The occurrence of adverse reactions of patients in the two groups during the whole period of treatment was observed and the incidence of adverse reactions was calculated. Data were statistically analyzed with analysis of variance for repeated measurement, chi-square test, paired t test, and Bonferroni correction. Results: The positive rates of bacterial culture in wound exudate of patients in PRP+ VSD on 7 and 14 d after the first treatment were 37.2% (16/43) and 11.6% (5/43), which were significantly lower than 56.8% (25/44) and 29.5% (13/44) in VSD alone group, χ(2)=4.212, 4.255, P<0.05. The wound healing rates of patients in PRP+ VSD group on 7 and 14, and 21 d after the first treatment were respectively (58±14)%, (70±13)%, (89±12)%, which were significantly higher than (41±11)%, (60±11)%, (74±12)% in VSD alone group, t=6.323, 3.820, 5.751, P<0.01. The complete wound healing time of patients in PRP+ VSD group was (30±6) d, which was significantly shorter than (61±8) d in VSD alone group, t=20.890, P<0.05. The VAS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group on 14 d after the first treatment (t=13.904, P<0.01). The VSS score of patients in PRP+ VSD group was significantly lower than that in VSD alone group in 1 and 2 months after the wound healed completely (t=3.307, 3.637, P<0.01). The incidence of adverse reactions of patients in PRP+ VSD group during the whole period of treatment was 7.0% (3/43), which was significantly lower than 22.7% (10/44) in VSD alone group, χ(2)=4.245, P<0.05. Conclusions: Autologous PRP gel combined with VSD technology in repairing refractory wounds not only has good bacteriostatic effect, but also can increase wound healing rate, shorten wound healing time, alleviate wound pain, reduce scar hyperplasia, with less adverse reaction, which is worthy of promotion.

Application effects of self-made simple vacuum sealing drainage device in postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle

Objective: To investigate the application effects of self-made simple vacuum sealing drainage (VSD) device in the postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle. Methods: From January 2017 to January 2019, 36 patients with foot and ankle skin defects and bone exposure admitted to People's Hospital of Xinjiang Uygur Autonomous Region met the inclusion criteria, and a retrospective cohort study was conducted. According to the bandaging method of the operative area, simple negative pressure group and antibacterial dressing group were both allocated with 18 patients, with 12 males and 6 females in the former group, 14 males and 4 females in the latter group, aged (41.6±2.8) and (42.3±2.6) years, respectively. Patients in the two groups all received sural neurocutaneous flap transplantation. Patients in antibacterial dressing group received nano silver antibacterial dressing change in the operative area, and the dressing was changed once every 3 days. In simple negative pressure group, the operative area was sealed with a simple VSD device made of gauze, silicone sputum suction tube with holes cut out, and biological permeable membrane, etc., which was connected with the wall central negative pressure suction system for continuous VSD treatment of -40.0 to -16.6 kPa. The negative pressure material was changed once every 5 days. The number of dressing change, the pain score evaluated by Numeric Rating Scale during each dressing change, the cost of dressing change, and the degree of flap swelling evaluated on the 3rd and 5th day after surgery were recorded, and the flap survival was observed. Data were statistically analyzed with independent sample t test, Wilcoxon rank sum test, and chi-square test. Results: The number of dressing change of patients in simple negative pressure group was (3.4±0.5) times, which was significantly less than (7.0±0.8) times in antibacterial dressing group (t=15.338, P<0.01). The pain score during dressing change of patients in simple negative pressure group was (4.3±0.8) points, which was significantly lower than (6.8±0.7) points in antibacterial dressing group (t=10.168, P<0.01). The cost of dressing change of patients was similar between the two groups. On the 3rd and 5th day after surgery, the degrees of flap swelling of patients in simple negative pressure group were significantly superior to those in antibacterial dressing group (Z=4.448, 2.395, P<0.05 or P<0.01). The flap survival of patients in simple negative pressure group was significantly superior to that in antibacterial dressing group (χ(2)=4.500, P<0.05). Conclusions: Compared with the traditional dressing bandage, the self-made simple VSD device used after sural neurocutaneous flap transplantation can reduce the frequency of dressing change, relieve the pain of dressing change and the swelling of flap, and promote the flap survival, which is worth popularizing and applying in clinic.

Early wound complications after orthopaedic surgery for haemophilia: What can we do more.

The characteristics of the haemophilia may endanger the patient with haemophilia (PWH) to higher ratio of wound complication, even lead to the refractory wound problem. The early wound complication in PWH has not been well studied in literature. Between the period from 2002 to 2018, 250 patients underwent 323 elective orthopaedic surgical procedures for the treatment of haemophilic musculoskeletal disorders. The medical records were retrospectively reviewed. The patients were evaluated for postoperative wound complications within 30days. Risk factors related to wound complications were further analysed. The patients underwent vacuum sealing drainage (VSD) for refractory wound healing problem were further analysed. Twenty-four patients of 250 patients experienced early wound complication within postoperative 30days. The incidence of wound complication in the patients without preoperative infection was 6.5%. Positive inhibitor and surgery for pseudotumour were associated with higher rate of wound complication after logistic regression, with the odds ratios (OR) of 5.7 (95% CI, 1.08 to 30.3) and 4.9 (95% CI, 1.3 to 18.5), respectively. Eight patients underwent VSD treatment for refractory wound healing problem and recovered uneventfully. The total VSD treatment cycle was 2.25 (from 2 to 4). The average factor consumption was 26.1IUkg-1 d-1 . The patients complicated with infection had higher, but not statistically significantly, treatment duration, factor consumption and peri-VSD total blood loss than the patients without infection. PWH had an incidence of 6.5% of early wound healing problem after elective orthopaedic surgery for musculoskeletal disorder in the present study. The presence of positive inhibitor and surgical procedure for haemophiliac pseudotumour are associated with higher incidence of wound healing problem. The VSD is an effective alternative for the treatment of refractory wound healing problem for PWH, especially for the patients complicated with infection.

Clinical effects of vacuum sealing drainage in the treatment of alkali burn wounds

Objective: To preliminarily observe the clinical effects of vacuum sealing drainage (VSD) in the treatment of alkali burn wounds. Methods: From June 2016 to March 2020, 60 male patients with alkali burns who met the inclusion criteria and hospitalized in the Affiliated Hospital of Jiangnan University were recruited in this prospectively randomized control study. According to the random number table, silver sulfadiazine group and VSD group were both allocated with 30 patients, aged (36±8) and (35±10) years respectively; with total burn area of (7.2±2.0) % and (8.5±3.0) % total body surface area respectively. After admission, patients in silver sulfadiazine group were treated with conventional silver sulfadiazine dressing change once a day after debridement; patients in VSD group were given continuous VSD treatment after debridement, with the negative pressure setting at -10.67 kPa, and the negative pressure materials were replaced every 6 to 8 days. On treatment day 1, 4, and 7, the exudate from the wounds of patients in silver sulfadiazine group and the wound drainage fluid of patients in VSD group were collected, the pH value was measured by a portable pH meter, and the volume of exudate/drainage fluid was measured. After 7, 14, and 21 days of treatment, the wound healing rates of patients were calculated in the two groups. Before treatment and 7 days after treatment, venous blood was collected from the patients in the two groups to detect the serum level of tumor necrosis factor α (TNF-α) and interleukin 8 (IL-8). Within treatment day 14, Visual Analogue Scale was used to assess the pain score of patients in the two groups during each time of dressing change. The medical costs and discharge satisfaction scores of patients in the two groups were recorded. Data were statistically analyzed with analysis of variance for repeated measurement, t test, and Bonferroni correction. Results: (1) On treatment day 1, 4, and 7, the pH values of the drainage fluid of patients in VSD group were 9.75±0.59, 9.01±0.46, and 8.13±0.28, respectively, which were significantly higher than 9.35±0.62, 8.18±0.18, and 7.58±0.09 of exudate of patients in silver sulfadiazine group (t=2.03, 6.80, 7.56, P<0.05 or P<0.01). On treatment day 1 and 4, the volumes of drainage fluid of patients in VSD group were (553±83) and (239±65) mL respectively, which were significantly higher than (440±77) and (175±49) mL of exudate of patients in silver sulfadiazine group (t=3.44, 2.24, P<0.05). On treatment day 7, the volume of drainage fluid of patients in VSD group was (21±8) mL, which was significantly lower than (149±44) mL of exudate of patients in silver sulfadiazine group (t=-12.61, P<0.01). (2) After 7, 14, and 21 days of treatment, the wound healing rates of patients in VSD group were (39±6) %, (74±10) %, and (92±3) %, respectively, which were significantly higher than (25±3) %, (59±6) %, and (77±6) % in silver sulfadiazine group (t=7.07, 5.59, 7.09, P<0.01). (3) Before treatment, the serum levels of TNF-α and IL-8 of patients in the two groups were similar. After 7 days of treatment, the serum levels of TNF-α and IL-8 of patients in VSD group were significantly lower than those in silver sulfadiazine group (t=-8.75, -8.04, P<0.01). (4) The pain score during dressing change and medical cost of patients in VSD group were significantly lower than those in silver sulfadiazine group (t=-4.28, -7.56, P<0.01), while the discharge satisfaction score of patients in VSD group was significantly higher than that in silver sulfadiazine group (t=10.91, P<0.05). Conclusions: The application of VSD technology in clinical alkali burn wounds can effectively promote the removal of residual lye, alleviate the further damage of lye to skin tissue, shorten the wound healing time, effectively remove inflammatory mediators, reduce the pain of dressing change, decrease the total cost of treatment, and enhance satisfaction of patient.

Effects of vacuum sealing drainage to improve the therapeutic effect in patients with orthopedic trauma and to reduce post-operative infection and lower-limb deep venous thrombosis.

The present study investigated the effects of vacuum sealing drainage (VSD) to improve the therapeutic efficacy in patients with orthopedic trauma (OT) and reduce post-operative infection and lower-limb deep venous thrombosis (DVT) through a retrospective analysis. A total of 76 patients with OT treated at our hospital were selected for observation. The patients were divided into the control group (CG; n=37) and the experimental group (EG; n=39) according to the treatment administered. For patients in the CG, routine dressing changes were applied. Patients in the EG underwent VSD treatment. The dressing change frequency, time between the first and second operation, hospital stay, treatment efficacy, wound healing time, interleukin-6 (IL-6) serum level, tumor necrosis factor-α (TNF-α) serum level, incidence of post-operative infection and incidence of lower-limb DVT were compared between the two groups. The dressing change frequency in the EG was less than that in the CG. The time between the first and second operation and hospital stay were shorter in the EG than in the CG (P<0.05). The total effective rate in the EG was 97.44%, which was higher than that in the CG (78.38%; P<0.05). The wound healing time in the EG was 1.72±0.73 weeks and shorter than that in the CG (2.23±0.85 weeks; P<0.05). With the progression of treatment, the serum IL-6 and TNF-α levels decreased in the two groups, but the levels in the EG were lower than those in the CG (P<0.05). The incidence of post-operative infection and lower-limb venous thrombosis in the EG were 7.69 and 0.00%, respectively, and lower than those in the CG (27.03 and 13.01%, respectively; P<0.05). In the treatment of OT, VSD may reduce the dressing change frequency, shorten the operation time and hospital stay, accelerate wound healing and reduce post-operative infection and lower-limb DVT. Thus, the VSD treatment method is worthy of promotion and implementation in clinic.

Clover-Style Fasciocutaneous Perforator Flap for Reconstruction of Massive Sacral Pressure Sores.

BackgroundAs a common complication of the long-term bedridden patients, pressure sore is a great challenge for surgeons. The purpose of this study was to explore the surgical method of using a clover-style fasciocutaneous perforator flap raised on the buttocks for the treatment of massive sacral pressure sores and report the clinical outcomes.MethodsThe study included 15 patients from January 2015 to June 2017 with an average age of 52.87 years (range, 32–73 years). The size of the sacral pressure sores ranged from 10 cm × 13 cm to 18 cm × 20 cm. The defects were reconstructed using a fasciocutaneous perforator flap raised on the buttocks after debridement and vacuum sealing drainage treatment for 1 to 2 weeks. All the donor areas were sutured directly.ResultsAll flaps survived completely; 13 patients achieved healing by primary intention, and the other 2 patients achieved healing by secondary intention. At the mean follow-up period of 20.8 months (range, 12–46 months), the appearance of the flap, including its texture and color, in all patients was satisfactory. No patients had deep infection, necrosis, or shrinkage of the flap during the follow-up period. One patient had a recurrent bedsore during the 2-year follow-up.ConclusionsThe clover-style fasciocutaneous perforator flap is ideal for the reconstruction of massive sacral pressure sores because it is a relatively simple procedure and results in good appearance and function, few complications, and a low recurrence rate.

Clinical effects of artificial dermis combined with vacuum sealing drainage and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn

Objective: To explore the clinical effects of artificial dermis combined with vacuum sealing drainage (VSD) and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn. Methods: A total of 8 patients with scar hyperplasia and contracture deformity on joint after healing of extensive burn were admitted to our hospital from August 2015 to August 2017. There were 5 females and 3 males aged 8 to 45 years with an average of 23 years. In the first stage operation, scar tissue on contracture site was removed, and the wound was covered by artificial dermis followed by continued VSD treatment. On 10-14 d after the first stage operation, the artificial dermis tissue formed, and the second stage autologous split-thickness skin grafting and continued VSD treatment were performed. Routine anti-scar therapy was carried out after healing of wounds. Time of wound healing after the second stage operation was recorded. Colour and texture of the split-thickness skin graft, scar formation condition of the donor site, and action condition of the operation site during follow-up were observed. Results: The wounds of 8 patients were healed in 10-14 d after the second stage operation. During follow-up of 6-24 months, the split-thickness skin graft was with smooth surface and good elasticity, and the function of joint recovered well. The donor site in head healed well with no scar. Only pigmentation was left in the donor site of thigh, and scar was not obvious. The patients and their family members were satisfied. Conclusions: After application of artificial dermis combined with VSD and autologous split-thickness skin graft in repair of scar contracture deformity after extensive burn, the skin grafting area and donor site were with unobvious scar hyperplasia, and the joint function in the operation area was good.

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

Influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage for inpatients in burn unit

Objective: To explore the influence of cluster nursing intervention on inadequate drainage in vacuum sealing drainage (VSD) for inpatients in burn unit. Methods: From October to December 2016, 60 patients, aged (43.6±2.8) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the routine nursing group, and among the patients, 37 cases were male and 23 cases were female. From May to July 2017, 58 patients, aged (44.2±3.2) years admitted to our department, receiving VSD treatment and conforming to the inclusion criteria, were included in the cluster nursing group, and among the patients, 36 cases were male and 22 cases were female. The patients' medical records were retrospectively analyzed. After VSD treatment, patients in routine nursing group received routine nursing, and patients in cluster nursing group received cluster nursing. A cluster intervention group was formed and headed by a chief surgeon. The cluster nursing plan was formulated and implemented strictly from the following six aspects of material preparation, negative pressure value control and negative pressure mode setting, drainage tube nursing, semi-permeable membrane reinforcement, standardizing changing process and timing of drainage capsule, and health education. During VSD treatment, the incidence of inadequate drainage, reasons of inadequate drainage and the occurrences, occurrences of inadequate drainage of wounds in different types and sites, and satisfaction of patients in two groups were observed and calculated. The patient satisfaction items included procedure of drainage capsule replacement, the method of tube fixation, the content and form of health education. Data were processed with independent sample t test and chi-square test. Results: (1) During VSD treatment, the incidence of inadequate drainage of patients in routine nursing group was 43.33% (130/300), which was significantly higher than 17.24% (50/290) in cluster nursing group (χ(2)=43.350, P<0.01). (2) During VSD treatment, the incidences of inadequate drainage caused by blockage of drainage tube due to scabbing of drainage, low negative pressure, air leakage of semi-permeable membrane, improper changing process of drainage capsule, shedding, compression, reversal of drainage tube of patients in cluster nursing group were 7.93% (23/290), 4.48% (13/290), 1.72% (5/290), 1.03% (3/290), and 2.07% (6/290), respectively, significantly lower than 16.67% (50/300), 11.67% (35/300), 4.33% (13/300), 4.00% (12/300), and 6.67% (20/300) in routine nursing group (χ(2)=10.379, 22.951, 4.832, 7.840, 7.399, P<0.05 or P<0.01). (3) During VSD treatment, the incidences of inadequate drainage of burn wounds, trauma wounds, pressure ulcer, venous ulcer in lower limbs, and diabetic foot of patients in cluster nursing group were significantly lower than those in routine nursing group (χ(2)=17.835, 6.809, 9.478, 4.939, 8.631, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different types of patients in the same group were close (χ(2)=0.434, 0.057, P>0.05). (4) During VSD treatment, the incidences of inadequate drainage of wounds in limbs, trunk, buttocks, and sacrococcyx of patients in cluster nursing group were significantly lower than those in routine nursing group (χ(2)=31.892, 9.588, 4.939, 4.549, P<0.05 or P<0.01). During VSD treatment, the incidences of inadequate drainage of wounds in different wound sites of patients in the same group were close (χ(2)=0.071, 0.069, P>0.05). (5) The satisfaction scores in changing process of drainage capsule, method of tube fixation, content and form of health education of patients in cluster nursing group after VSD treatment were significantly higher than those in routine nursing group (t=5.166, 4.471, 7.958, 8.975, P<0.01). Conclusions: Cluster nursing intervention on patients receiving VSD treatment could reduce the incidences of inadequate drainage of wounds in different types and sites caused by various reasons. It also can improve patient satisfaction.

Clinical value of vacuum sealing drainage in the treatment of oral and maxillofacial space infection

This study aims to observe the efficacy of vacuum sealing drainage (VSD) by continuous negative pressure drainage and saline irrigation in the treatment of oral and maxillofacial space infection. Retrospective analysis was conducted on 116 cases of maxillofacial space infection, and clinical data were collected to compare the therapeutic effects of routine incision with drainage treatment (traditional treatment group, 58 cases) and VSD treatment (VSD group, 58 cases). The length of hospital stay, white blood cell count, scar length, frequency of dressing change, and pain degree of patients in the VSD group were all lower than those in the traditional treatment group. Moreover, the improvement degree of mouth opening in the VSD groups was better than that in the traditional treatment group (P<0.05). VSD is a more effective method for the treatment of oral and maxillofacial space infection.

Pelnac® Artificial Dermis Assisted by VSD for Treatment of Complex Wound with Bone/Tendon Exposed at the Foot and Ankle, A Prospective Study

Purpose: This study aims to assess the efficacy and safety of Pelnac dermal regeneration template assisted by vacuum sealing drainage (VSD) and a split-thickness skin graft to cover the large skin and soft-tissue defects at foot and ankle. Methods: This study began from March 2013, up to February 2017. A total of 16 patients met the inclusion and exclusion criteria and were included. For every patient, 2 separate operations were performed, the first being thorough debridement of necrotic tissues immediate coverage of VSD at continuous negative pressure suction, and the second being the autologous split-thickness skin graft. At each follow-up, relevant data were documented. Results: The average follow-up was 16.5 months (range, 12 to 42 months). No infections, hematoma, or seroma were observed. 13 out of 16 patients had a complete skin graft “take” (100%). Patients’ satisfaction of esthetic appearance was 76.5 ± 5.2/100. The VSS value was 2.2 ± 2.1, representing a good result. Regarding the sensory recovery, the response “normal or near normal” could be obtained in 14/16 patients. Mean AROM for extension/flexion of the ankle was 48.5 ± 4.8° (range 35–62°), and 93.7% (15/16) of patient could obtain a satisfying functional result. Conclusions: Our report indicated Pelnac provided an effective method for management of complex wounds with underlying bone or tendons exposed.