Vacuum Sealing Drainage Treatment Research Articles

Vacuum sealing drainage with anterolateral thigh perforator flap for repair foot soft tissue defect

To investigate clinical effect of vacuum sealing drainage(VSD) with anterolateral thigh perforator flap for repair foot soft tissue defect. From September 2014 to September 2016, 45 patients with foot soft tissue defect repaired by VSD with anterolateral thigh perforator flap, including 31 males and 14 females aged from 17 to 55 years with an average of 36 years old. Thirty patients were dorsal soft tissue defects, and 15 patients were plantar soft tissue defects. Sizes of soft tissue defect ranged from 7 cm×10 cm to 11 cm×18 cm, the wound was contaminated seriously and assisted with deep soft tissue exposure. Emergency surgical wound debridement with VSD treatment were performed, and wound surface was cleaned after 5 to 7 days, free anterolateral thigh flap were repaired. Sizes of flap ranged from 9 cm×12 cm to 13 cm×21 cm. Appropriate method was used to repair flap donor area. All 45 free propeller flap were survived without skin edge necrosis, ulcerative infection. Forty patients were followed up from 3 to 24 months with an average of 13 months. Flap showed good color, beautiful appearance, good elasticity, soft texture, but without obvious bloated, the wood of leg healed well. VSD with anterolateral thigh perforator flap for repair foot soft tissue defect could effective control wound soft tissue infection, receive reliable flap blood supply and skin flap could repaired at stage I. It is an effective method for repairing foot soft tissue defects.

Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees

Objective: Strategy for wound repair of skin and soft tissue defect and systematic rehabilitation treatment for functional reconstruction of patients with severe burn or trauma on knees. Methods: From January 2015 to October 2016, 26 patients with skin and soft tissue defect on knees after severe burn or trauma were hospitalized in our unit. Among these patients, 14 patients had patellar ligament defect, and 16 patients had knee joint capsule defect. Wound debridement was operated on 1 to 3 days after admission. After debridement, the area of skin and soft tissue defect ranged from 10 cm×7 cm to 42 cm×18 cm. Vacuum sealing drainage (VSD) treatment was performed after debridement, and flap transplantation operation was performed after VSD treatment for 5 to 7 days. Defects of nine patients were treated with local rotation flaps. Seven patients with skin and soft tissue defects on knees and knee joint capsule defects of 5 cm×3 cm to 9 cm×7 cm were treated with free anterolateral femoral flaps combined with fascia lata. Ten patients with skin and soft tissue defects on knees and patellar ligament defects of 6 cm×3 cm to 12 cm×4 cm were treated with free anterolateral femoral flaps combined with iliotibial tract. The area of flaps ranged from 11 cm×9 cm to 22 cm×15 cm. After flap transplantation operation, functional reconstruction of knee joint was carried out according to early, continuous, and sequential systematic rehabilitation treatment strategy. The pain degree and function of knee joint of patients were scored by the International Knee Documentation Committee (IKDC) Knee Evaluation Form before operation and 12 months after operation. The knee joint flexion and extension degrees of patients were measured by joint protractor in 2 weeks and 12 months after operation. The color Doppler ultrasound was used to evaluate integrity of knee joint capsule and continuity of patellar ligament of patients in 6 and 12 months after operation. Results: All flaps of 26 patients survived well, and wounds healed completely after the operation. Distal parts of flaps of 2 patients treated with free anterolateral femoral flaps had local necrosis after the operation, and their wounds healed after debridement and transplantation of autologous intermediate split-thickness skin graft of thigh. The IKDC Knee Evaluation Form score of patients was (79±8) points in 12 months after operation, which was significantly higher than (64±7) points before operation (t=7.20, P<0.05). The flexion degree of knee joint of patients was (117±10)° in 12 months after operation, which was significantly larger than (35±8)° in 2 weeks after operation (t=32.65, P<0.05). The extension degree of knee joint of patients was (12±9)° in 12 months after operation, which was significantly smaller than (61±9)° in 2 weeks after operation (t=19.63, P<0.05). In 6 and 12 months after operation, 9 patients treated with local rotation flaps had good integrity of knee joint capsule and continuity of patellar ligament; 7 patients treated with free anterolateral femoral flaps and fascia lata had good integrity of knee joint capsule; 10 patients treated with free anterolateral femoral flaps and iliotibial tract had good continuity of patellar ligament. During follow-up of 12 months, all flaps survived well; knees of all patients had good appearance; knee joints functioned normally. Conclusions: Good appearance and function of knees can be achieved by repairing wound of skin and soft tissue defect on knees after severe burn or trauma with local rotation flaps or free anterolateral femoral flaps with fascia lata or iliotibial tract plus systematic rehabilitation treatment of knee joint in early stage after flap transplantation operation.

Flap transplantation combined with Masquelet technique in the treatment of bone and soft defect

Objective To explore the effect of the use of flap transplantation combined with Masquelet tech- nique in the repair of long bone accompanied with soft tissue defect. Methods The retrospective study includes 16 cases of bone defects over 6.0 cm combined with soft tissue defect from March, 2013 to March, 2016, 13 males and 3 females, of which the ages range from 16 to 65 years. The length of bone defect ranged from 6.0 to 12.0 cm, with an average of 8.5 cm, while the wound defect ranged from 5.2 cm×3.5 cm to 16.0 cm×7.5 cm. There were 8 cases out of 16 involve an infection: 3 cases of Staphylococcus aureus (including 1 MRSA) , 2 cases of Staphylococcus epidermidis, 2 cases of Enterobacter cloacae, and 1 case of Acinetobacter baumannii. The 1 stage surgery in all patients admitted to hospital after complete debridement and external fixation, the clean wounds with bone defect received antibiotic-impregnated bone cement filling operation and a flap transplantation or transposition directly after the debridement, but the infected wounds received vacuum sealing drainage treatment firstly, associated with adequate use of antibi- otics for 1-2 weeks and then the bone cement filling and flap transplantation with infection totally controlled. After 8- 12 weeks, we conducted the secondary internal fixation surgery replacing antibiotic -impregnated bone cement with autogenic cancellous bone, vancomycin artificial bone as well as rhBMP-2. All the cases were followed for 6 to 18 months. Results All patients with primary surgery are effectively controlled after 1-4 weeks of anti-infection treat- ment exclusive of the case with MRSA. As the condition of the patient with MRSA relapse, we changed to onvention- al treatment: placed a continuous irrigation and suction equipment instead of the bone cement filling, the wound healed completely without fistula formation of osteomyelitis in 6 months after the treatment of Ilizarov technique.All transplantation and transposition flaps survived. As for those who received a secondary bone graft operation, all achieved a bony union in a period of 4 -6 months. Conclusion The combination of flap transplantation and Masquelet technique is an effective method to repair limb long bone and soft tissue defect currently. Key words: Masquelet technique; Perforator flap; Composite defect; Stage treatment

Clinical application of VSD negative pressure aspiration and detoxification in severe snake bite

To assess the clinical efficacy of vacuum sealing drainage (VSD) in the treatment of mixed poisonous snake bite. A prospective study was conducted. Forty-three snake bite patients by mixed poisonous snakes admitted to Department of Emergency of the 175th Hospital of People's Liberation Army from February 2015 to February 2017 were enrolled. All patients were divided into routine treatment group (n = 20) and VSD treatment group (n = 23) according to whether early incision decompression and using the VSD technique. The patients in the routine treatment group were treated with injection of antivenoms, Jidesheng snake tablets external coating, and wound incision detoxification. Beside the routine treatments, patients in the VSD treatment group were treated with incision decompression and the VSD suction aspiration for the swelling limb. Bite wound infection rate, local skin necrosis area, maximum level of C-reactive protein (CRP), length of hospital stay and disability rate were compared between the two groups. Forty-three patients were followed up for 6-12 months with average of (10.3±1.4) months postoperatively. There were no deaths in both groups. Compared with the routine treatment group, wound infection rate in the VSD treatment group was significantly lowered [8.7% (2/23) vs. 40.0% (8/20)], local skin necrosis area was significantly reduced (cm2: 4.2±0.8 vs. 6.0±1.3), the maximum CRP was significantly lowered (mg/L: 50.0±12.1 vs. 68.0±13.4), the hospitalization time was significantly shortened (days: 11.7±2.9 vs. 17.7±4.9), and the difference above was statistically significant (all P < 0.05). The disability rate of the VSD treatment group was lowered as compared with routine treatment group [13.0% (3/23) vs. 13.0% (6/20)] without statistically significant difference. Early incision decompression and VSD pressure suction of the swelling limb associated with combination therapy of drugs is a reliable and effective method for severe snakebite, and can promote physical rehabilitation and shorten hospital stay.

Efficacy of combined treatment with vacuum sealing drainage and recombinant human epidermal growth factor for refractory wounds in the extremities and its effect on serum levels of IL-6, TNF-α and IL-2.

The objective of this study was to investigate the efficacy of combined treatment with vacuum sealing drainage (VSD) and recombinant human epidermal growth factor (rhEGF) for refractory wounds in the extremities, and its effect on serum levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and IL-2. Ninety-eight patients with refractory wounds in the extremities were recruited and randomly divided into the combined treatment group (underwent VSD and rhEGF treatment) and control group (underwent VSD only) with 49 cases each. Formation of granulation tissue on the wound surface was assessed and scored. The wound healing rate was calculated after 1 week of treatment, and the time of complete healing was recorded. Serum levels of IL-6, IL-2, and TNF-α were measured using enzyme-linked immunosorbent assay. After 1 week of treatment, granulation tissue formation on wound surfaces was significantly improved (p<0.05) compared with that before treatment in both groups. Moreover, granulation tissue formation on wound surfaces was superior in the combined treatment group than in the control group (p<0.05). The wound healing rate was 63.50±4.75% in the combined treatment group and 31.79±3.52% in the control group, and the difference was statistically significant (p<0.05). The time of complete healing was 15.11±2.24 days in the combined treatment group and 19.63±2.76 days in the control group, and the difference was statistically significant (p<0.05). The serum levels of IL-6, IL-2, and TNF-α, in the two groups were significantly lower than those before treatment (p<0.05). Moreover, the levels in the combined treatment group were significantly lower than those in the control group (p<0.05). In conclusion, combined treatment with VSD and rhEGF reduced inflammation and shortened the time of complete healing of refractory wounds in the extremities. Measurement of the levels of related inflammatory factors provided a reference for the prognosis of refractory wounds.

Clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle

Objective: To investigate clinical effects of middle and low peroneal artery perforator flap with pedicle on repairing skin and soft tissue defects of ankle. Methods: Twenty patients with skin and soft tissue defects of ankle and exposure of tendon and bone were admitted in our burn wards from April 2012 to December 2015. The size of skin and soft tissue defects ranged from 5 cm×4 cm to 23 cm×10 cm. Patients were treated with debridement and vacuum sealing drainage (VSD) after admission. After VSD treatment for 1 week, flap transplantation operation was performed. Middle and low perforating branches of peroneal artery were detected by portable Doppler blood flow meter before the operation. Flaps were designed and resected according wounds during the operation, with 1 or 2 middle and low perforating branches of peroneal artery in flaps. Seventeen patients were treated with middle and low peroneal artery perforator flap. Larger wounds with exposure of tendon and bone were repaired with middle and low peroneal artery perforator flap, and the other wounds were repaired with intermediate split-thickness skin graft of thigh on the same side in three patients. The size of flap ranged from 6 cm×5 cm to 25 cm×12 cm. The donor sites were sutured directly or repaired with intermediate split-thickness skin graft of thigh on the same side. Results: After operation, 1 patient with partial skin necrosis at the distal of the flap because of disorder of venous circulation healed after dressing change and physiotherapy, and flaps of the other 19 patients survived well. During follow-up of 3 to 36 months, flaps of all patients were in good appearance, with no obvious cicatrix, and the affected limbs and ankle joints functioned well. Conclusions: Middle and low peroneal artery perforator flap with advantages of stable perforating branch, reliable blood supply, and large resected size, can repair skin and soft tissue defects of ankle.

Drainage à pression négative en préopératoire des traumatismes complexes ouverts de la main : à propos de 17 cas

BackgroundFew studies have been conducted to explore the use of the vacuum sealing drainage (VSD) technique in complex hand injuries. The aim of this study was to report outcomes in patients with complex hand injuries receiving VSD as a coadjuvant treatment prior to second-stage surgery. MethodsThis case series study retrospectively reviewed the patients who underwent VSD for treatment of hand injuries. Inclusion criteria for the study were: (1) traumatic soft tissue defects of the hand and wrist, accompanied by different degrees of injury and exposure of bone, tendon, or blood vessel; (2) the wound surface of hand and wrist was seriously contaminated and direct wound closure was not possible; and (3) the soft tissues of hand and wrist were seriously lacerated or avulsed, and showed necrosis or acute infection. After debridement, one-stage and/or two-stage repairs using healthy adjacent tissues were performed and the wound was covered by the VSD materials. The non-cytotoxic polyethylene alcohol hydration seaweed salt foam was applied during the VSD treatment for its good biocompatibility. The drainage tube was connected to the vacuum equipment and the negative pressures were set at –60kPa to –40kPa. The VSD device was left in place for 5 to 7 days before removal. Either free skin grafting or skin flap transplantation was used for wound closure and/or reconstructive surgery. The hand injury severity score was used to assess wound severity. The surgical results were scored using the total active motion classification. ResultsA total of 17 patients (13 and 4 patients had major and severe hand injuries), averaging 33.8years were included. During the study period, 6 patients with severe hand injuries were not treated with VSD for the following reasons: (1) hemodynamic instability (n=1); (2) impaired coagulation function (n=1); (3) uncontrollable hemorrhage on the wound surface (n=2); and (4) exposure of the main blood vessels after surgical repair (n=2). VSD treatment was performed for an average of 7.4days (range, 6–14days) and the duration of wound healing averaged 23days (range, 20–43days). Wound infection was not reported prior to second-stage surgery. Only one of 17 patients had superficial necrosis at the flap edge, for a success rate of 94%. Average follow-up was 8.7months (range, 4–13months). Twelve (71%) patients reported excellent or good, four (23%) reported fair, and one (6%) reported poor results. ConclusionThe VSD can effectively promote safe and rapid repair of local soft tissues with good prognosis.

Vacuum sealing drainage as a pre-surgical adjunct in the treatment of complex (open) hand injuries: Report of 17 cases

BackgroundFew studies have been conducted to explore the use of the vacuum sealing drainage (VSD) technique in complex hand injuries. The aim of this study was to report outcomes in patients with complex hand injuries receiving VSD as a coadjuvant treatment prior to second-stage surgery. MethodsThis case series study retrospectively reviewed the patients who underwent VSD for treatment of hand injuries. Inclusion criteria for the study were: (1) traumatic soft tissue defects of the hand and wrist, accompanied by different degrees of injury and exposure of bone, tendon, or blood vessel; (2) the wound surface of hand and wrist was seriously contaminated and direct wound closure was not possible; and (3) the soft tissues of hand and wrist were seriously lacerated or avulsed, and showed necrosis or acute infection. After debridement, one-stage and/or two-stage repairs using healthy adjacent tissues were performed and the wound was covered by the VSD materials. The non-cytotoxic polyethylene alcohol hydration seaweed salt foam was applied during the VSD treatment for its good biocompatibility. The drainage tube was connected to the vacuum equipment and the negative pressures were set at –60kPa to –40kPa. The VSD device was left in place for 5 to 7 days before removal. Either free skin grafting or skin flap transplantation was used for wound closure and/or reconstructive surgery. The hand injury severity score was used to assess wound severity. The surgical results were scored using the total active motion classification. ResultsA total of 17 patients (13 and 4 patients had major and severe hand injuries), averaging 33.8 years were included. During the study period, 6 patients with severe hand injuries were not treated with VSD for the following reasons: (1) hemodynamic instability (n=1); (2) impaired coagulation function (n=1); (3) uncontrollable hemorrhage on the wound surface (n=2); and (4) exposure of the main blood vessels after surgical repair (n=2). VSD treatment was performed for an average of 7.4 days (range, 6–14 days) and the duration of wound healing averaged 23 days (range, 20–43 days). Wound infection was not reported prior to second-stage surgery. Only one of 17 patients had superficial necrosis at the flap edge, for a success rate of 94%. Average follow-up was 8.7 months (range, 4–13 months). Twelve (71%) patients reported excellent or good, four (23%) reported fair, and one (6%) reported poor results. ConclusionThe VSD can effectively promote safe and rapid repair of local soft tissues with good prognosis.

Bone transport combined with open bone grafting and vacuum sealing drainage for treatment of infectious tibial bone defect

Objective To assess the efficacy of using the Ilizarov bone transport combined with open bone grafting and vacuum sealing drainage (VSD) to treat infected tibial bone defect. Methods A retrospective case series study was made on 8 patients sustaining posttraumatic infectious tibial bone defect treated between March 2010 and May 2015. There were 7 male and 1 female patients between 22 and 51 years (mean, 39.4 years). All patients underwent radical resection of the infected/necrotic bone and debridement of the soft tissue. Length of bone defects after debridement averaged 8 cm (range, 3.5-13.5 cm) and wound size averaged 4.8 cm×2.5 cm (range, 2.3 cm×1.1 cm-8.5 cm×6.0 cm). Stabilization was finished with Ilizarov circular external frame in all patients. Six patients were candidates for single- or double-level bone transport, and the cancellous bone autograft was placed openly within the butterfly defect after docking. Other 2 patients were treated with one-stage shortening of the fracture ends and open cancellous bone grafting, and the bone lengthening was performed. Then the grafted wounds were covered by VSD. Data were recorded including the bone transport or lengthening time, wound healing time, union time of docking sites, consolidation time of regenerate zones, external fixation time and external fixation index. Bone results and functional results were evaluated according to the criteria given by association for the study and application of the method of Ilizarov (ASAMI). Results Duration of follow-up was 10.2-36.4 months (mean, 12.2 months). All the wounds achieved successful healing and eradication of infection. Mean bone transport time was 50 days (range, 30-69 days). Seven patients showed self-healing wounds, and mean healing time was 3.4 months (range, 1.2-6 months). One patient experienced wound closure by skin grafting. Union and consolidation were achieved in all docking sites and regenerate zones. Mean union time of docking sites after bone grafting was 6.8 months (range, 5.3-10 months). Mean consolidation time of regenerate zones was 6.2 months (range, 4.8-8.5 months). Mean external fixation time was 8.6 months (range, 6.5-11.5 months) with a mean external fixation index of 1.2 months/cm(range, 0.7-1.9 months/cm). According to the criterion of ASAMI, bony results were excellent in 7 patients and poor in 1 patient, and functional results were excellent in 4 patients and good in 4 patients. Conclusion Ilizarov bone transport technique combined with open bone grafting and VSD for infectious tibial bone defect can accelerate bone union and wound healing at docking sites and reduce external fixation time. Key words: Tibia; Osteomyelitis; Ilizarov technique; Fractures, ununited; Bone transplantation

Effect of vacuum sealing drainage on the expression of VEGF and miRNA-17-5p in seawater-immersed blast-injury wounds.

The aim of the present study was to compare and observe the expression levels of vascular endothelial growth factor (VEGF) and miRNA-17-5p during the treatment of seawater-immersed blast-injury wounds (SIBIW) under different conditions of vacuum sealing drainage (VSD), and to identify the optimized range of VSD treatment and partially explain its mechanisms. The bilateral hips and scapulae of experimental pigs (weight, 25-30 kg) were subjected to blast-injury wounds, followed by the seawater immersion. The animals then underwent conventional dressing treatment under 120, 180 and 240 mmHg VSD. Visual observation, in addition to histological, immunohistochemical and molecular biological techniques were applied to compare and observe the extent of wound healing and expression levels of VEGF and miRNA-17-5p. The wound healing of the VSD treatment group was improved compared with the control group, with 120 mmHg negative pressure producing the most marked effect. miR-17-5p expression was detected in the SIBIW granulation tissues. There was significant difference between each VSD treatment group and control group at each time point (P<0.05). Thus, the present results show that miR-17-5p can be expressed in SIBIW granulation tissues, and this effect is most evident under 120 mmHg negative pressure, which may inform the optimized negative range for the treatment of SIBIW.

Effects of vacuum sealing drainage on the treatment of cranial bone-exposed wounds in rabbits.

This study was designed to assess the efficacy of vacuum sealing drainage (VSD) on skull exposure wounds in rabbits and to investigate the underlying mechanism of the process. Full-thickness excisional circular wounds 2×2 cm with or without periosteum involvement were created in 88 New Zealand white rabbits (mean body weight: 3.0±0.65 kg). Animals were randomly divided into 4 groups: periosteum-intact wounds treated with traditional dressing (p+control), periosteum-intact wounds treated with VSD (p+VSD), periosteum-lacking wounds treated with traditional dressing (p–control) and periosteum-lacking wounds treated with VSD (p–VSD). The wounds treated with traditional dressing were covered with Vaseline gauze, while VSD treatment was accompanied with continuous –120 mmHg pressure. Finally, wound tissues were harvested for analysis of hydroxyproline content and histologic detection. VSD hastened the wound healing process significantly (P<0.05) compared to the corresponding control groups. VSD alleviated the inflammation reaction, accelerated re-epithelialization and facilitated the organization of collagen fibers into neat rows. During the wound healing process, the hydroxyproline content increased overtime [i.e., postoperative days (POD) 7, POD 10 and POD 15] in all four groups, and it peaked in the p+VSD group. VSD also promoted angiogenesis via increasing number and quality of collagen. We concluded that VSD can promote healing in bone-exposed wounds via increasing hydroxyproline content and vessel density, reducing inflammatory responses and generating ordered collagen arrangement.

Vacuum Sealing Drainage Treatment of Multi-Drug–Resistant Enterobacter Cloacae Wound Infection in a Diabetic Patient: A Case Report and Review of the Literature

Diabetic foot ulcers differ from non-diabetic trauma, as diabetic patients have dysfunctional wound healing owing to changes in the microcirculation. Herein, we report the case of a 48-year-old man with a 4-year history of uncontrolled type 2 diabetes. The patient had developed a 3-cm-wide ulcer deep to the phalanx on the big toe of the right foot 3 weeks ago, and the ulcer became infected with multi-drug–resistant Enterobacter cloacae 1 week later. We performed thorough wound debridement combined with Vacuum Sealing Drainage (VSD) and intravenous immunoglobulin administration without antibiotic therapy. This treatment strategy reduced the size of the ulcer. Three weeks later, antibiotic-susceptible Staphylococcus aureus was cultured from the wound tissue instead of Enterobacter cloacae, and so, the patient was administered antibiotics. The patient recovered well after this simple procedure followed by antibiotic therapy.

Clinical efficacy of vacuum sealing drainage in treatment of postoperative infection of filling injection

Objective To investigate the clinical efficacy of the vacuum sealing drainage (VSD), which was used in postoperative infection of filling injection. Methods VSD technology was applied to treat 16 infected cases after local injection of filler or autologous fat. The wound recovery was observed for 3 to 8 months. Results Of the 16 patients, 3 used VSD twice, and the rest used once. All wound closured and cured. 2 to 3 days after negative pressure treatment, infection site swelling began to fade, and secretion also gradually become clear. The wound healed well with no recurrence of infection. No nerve and organ injury occured. Conclusions VSD technology applied in the infection of local injection of filling can be fully drainage, control infection and promote wound healing. Therefore, it is worth using in clinic setting. Key words: Vacuum sealing drainage; Injection filling; Injection

Vacuum Sealing Drainage Treatment Combined with Antibiotic-Impregnated Bone Cement for Treatment of Soft Tissue Defects and Infection.

BackgroundThis study aimed to evaluate the combined effect of vacuum sealing drainage (VSD) and antibiotic-loaded bone cement on soft tissue defects and infection.Material/MethodsThis prospective non-blinded study recruited 46 patients with soft tissue defects and infection from January 2010 to May 2014 and randomly divided them into experimental and control groups (n=23). Patients in the experimental group were treated with VSD and antibiotic-loaded bone cement, while the patients in the control group were treated with VSD only.ResultsIn the experimental group, the wound was healed in 23 cases at 4 weeks postoperatively, of which direct suture was performed in 12 cases, and additional free flap transplantation or skin grafting was performed in 6 cases and 5 cases, respectively. No infection reoccurred in 1-year follow-up. In the control group, the wound was healed in 15 cases at 6 weeks postoperatively, of which direct suture was performed in 8 cases, and additional free flap transplantation or skin grafting was performed in 3 cases and 4 cases, respectively. In the other 8 cases the wound was healed at 8 weeks postoperatively. Infection reoccurred in 3 cases during the follow-up. The experimental group had significantly fewer VSD dressing renewals, shorter time needed until the wound was ready for surgery, shorter duration of antibiotic administration, faster wound healing, and shorter hospital stay than the control group (p<0.01).ConclusionsThe combination of VSD and antibiotic bone cement might be a better method for treatment of soft tissue defects and infection.

Thérapie séquentielle associant pansement aspiratif, greffe dermique artificielle puis greffe fine cutanée pour de larges pertes de substances cutanées infectées chez l’enfant

ObjectiveTo evaluate the efficacy of a “vacuum sealing drainage (VSD) – artificial dermis implantation (ADI) – thin partial thickness skin grafting (TSG)” sequential therapy for deep and infected wounds in children. Materials and methodsFifty-three pediatric patients with deep and infected wounds were treated with sequential VSD-ADI-TSG therapy. The efficacy of this treatment was compared with that of the surgical debridement-change dressings-thin partial thickness skin grafting previously performed on 20 patients. Survival of tissue grafts, color and flexibility, subcutaneous fullness and scar formation of the graft site were examined and compared. ResultsThe sequential therapy combined the advantages of the VSD treatment, in reducing tissue necrosis and infection on the wound surfaces and promoting the growth of granulation tissue, with the enhancement of grafting by artificial dermis. Compared with the 20 controls, skin grafted on the artificial dermis was more smooth and glossy, while the textures of the region were more elastic, and the scars were significantly lighter in Vancouver scale. ConclusionThe sequential VSD-ADI-TSG therapy is a simple and effective treatment for children with deep and infected wounds. Level of evidenceIV.

Sequential therapy with “vacuum sealing drainage-artificial dermis implantation-thin partial thickness skin grafting” for deep and infected wound surfaces in children

ObjectiveTo evaluate the efficacy of a “vacuum sealing drainage (VSD) – artificial dermis implantation (ADI) – thin partial thickness skin grafting (TSG)” sequential therapy for deep and infected wounds in children. Materials and methodsFifty-three pediatric patients with deep and infected wounds were treated with sequential VSD-ADI-TSG therapy. The efficacy of this treatment was compared with that of the surgical debridement-change dressings-thin partial thickness skin grafting previously performed on 20 patients. Survival of tissue grafts, color and flexibility, subcutaneous fullness and scar formation of the graft site were examined and compared. ResultsThe sequential therapy combined the advantages of the VSD treatment, in reducing tissue necrosis and infection on the wound surfaces and promoting the growth of granulation tissue, with the enhancement of grafting by artificial dermis. Compared with the 20 controls, skin grafted on the artificial dermis was more smooth and glossy, while the textures of the region were more elastic, and the scars were significantly lighter in Vancouver scale. ConclusionThe sequential VSD-ADI-TSG therapy is a simple and effective treatment for children with deep and infected wounds. Level of evidenceIV.

Vacuum Sealing Drainage as Treatment of Severe Buttocks and Perianal Infection

Vacuum sealing is a therapeutic concept to achieve secure and rapid wound healing in traumatic soft tissue damage. Its application and effect in the treatment of severe buttocks and perianal infection are unclear.We describe a case of buttocks and perianal infection using the vacuum sealing drainage (VSD) technique. A 58-year-old man was admitted with buttocks and perianal severe infection, which was caused by injection. The size of the wounds was 40 × 30 cm. Colostomy was applied prior to the prompt surgical debridement to prevent defecation and keep the perianal region clean. Emergency debridement was then conducted. After the wounds were thoroughly washed with conventional disinfection solution, they were then covered by VSD system.The infection was controlled 9 days after the first surgery by prompt surgical debridement, the application of VSD treatment, and the use of narrow-spectrum antibiotics based on susceptibility result. After 3 applications of VSD treatment, skin grafting harvested from the left leg was conducted. All free skin grafts survived at 8 weeks. Colon was placed back into the abdominal cavity finally.Initial colostomy and debridement, the temporary VSD cover followed after several days by skin grafting is a reliable treatment regimen for severe buttocks and perianal infection.

Clinical efficacy of vacuum-sealing drainage in treatment of Fournier’s gangrene

Clinical efficacy of vacuum-sealing drainage in treatment of Fournier’s gangrene

Construction of nursing quality evaluation system of the vacuum sealing drainage treatment of soft tissue blast injury wounds

Vacuum sealing drainage （VSD） is widely used in the treatment of soft tissue blast injury wounds, how to care for the wound healing plays an extremely important role. By analyzing the past blast injury data, we found that the current lacking of scientific, standardized and systematic criteria to evaluate the quality of care and clinical pathways mass system management mode, nursing research on the body skin or soft tissue wounds lacking of systematic and comprehensive exposition in soft tissue blast injury and it is still a systemic blank for wounds nursing. So, formulating a more scientific evaluation system of quality of care standards, and designing a scientific and effective quality management of clinical pathway-model is important to provide scientific basis and normative guidance for comprehensive blast injuries care in future wars. Key words: Vacuum sealing drainage; Soft tissue blast injury; Nursing quality evaluation system

Evaluation of the effect of the silver sulfadiazine lipid water gel dressings combined with VSD on treatment of deep wound infection

Objective To observe the effect of silver sulfadiazine lipid water gel dressings combined with vacuum sealing drainage （ VSD） on the treatment of deep wound infection .Methods From April 2010 to December 2012, 44 patients with wound clinic were randomly divided into treatment group （n=24） and control group （ n=20 ） .And treatment group received water gel dressing with silver sulfadiazine lipid binding VSD treatment,while control group received theordinary sterile gauze combination VSD treatment .Then, patients dressing pain , bacterial clearance rate at the same point , wound cleaning time , the number of times of plugging and times of changing drainage tube were observed .Results Pain with the treatment group was mild compared with the control group,and the difference was statistically significant （Z =-4.036, P ＆lt;0.05）.Bacterial clearance rate （94% vs 73%）, wound cleaning time （12 d vs 28 d）, plugging （0% vs 70%）, times of changing drainage tube （3.2 vs 9.1） in treatment group were significantly better than that in control group （χ2 =21.32,P＆lt;0.05）.Conclusions Silver sulfadiazine lipid water glue dressing combined with VSD can effectively improve the rate of bacterial clearance , prevent the drainage tube blockage , reduce the number of drainage tube replacement , shorten wound cleaning time , reduce the patient ’ s degree of pain , and be shorter hospital stay . Key words: Dressing,silver sulfadiazine lipid water glue; Infection; Vacuum sealing drainage; Deep wound