Negative pressure closed drainage can promptly and thoroughly remove the exudate from the trauma surface and cavity due to continuous high negative pressure drainage. This keeps the trauma surface clean, avoids cross-infection and promotes tissue repair, which has been widely used in orthopedic clinics. From March 2006 to 2010, we treated 56 patients with complex trauma with negative pressure closed drainage technique and achieved satisfactory results, which are reported as follows.
1.Data and methods
1.1 General information
There were 56 cases in this group, 39 men and 17 women; their ages ranged from 24 to 57 years old, with an average age of 36 years old. Among them, there were 14 cases of sacrococcygeal decubitus ulcer, 25 cases of open fracture bone exposure of the lower leg, and 17 cases of in situ counterimplantation.
1.2 Surgical materials
1VSD medical foam material (produced by Wuhan Visdi Medical Co., Ltd.) is a foam-type synthetic dressing, shaped like a sponge, white, non-toxic, and with good histocompatibility. It has excellent adsorption and water permeability, with 3 sizes available and a multi-lateral hole rigid drainage tube. 2 Single transparent patch (produced by SmithNephew) has good oxygen permeability and air permeability and can be waterproof.
1.3 Surgical method
Choose the appropriate position and anesthesia method according to the site of the patient’s trauma. For sacrococcygeal decubitus ulcers, the bad tissues were thoroughly excised, the potential dead cavity was fully opened, the wound was repeatedly flushed with hydrogen peroxide and saline and then ligated to deal with the active bleeding point, and then the VSD dressing was sutured. For skin avulsion injuries, the avulsed skin is laid back on a sterilized board, all subcutaneous adipose tissue is removed, the subdermal vascular network is preserved, a large sheet of medium-thick skin is made, and then the skin is poked with a knife into a sieve mesh and sutured to the wound edge, and proper tension is maintained, and the VSD dressing is sutured at the same time.
For open fractures of the lower leg, if the bone tissue is exposed after the first stage of fixation, the VSD dressing is sutured directly after thorough debridement; if the bone is exposed at a later stage, the exposed bone is properly drilled with a drill bit and the skin margin is excised, and then a suitable VSD dressing is selected to cover the wound and sutured according to the size of the wound. If the wound is too large, several VSD dressings can be sutured in series. Finally, alcohol is used to remove the oil from the skin and dry gauze is applied to the skin until it is dry. A semi-permeable membrane is placed over the entire wound and the drainage tube, either by the dumpling method or by the ligature method (1) to ensure that it is sealed without air leakage. The drainage tube is connected to the negative pressure suction device, and the negative pressure is maintained at 125-450 mmHg. If there are more drainage tubes, a tee connector can be used to connect the drainage tube to the suction device in series.
1.4 Postoperative treatment
After the operation, close observation of the wound closure and the reliability of the connection of the tube is needed. If air leakage is found, close it with a patch in time to prevent negative pressure failure. If a large amount of blood is found in the drainage fluid, timely hemostasis treatment or lowering the negative pressure should be observed. Due to the large amount of protein in the drainage fluid and the high metabolic reaction under trauma, nutritional support should be given to promote positive nitrogen balance; encourage patients to eat high protein, high calorie and easily digestible food rich in vitamins, minerals and trace elements, and pay attention to monitoring the changes of water and electrolytes, and make timely supplementation and adjustment. Use antimicrobials reasonably to prevent infection. At the same time, the corresponding functional exercise was instructed to reduce the occurrence of bed-ridden complications.
2.Results
The patients in this group used VSD for 7-12 days, with an average of 9 days. 14 patients with decubitus ulcers had red and fresh trabecular granulation after one negative pressure suction treatment. In the first stage, local transfer flap was performed to cover the decubitus ulcer, and the flap had good elasticity and color. 17 patients with counter-implantation had most of their skin survived, and the residual trauma was completely covered by dotted skin implantation. 19 of 25 patients with bony exostosis had subsequent myocutaneous flap transfer after one negative pressure suction, and 6 patients with large bony exostosis had their trauma covered by free myocutaneous flap after two suction, and the flaps were all survived.
3. Discussion
The management of soft tissue defects is tricky in orthopedic clinics. Traditional dressing changes and intravenous anti-inflammatory treatment have long cycles, slow granulation growth, and great patient pain. Moreover, long-term trauma exposure is very easy to combine with multiple bacterial infections, which makes the treatment of trauma more difficult. Therefore, how to make the granulation healthy growth early and close the wound as early as possible is the focus of treatment.
It has the following advantages
①Negative pressure closed drainage device, because of the medical foam material, the traditional point or local drainage, into the surface drainage, to ensure that the necrotic tissue and exudate of each part of the wound can be removed at any time, and therefore can be kept open for a longer period of time, to ensure the drainage effect.
②The negative pressure can make the pus, exudate and part of necrotic tissue in the drained wound be promptly and thoroughly drained out of the body, thus speeding up the closure of the deep cavity and the healing of the infected wound.
③The transparent adhesive film facilitates the observation of wounds or wounds.
④Reduces the pain of changing medication for patients, reduces the workload of doctors, reduces the amount of antibiotics and shortens the treatment cycle.
Maintaining continuous effective negative pressure is the key to negative pressure closed drainage, in the process of clinical application, if found in the negative pressure deflated medical foam back to its original state, the loss of tubular shape, the film under the accumulation of fluid are signs of negative pressure failure, should be dealt with in a timely manner. The most common cause of negative pressure failure is air leakage and blockage.
The most common leaky parts are the drainage tube and the connection of the tee joint, the edge with liquid seepage, the skin folds, and the “leaky gap” between the film and the membrane. In this case, it is necessary to re-seal the air permeability with semi-permeable film. Blockage is mainly due to sticky drainage material, which can be properly flushed through the drainage tube with saline, and if it cannot be solved, the dressing or drainage tube should be changed.