Labler Ludwig, Trentz Otmar
Division of Trauma Surgery, Department of Surgery, University Hospital Zürich, Rämistrasse 100, 8091, Zürich, Switzerland.
Langenbecks Arch Surg. 2007 Sep;392(5):601-9. doi: 10.1007/s00423-006-0090-0. Epub 2006 Sep 16.
Application of vacuum-assisted closure (VAC) in soft tissue defects after high-energy pelvic trauma is described as a retrospective study in a level one trauma center.
Between 2002 and 2004, 13 patients were treated for severe soft tissue injuries in the pelvic region. All musculoskeletal injuries were treated with multiple irrigation and debridement procedures and broad-spectrum antibiotics. VAC was applied as a temporary coverage for defects and wound conditioning.
The injuries included three patients with traumatic hemipelvectomies. Seven patients had pelvic ring fractures with five Morel-Lavallee lesions and two open pelviperineal trauma. One patient suffered from an open iliac crest fracture and a Morel-Lavallee lesion. Two patients sustained near complete pertrochanteric amputations of the lower limb. The average injury severity score was 34.1 +/- 1.4. The application of VAC started in average 3.8 +/- 0.4 days after trauma and was used for 15.5 +/- 1.8 days. The dressing changes were performed in average every 3 days. One patient (8%) with a traumatic hemipelvectomy died in the course of treatment due to septic complications.
High-energy trauma causing severe soft tissues injuries requires multiple operative debridements to prevent high morbidity and mortality rates. The application of VAC as temporary coverage of large tissue defects in pelvic regions supports wound conditioning and facilitates the definitive wound closure.
在一家一级创伤中心进行的一项回顾性研究中，描述了真空辅助闭合（VAC）在高能骨盆创伤后软组织缺损中的应用。
2002年至2004年期间，13例患者因骨盆区域严重软组织损伤接受治疗。所有肌肉骨骼损伤均采用多次冲洗和清创手术以及广谱抗生素治疗。VAC被用作缺损的临时覆盖和伤口处理。
损伤包括3例创伤性半侧骨盆切除术患者。7例患者有骨盆环骨折，其中5例伴有莫雷尔-拉瓦利损伤，2例开放性骨盆会阴创伤。1例患者患有开放性髂嵴骨折和莫雷尔-拉瓦利损伤。2例患者下肢转子附近几乎完全截肢。平均损伤严重程度评分为34.1±1.4。VAC平均在创伤后3.8±0.4天开始应用，使用15.5±1.8天。平均每3天更换一次敷料。1例（8%）创伤性半侧骨盆切除术患者在治疗过程中因感染并发症死亡。
导致严重软组织损伤的高能创伤需要多次手术清创以防止高发病率和死亡率。VAC作为骨盆区域大组织缺损的临时覆盖物，有助于伤口处理并促进最终伤口闭合。
