Baradarian Sam, Stahovich Marcia, Krause Susan, Adamson Robert, Dembitsky Walter
Mechanical Assist Device Department, Sharp Memorial Hospital, San Diego, CA 92123, USA.
ASAIO J. 2006 May-Jun;52(3):354-6. doi: 10.1097/01.mat.0000204760.48157.cc.
Percutaneous driveline lead and pocket sites are potential sources of drainage that can lead to infection. Some patients experience a slower closure of tissue growth into the driveline. The management of chronically open and or draining driveline wounds is a challenge. The KCI vacuum-assisted closure (VAC) device is a noninvasive negative-pressure therapy that promotes the healing of wounds not responding to conventional treatment. Vacuum-assisted closure therapy has proven safe, effective, and cost efficient by decreasing the number of dressing changes and length of stay. The left ventricular assist device (LVAD) team initiated VAC therapy in 3 patients. The tunneling method allowed the wound to heal from the inside out. The dressing was changed every 3 days, and the size and depth of the wound was monitored. Patients may be sent home using a portable VAC device until wound closure is obtained, which decreases the hospital length of stay. Our experience with three patients suggests the VAC device can be used for draining and tunneling LVAD driveline-site wounds and may prevent fistula formation. It is especially useful for patients with ascites that may be draining along the driveline tract. The sites showed increased granulation, decreased drainage, and a reduced bacterial burden after having the device in place.
经皮驱动线导线和囊袋部位是可能导致感染的引流潜在来源。一些患者组织向驱动线内生长的闭合速度较慢。慢性开放和/或有引流的驱动线伤口的处理是一项挑战。KCI负压封闭引流（VAC）装置是一种无创负压治疗方法，可促进对传统治疗无反应的伤口愈合。负压封闭引流疗法已被证明是安全、有效的，且通过减少换药次数和住院时间具有成本效益。左心室辅助装置（LVAD）团队对3例患者启动了VAC治疗。隧道式方法使伤口从内向外愈合。每3天更换一次敷料，并监测伤口的大小和深度。在伤口闭合之前，患者可以使用便携式VAC装置回家，这缩短了住院时间。我们对3例患者的经验表明，VAC装置可用于引流和形成隧道式LVAD驱动线部位伤口，并可能预防瘘管形成。对于可能沿驱动线管道引流腹水的患者尤其有用。在使用该装置后，这些部位显示出肉芽组织增多、引流减少和细菌负荷降低。
