Vacuum Sealing Drainage Research Articles

Effect of decellularized adipose tissue combined with vacuum sealing drainage on wound inflammation in pigs

To preliminary explore the effect of decellularized adipose tissue (DAT) combined with vacuum sealing drainage (VSD) on wound inflammation in pigs. The DAT was prepared through the process of freeze-thaw, enzymatic digestion, organic solvent extraction, and vacuum freeze-drying. The appearance of DAT was observed before and after freeze-drying. HE staining was used to observe its structure and acellular effect. Eighteen male Bama minipigs were recruited, and four dorsal skin soft tissue wounds in diameter of 4 cm were made on each pig and randomly divided into 4 groups for different treatments. The wounds were treated with DAT combined with VSD in DAT/VSD group, DAT in DAT group, VSD in VSD group, and sterile gauze dressing in control group. HE staining was performed at 3, 7, 10, and 14 days after treatment. Moreover, the expressions of inflammatory factors [interleukin 1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α)], as well as the phenotypes of M1 and M2 macrophage phenotypic markers [inducible nitric oxide synthase (iNOS) and arginase 1 (ARG-1)] were detected by real-time fluorescence quantitative PCR (qRT-PCR). ELISA was used to determine the content of iNOS and ARG-1. General observation and HE staining showed that DAT obtained in this study had a loose porous structure without cells. The neutrophils of wounds were significantly less in DAT/VSD group than in control group and DAT group ( P<0.05) at 3 days after treatment, and the difference was not significant ( P>0.05) between DAT/VSD group and VSD group. And the neutrophils were significantly less in DAT/VSD group than in other three groups ( P<0.05) at 7, 10, and 14 days. The mRNA expressions of IL-1β, IL-6, TNF-α, and iNOS were significantly lower in DAT/VSD group than in other three groups at 3, 7, 10, and 14 days ( P<0.05), while the mRNA expression of ARG-1 was significantly higher in DAT/VSD group than in other three groups ( P<0.05). ELISA showed that the content of iNOS was significantly lower in DAT/VSD group than in other three groups at 3, 7, 10, and 14 days ( P<0.05), while the content of ARG-1 was significantly higher in DAT/VSD group than in other three groups ( P<0.05). DAT combined with VSD can significantly reduce inflammatory cell infiltration during wound healing, regulate the expressions of inflammatory factors and macrophage phenotype, and the effect is better than single use of each and conventional dressing change.

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

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

Surgical treatment of deep infection around the spine

To study the surgical method and clinical effect of deep infection around the spine. The clinical data of 7 patients with deep infections around the spine treated from January 2015 to January 2018 were retrospectively analyzed. All patients were acute infection within 3 weeks after spinal surgery. There were 5 males and 2 females, aged from 29 to 67 years old with an average of 42 years old. Four of them had implants and the other three didn't. After infection was diagnosed, they accepted aggressive debridement with assistance of vacuum sealing drainage(VSD). The antibiotic artificial bones were put in wounds, combined with intravenous antibiotics. Blood-rich adjacent tissue flaps were used to reconstruct defect of wounds. The tissue flaps included 4 paraspinal muscle flaps, 1 thoracolumbar fascial flap, 1 latissimus dorsi flap and 1 paraspinal muscle combined with thoracolumbar fascial flap. All 7 patients were followed up from 6 to 24 months with an average of 13.28 months. During the follow-up period, among the 4 patients with instrument, except one patient of lumbar fusion removed internal fixation due to postoperative infection, the other 3 patients successfully kept the implants. One case of cervical fracture and dislocation was repaired by latissimus dorsi transposition. Its wound healed but hydrops accumulated under the flap. This patient was cured by puncture drainage and local pressure bandaging. The other 5 wounds' healing were first intention and no postoperative complications such as infection recurrence, hematoma, effusion or wound dehiscence occurred. Deep infection around the spine is a serious complication and should be treated aggressively once diagnosed. Thorough debridement with the help of negative pressure closed drainage, local application of antibiotic artificial bone combined with systemic intravenous antibiotics and repairing wounds with adjacent tissue flaps are effective procedures for the treatment of deep infection around the spine.

Clinical therapeutic observation on sequential treatment of chronic wounds with repeated recurrence of hidradenitis suppurativa in buttocks

Objective: To observe the clinical effects of sequential treatment with extensive lesion resection, vacuum sealing drainage (VSD) combined with irrigation of oxygen-loaded fluid, and tissue transplantation on hidradenitis suppurativa (HS) in buttocks which recurred after multiple surgeries. Methods: From January 2012 to March 2017, 15 male patients (aged 26-53 years) hospitalized in our burn ward with Hurley's stage Ⅲ HS in the buttocks recurred after 2-5 operations who met the inclusion criteria were enrolled in the prospective self pre- and post-control study. After extensive resection of the lesion, continuous VSD combined with intermittent irrigation of oxygen-loaded fluid was given, with negative pressure of -16.7 kPa and flow rate of pure oxygen of 1.0 L/min. After 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid, the negative pressure device was removed and autologous posterior thigh split-thickness skin grafts and/or local flaps were transplanted to repair the wounds. Six patients were performed with split-thickness skin grafting, 4 patients with local flap transplantation, and 5 patients with split-thickness skin grafting together with local flap transplantation. The donor sites of local flaps were sutured directly or transplanted with autologous posterior thigh split-thickness skin grafts, and the donor sites of split-thickness skin grafts with autologous thin split-thickness scalp. The wound tissue or wound granulation tissue was collected before lesion resection and 7 days after treatment with VSD combined with irrigation of oxygen-loaded fluid respectively for bacterial culture and detecting of the content of tumor necrosis factor-alpha (TNF-α) by enzyme-linked immunosorbent assay. Survival of skin grafts and flaps after operation was observed, hospitalization time was recorded, and recurrence and complications of HS were followed up. Data were processed with paired sample t test. Results: Bacterial culture result of wound tissue before lesion resection was positive in all patients, mainly Staphylococcus, Streptococcus, Proteus mirabilis, and anaerobic bacteria, etc., while that of wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was negative. The content of TNF-α in wound granulation tissue after 7 days of treatment with VSD combined with irrigation of oxygen-loaded fluid was (10.1±2.9) pg/L, significantly lower than (73.6±5.6) pg/L before lesion resection (t=33.47, P<0.01). The skin grafts and/or flaps of 15 patients survived post operation, and the wounds were healed. The patients were hospitalized for 17-31 days. During follow-up of 1 to 5 years, no recurrence of HS occurred in operative site of buttocks of 15 patients, but 1 patient had ulceration of healed perianal incision caused by high anal fistula and was healed after treatment. Conclusions: Sequential treatment with extensive resection, VSD combined with irrigation of oxygen-loaded fluid, and tissue transplantation can thoroughly remove HS lesions in the buttocks and improve the condition of wound bed for skin acceptance after debridement, which is conducive to the cure of HS in the buttocks which has undergone multiple operations but still recurs after operation.

Effects of Vacuum Sealing Drainage Combined with Ilizarov Bone Transport Technique in the Treatment of Tibial Traumatic Osteomyelitis.

BackgroundThe aim of this study was to analyze the efficacy of vacuum sealing drainage combined with Ilizarov bone transport technique in the treatment of tibial traumatic osteomyelitis and risk factors for postoperative pin infection.Material/MethodsWe enrolled 78 patients with tibial traumatic osteomyelitis admitted at the First People’s Hospital of Kashgar from January 2015 to September 2017 and treated with vacuum sealing drainage combined with Ilizarov bone transport technique.ResultsAfter combined treatment, SAS and SDS scores decreased significantly, while SF-36 scores increased significantly. Comparisons showed that there were significant differences in the scores of patients after treatment (P<0.05). Univariate analysis showed that there were no significant differences in gender, BMI, hypertension, diabetes mellitus, COPD, smoking index, alcohol abuse history, or residence (P>0.05). There were significant differences in age, fracture type, fixation type, pin loosening, and indwelling time between the 2 groups (P<0.05). Multivariate logistic analysis showed that age, fracture type, fixation type, pin loosening, and indwelling time were independent risk factors for pin infection. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis.ConclusionsCombination of vacuum sealing drainage with Ilizarov bone transport technique can effectively improve the condition of tibial traumatic osteomyelitis, improve the quality of life of patients, and reduce the occurrence of adverse emotions of patients. Age, fracture type, fixation type, pin loosening, and indwelling time are independent risk factors for pin infection in patients with tibial traumatic osteomyelitis.

Effects of different frequency normal saline flushing in vacuum sealing drainage wound care

Objective To explore the effect of 0.9% sodium chloride solution (normal saline) flushing with different frequencies on the prevention of blockage, complications and wound healing time in vacuum sealing drainage (VSD) wound care. Methods Totally 125 patients hospitalized in the Orthopaedic Department of the Ninth People's Hospital Affiliated to Medical College of Shanghai Jiaotong University and were given VSD would care from April 2016 to January 2018 were selected by convenient sampling method. Non-synchronized controlled trial was used, 40 patients from April to October 2016 were taken as control group and received routine VSD nursing; 44 patients from November 2016 to June 2017 were taken as observation group A and received 50 ml normal saline flushing combined with routine VSD nursing once a day; while 41 patients from July 2017 to January 2018 were assigned into observation group B and received normal saline flushing twice a day combined with routine VSD nursing. The differences in the number of tube blockages, wound healing time and complications between the three groups were compared. Results The total number of tube blockage in the observation group was lower than the control group with statistical difference (χ2=20.048, P 0.05) . The wound healing time of observation group A was (14.02±9.71) days, while that of observation group B was (13.85±7.63) days, both shorter than that of control group (19.73±12.94) days. The differences were statistically significant (P 0.05) . The overall incidence of complications in the observation group was lower than that in the control group with statistical difference (χ2=9.486, P 0.05) . Conclusions Normal saline flushing combined with VSD routine nursing once a day can effectively prevent tube blockage, promote wound healing and reduce complications, which is suitable for clinical promotion. Key words: Negative-pressure wound therapy; Wound nursing; Vacuum sealing drainage; Normal saline; Flushing; Frequency

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.

Minimally invasive single locking plate combined with multiple planar screw internal fixation for pilon fracture

Objective To investigate the clinical effect of minimally invasive single locking plate combined with multiplanar screw internal fixation on pilon fracture of distal tibia. Methods A retrospective case control study was conducted to analyze the clinical data of 51 patients with pilon fracture involving distal tibial articular surface admitted to 81th Group Military Hospital of the Army from January 2013 to August 2017. Among the patients, 20 patients including 15 males and five females, aged (37.5±9.9)years were treated with closed traction reduction or open joint reduction through minimally invasive incision and single main locking plate combined with multiplanar screw placement (study group). There were 13 patients with type II and seven patients with type III according to Ru edi-Allgwer classification of fracture. In addition, 31 patients were treated with open reduction and multi-plate internal fixation (control group), including 25 males and six females, aged (43.4±11.3) years. There were 20 patients with type II and 11 with type III according to Ru edi-Allgwer classification. The operation time, fracture healing time, postoperative complications were compared between the two groups. Burwell-Charnley imaging evaluation criteria were used to assess the quality of fracture reduction. At the last follow-up, ankle function was assessed by the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot functional score. Results All 51 patients were followed up for 6-24 months, with an average of 16 months. The operation time was (82.5±19.2)minutes in the study group and (127.7±40.8)minutes in the control group (P 0.05). Local skin necrosis (not above the plate) occurred in two patients in the study group and in three patients in the control group, with the wounds being healed within 3 months after dressing change and vacuum sealing drainage (VSD). In the control group, one patient had severe infection and recovered after treatment of steel plate removal, debridement and irrigation, and external fixator fixation. Three patients in the control group had skin necrosis resulting in plate exposure, who received transferred skin flaps to cover the wound. The incidence of postoperative complications were 10% (2/20) and 23% in the study group and the control group, respectively (7/31)(P>0.05), with the incidence of severe complications for 0 and 13% (4/31)(P 0.05). At the last follow-up, AOFAS ankle-hind foot function scores were excellent in 12 patients, good in five patients, fair in two patients and poor in one patient in the study group with excellence rate of 85%, while the scores were excellent in 20 patients, good in six patients, fair in three patients and poor in two patients in the control group, with excellence rate of 84% (P>0.05). Conclusion For pilon fracture of distal tibia, both minimally invasive single locking plate combined with multi-plate screw internal fixation and open reduction combined with multi-plate internal fixation have good reduction effect and satisfactory recovery of ankle function, but the former can significantly shorten the operation time and reduce the incidence of serious complications after operation. Key words: Tibial fractures; Fracture fixation, internal; Pilon fractures

Clinical effects of autologous platelet-rich plasma gel in the repair of chronic wounds

Objective: To explore the clinical application effects of autologous platelet-rich plasma gel in the repair of various chronic wounds. Methods: From January 2015 to January 2018, 76 patients with chronic wounds were admitted to our unit, with 39 men and 37 women, aged 28 to 75 (52±6) years. Before the operation, areas of wounds ranged from 2.0 cm×0.5 cm to 17.0 cm×5.0 cm, depths of wounds ranged from 1 to 6 cm, areas of wounds substrate ranged from 3 cm×3 cm to 17 cm×8 cm, and volumes of deep cavities ranged from 7 to 55 mL. All patients received operation 2 to 7 days after admission. Autologous platelet of 220-250 mL was collected from each patient by single extraction to make platelet-rich plasma of 10-50 mL. The cavity was filled completely by injection of platelet-rich plasma gel for 1-3 times. Wounds were sutured directly or covered by local flaps or other materials according to the conditions of wounds, and the unclosed wounds in primary stage were treated by continuous vacuum sealing drainage (VSD). Ultrasound, CT, or magnetic resonance imaging was performed to detect the healing of cavity after the operation. The healing of wound and repair of cavity after the operation and during follow-up were observed. Results: Wounds in 39 patients were closed directly after primary operation. Among them, wounds of 36 patients were healed completely, and wounds of the other 3 patients were healed completely after second debridement and topical filling of platelet-rich plasma gel. The cavities in 35 patients were filled with granulation tissue after treatment of platelet-rich plasma gel for 1-3 times combined with VSD, and the wounds were healed after skin grafting or flap transplantation. The treatment of wounds discontinued in the other 2 patients after treatment of platelet-rich plasma gel for once. Postoperative follow-up was lost in 7 patients. During follow-up of 2 and/or 4 months after the primary operation, wounds were healed well with no recurrence, and cavities were filled with fibrous tissue. Conclusions: Autologous platelet-rich plasma gel has advantages in treating chronic wounds, including a large amount by single extraction, flexible use mode, ability to fully fill the complex cavity, high surgical safety, and mild secondary injury. It's a new choice for repair of chronic wounds in clinic.

Clinical study and nursing on vacuum sealing drainage combined with topical oxygen therapy in treating pressure ulcers within intensive care unit

Objective To investigate the efficacy and the nursing experience of vacuum sealing drainage (VSD) combined with topical oxygen therapy on healing of pressure ulcers in intensive care unit. Methods Totally 44 cases of patients in intensive care unit with pressure ulcers on stage Ⅲ and Ⅳ bedsore, from May 2015 to October 2017, were divided into 2 groups according to the random number table.22 cases, as the control group, were treated with routine methods and VSD.22 cases, as the test group, were treated with topical oxygen therapy on basis of the treatment of control group, 10 days for a cycle. The effects of the two methods were compared according to the wound healing rate, the bacterial quantitative, the cell apoptosis rate and the capillary density after a treatment cycle. Results The average wound healing rates of the control group and the test group were (16.5±6.7)% and (26.2±5.6)% respectively, between which there was a significant difference (t=5.09, P 0.05). After treatment, the bacterial quantitative, cell apoptosis rate and capillary density in the control group were (4.9±1.4) ×104CFU/g, (5.5±0.8)%, 38.64±10.14, and in the test group were (2.5±0.7) ×104CFU/g, (2.9± 0.9)%, 41.09±9.28. The differences before and after treatment in the control group were statistically significant (q=1 967.75, 3.51, 6.12, all P 0.05). Conclusion The vacuum sealing drainage combined with topical oxygen therapy can enhance wound healing and control infection significantly, is a safe and effective therapeutic method. Key words: Pressure ulcers; Drainage; Occlusive dressings; Oxygen

Repair of complex wounds on hands after burns or trauma

Objective: To explore the repair methods and effects of the complex wounds on hands after burns or trauma. Methods: From January 2008 to December 2017, 45 patients (28 males and 17 females, aging 8 to 58 years) with severe hand injuries after burns or trauma combined with deep tissue exposure were admitted to our hospital. Two patients had whole-fingers degloving injuries, 27 patients had dorsal hand injuries, and 16 patients had palmar injuries. After debridement, the area of soft tissue defects was 7 cm×6 cm to 19 cm×12 cm combined with 0.5 cm×0.4 cm to 10.0 cm×4.0 cm of single deep tissue exposure. Different repairing methods were adopted according to the area and location of deep tissue exposure. Five patients with small area exposure were treated with artificial dermis+ vacuum sealing drainage (VSD)+ autogenous skin grafting. Thirty-eight patients with unilateral large area exposure on palm or dorsum were treated with segmented ligation of abdominal thin flaps (with area of 8 cm×7 cm to 15 cm×9 cm). Two patients with bilateral large area exposure in dorsal and palmar hands were treated with modified abdominal bag-shaped delayed thin flaps (with area of 12 cm×5 cm to 12 cm×9 cm and 12 cm×6 cm to 14 cm×9 cm). The donor sites were directly sutured or repaired with intermediate split-thickness skin or adjacent flap. The survival of grafts and flaps was observed, number of operations, wound healing time, and follow-up were recorded. Results: (1) Among the patients receiving artificial dermis+ VSD+ autogenous skin grafting, the wounds of 3 patients were healed after 2 operations, and 2 patients had artificial dermis infection and lysis, and tendon necrosis, which were healed after 3 operations. The wound healing time of 5 patients was 14 to 33 days post injury. During the follow-up of 3 months, the affected hands were in good shape with soft texture and fewer scars, and functional evaluation of hand was good in 3 cases and modest in 2 cases. (2) The patients receiving segmented ligation of abdominal thin flaps all underwent 2 operations without flap necrosis. The wound healing time was 2 to 3 weeks post injury. Thirty-five patients underwent one to six-years' follow-up, which showed that the flaps were in good shape and color with soft texture, and the functional evaluation of hand was excellent in 25 cases, good in 7 cases, and modest in 3 cases. Three patients were lost to follow-up. (3) In the 2 patients receiving modified abdominal bag-shaped delayed thin flaps, all flaps survived after 5 operations, the wounds were healed on post injury day 22 and 24 respectively, the shape and texture of the affected hands was good with no bloated appearance after separating fingers and revision. During the follow-up of 2 years, the functional evaluation of hand was good in 2 cases. Conclusions: For the complex wounds on hands after burns or trauma, if the area of deep tissue exposure is small, artificial dermis+ VSD+ autogenous skin grafting should be adopted, which has good effects. If the area of unilateral deep tissue exposure is large, segmented ligation of abdominal thin flap should be adopted; if the area of bilateral deep tissue exposure is large, modified abdominal bag-shaped delayed thin flap should be adopted. These methods can reduce the number of operations, shorten wound healing time, and obtain good shape and function of hands.

Application experience of integrated nursing mode for extremely severe burn patients in August 2nd Kunshan factory aluminum dust explosion accident

Objective: To explore the application experience of integrated nursing mode in the treatment of extremely severe burn patients in August 2nd Kunshan factory aluminum dust explosion accident. Methods: On August 2nd, 2014, 35 extremely severe burn patients involved in the August 2nd Kunshan factory aluminum dust explosion accident were admitted to Wuxi Third People's Hospital, including 18 males and 17 females, aged 21-50 years. According to the characteristics of the wounded, the situation of the nursing staff, and the characteristics of the nursing work, the integrated nursing mode was constructed and implemented to improve overall nursing quality. The standardized management measures such as cluster management of facilities and equipments in wards, improving and unifying nursing system, standardized training, drawing up " Nurses Compulsory Reading" , optimizing nursing shift handover and so on were taken. Professional quality control groups such as continuous renal replacement therapy (CRRT) group, static therapy group, airway group, and burn group were established, and standardized writing nursing group, wound nursing group, psychological nursing group, and enteral nutrition nursing group were set up under burn group. The treatment outcomes of patients and effects of nursing management, nursing methods, and specialty nursing were recorded. Results: Twenty-seven patients survived the shock period, infection period, and recovery period smoothly. The success rate of rescue was 77.14%. During the treatment, the ward was in good order. The implementation rate of disinfection and isolation system, the completion rate of shift handover, the standard rate of intravenous therapy, the implementation rate of bed head elevation, the correct rate of posture placement, and the success rate of CRRT were all 100%. Successful turn over of rotating bed without interruption of CRRT for 24 hours was implemented in two patients. In many cases, the single filter for hemodialysis continuously run for more than 72 hours. The airway mucosa of patients healed around 20 days after injury. No adverse nursing events such as tracheal cannula detachment/blockage, respiratory distress, atelectasis, lung consolidation, aspiration by mistake, rotating bed rollover, ear chondritis, nasal septal pressure ulcer, vacuum sealing drainage (VSD) catheter blockage, VSD dressing leakage, severe abdominal distension/diarrhea, non-planned extubation/blockage of various intravenous treatment catheters implanted into deep veins and arteries were observed. Conclusions: The integrated nursing mode significantly optimizes the nursing work process in the treatment of extremely severe mass burns, clarifies the duties of nursing staff, and improves the quality of nursing. This mode is worthy of taking reference by other burn treatment units.

Nursing care of pelvic fracture combined with soft tissue defect by vacuum sealing drainage and external fixator

Objective To explore the perioperative nursing pattern in patients with pelvic fracture and soft tissue defect in treatment with vacuum sealing drainage(VSD) and external fixator. Methods A total of 60 cases of patients with pelvic fracture combined with soft tissue defect admitted to the hospital from January 2014 to January 2016 were selected. According to the random number table method, they were divided into the observation group and the control group, 30 cases of each group, and were treated with VSD combined with external fixator.The observation group was given routine nursing and the control group was given comprehensive nursing.The body temperature of the two groups was higher than normal time, hospitalization time, fracture healing time, survival rate of first-stage skin grafting, incidence of complications, blood routine and indexes of liver and kidney function at 1 week after surgery, quality of life score at 1 week after surgery and patient satisfaction were compared. Results The body temperature of the observation group was higher than normal time and the length of hospitalization was shorter than that of the control group, and the difference was statistically significant (P<0.05). There was no significant difference in fracture healing time between the two groups (P<0.05). The survival rate of the observation group was higher than that of the control group, and the incidence of postoperative complications was lower than that of the control group, and differences were statistical significance (P<0.05). At 1 week after surgery, WBC, NEU, AST, ALT and Ccr of the observation group were all lower than those of the control group, while the scores of sleep, spirit, diet, psychology and total condition were all higher than those of the control group, and the differences were statistically significant (P<0.05). The satisfaction of the observation group was higher than that of the control group, and the difference was statistically significant (P<0.05). Conclusions For the patients with pelvic fracture combined with soft tissue defect, the implementation of comprehensive nursing in the perioperative period of VSD combined with external fixation is conducive to the recovery of the body, reducing the risk of postoperative complications, and the patients are highly satisfied, which is worthy of promotion. Key words: Pelvic fracture; Soft tissue defect; Vacuum sealing drainage; External fixator; Nursing

Effect of vacuum sealing drainage on the clinical effect of high perianal abscess and the expression of vascular endothelial growth factor and platelet-derived endothelial cell growth factor

Objective To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of high perianal abscess and its effect on the expression of vascular endothelial growth factor (VEGF) and PD-ECGF. Methods 40 cases of high perianal abscess were divided into 2 groups according to the random digital table method, with 20 cases in each group. In the study group, + VSD was closed to the internal and mouth closure of perianal abscess, and the control group was performed the traditional low position incision of the perianal abscess. Postoperative pain, , anal function, healing time, hospitalization time, treatment cost and recurrence rate were compared between the 2 groups. Serum levels of VEGF and PD-ECGF and their phosphorylation levels were detected at different time points. Results There were significant differences in pain and anal function score, wound healing and hospitalization time, treatment cost, recurrence rate between the study group and the control group (P 0.05). The postoperative 7 d study group (0.62±0.025) and the control group (0.45±0.038) all increased significantly, which was statistically significant compared with the postoperative 1 d (P 0.05). The postoperative 7 d study group (0.67±0.029) and the control group (0.49±0.016) all increased significantly, which was statistically significant compared with the postoperative 1 d (P<0.05). The difference was statistically significant between the two groups postoperative 7 d (P<0.05). Conclusion The application of VSD technology in patients with high anal abscess can make pain relief and heal and shorten hospitalization time, save cost and reduce relapse rate, and the anal function is effectively protected. By promoting the expression of VEGF and PD-ECGF, we can regulate wound angiogenesis and promote wound healing. Key words: Vacuum sealing drainage; High perianal abscess; Clinical efficacy; Vascular endothelial growth factor; Platelet-derived endothelial cell growth factor

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.

Therapeutic efficacy of vacuum sealing drainage-assisted irrigation in patients with severe multiple-space infections in the oral, maxillofacial, and cervical regions

ObjectiveWe compared the clinical efficacy between the vacuum sealing drainage (VSD)-assisted irrigation technique and traditional abscess incision and drainage technique in the treatment of severe multiple-space infections in the oral, maxillofacial, and cervical regions. MethodsData of 73 patients with severe oral, maxillofacial, and cervical infections, who were admitted to the Oral and Maxillofacial Surgery Department at the First Affiliated Hospital of Fujian Medical University between June 2014 and May 2017, were retrospectively collected. Patients were divided into two groups based on the treatments. The cure duration, incision length, physician workload (frequency of dressing-change), and treatment costs were compared between the two groups. ResultsOf 73 patients, 38 were treated with the VSD-assisted irrigation technique, and 35 with the traditional technique. All patients were cured following treatment. The cure duration, surgical scar length, and physician workload were smaller for the former group than for the latter group (p < 0.05). There was no difference in the treatment costs between the two groups (p > 0.05). ConclusionVSD-assisted irrigation technique used in the treatment of severe multiple-space infection in the oral and maxillofacial cervical regions shows favorable clinical effects and enables short treatment duration, lesser pain-experience, and high clinical and therapeutic efficacy.

Clinical research progress of refractory wounds treated by Traditional Chinese Medicine combined with VSD

This article systematically reviewed the clinical research of Traditional Chinese Medicine (TCM) combined with Vacuum Sealing Drainage (VSD) in the treatment of refractory wounds. The results showed that TCM combined with VSD for refractory wounds was characterized by abundent treatment and effectiveness. Treatments such as oral administration of TCM decoction, injection and lavage administration of TCM decoction, and external application of TCM ointment can reduce the level of inflammation in the wound, improve local microcirculation, promote granulation tissue growth and wound healing, and improve clinical efficacy. This paper summarized the clinical researches on the treatment of refractory wounds by TCM and VSD, and provide a useful reference for clinical treatment of refractory wounds. Key words: Traditional Chinese Medicine; Vacuum sealing drainage; Refractory wounds; Review

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.

Research on the oxygen partial pressure with vacuum sealing drainage in rabbits

Objective To measure the oxygen partial pressure (PtO2) within a situation of vacuum sealing drainage (VSD) implement, and to discuss the potential mechanism of VSD alleviating skeletal muscle ischemia reperfusion (I/R) injury in rabbits. Methods Rabbits were randomly(random number) divided into three groups: sham (n=10), I/R (n=10) and I/R+VSD (n=10) groups. In the I/R group, left hind limb ischemia was induced by clamping the femoral artery and vein for 4 h, then released for 6 h, to allow reperfusion of the limb. VSD was only performed in the I/R+VSD group during the reperfusion period. All rabbits were administered a series test of PtO2 in different time points before and after reperfusion, and the left hind limb skeletal muscle and ear vein blood samples were immediately harvested for biochemical analyses, including hypoxia inducible factor 1 alpha (HIF-1α) mRNA and protein, and lactic acid (LA). One-way analysis of variance (ANOVA), Fisher’s least significant difference (LSD) test or Tamhane’s T2 test was used where appropriate to analyze the experimental results. Results The levels of PtO2 in the I/R and I/R+VSD groups were decreased after ischemia, but no significant difference was noted between the two groups (t=1.322, P=0.296). The PtO2 levels in the I/R+VSD group were less increased than those in the I/R group after reperfusion (t=2.015, P=0.046). The levels of HIF-1α mRNA and protein were increased after I/R injuries (F=10.120, P=0.002; F=36.480, P<0.01; F=6.960, P=0.015, F=4.470, P=0.035), and the levels in the I/R+VSD group were greater than those in the I/R group (t=1.799, P=0.048, t=5.911, P=0.019; t=1.878, P=0.046, t=2.609, P=0.030). The LA levels were significantly increased in the skeletal muscle and blood samples in the I/R and I/R+NPWT groups compared with those in the sham group at the final stage (F=9.540, P=0.002 and F=13.750, P<0.01), but the levels in the I/R+VSD group were less than those in the I/R group (t=2.263, P=0.040 and t=3.617, P=0.027). Conclusions Our results suggested that VSD technique decreased PtO2 in regional ischemic muscles and led to increases in HIF-1α mRNA and protein that subsequent accumulation of less LA in both of regional skeletal muscle and systemic blood circulation, which provided protection effect after I/R injury in rabbits. Key words: Trauma; Ischemia reperfusion injury; Vacuum sealing drainage; Oxygen partial pressure; Hypoxia inducible factor 1 alpha; Lactic acid