Chariker Mark E, Gerstle Theodore L, Morrison Clinton S
Louisville, Ky. From the Aesthetic Plastic Surgery Institute.
Plast Reconstr Surg. 2009 May;123(5):1510-1520. doi: 10.1097/PRS.0b013e3181a20563.
The efficacy of negative-pressure wound therapy as a bridge to definitive closure of traumatic extremity wounds has been demonstrated in adults. Gauze-based negative-pressure wound therapy has been used to facilitate granulation tissue formation and promote closure in a number of wound types. In this study, the authors evaluated the efficacy of gauze-based negative-pressure wound therapy using the Chariker-Jeter technique for pediatric extremity wounds requiring delayed closure.
A retrospective review was conducted of 24 pediatric patients presenting with extremity injuries involving soft-tissue defects not amenable to immediate primary closure. After initial irrigation, débridement, and antibiotic therapy, negative-pressure wound therapy using the Chariker-Jeter technique was applied and dressings were changed at 48- to 72-hour intervals before secondary closure or primary closure by skin graft, local flaps, or free tissue transfer.
Granulation tissue was noted in all wounds by day 4. The duration of vacuum therapy averaged 10 days in patients whose wounds were closed primarily (n = 19) and 17 days in patients who were allowed to heal by secondary intention (n = 5). Nine patients' wounds were closed with skin grafts and local flaps, eight were closed with local flaps only, and three were closed with free tissue transfer. There was no incidence of skin graft loss or flap failure. Follow-up evaluation of the wounds averaged 24 months, during which no complications were noted.
As a relatively atraumatic wound care technique with few complications, gauze-based negative-pressure wound therapy with the Chariker-Jeter technique provides a highly effective option for temporary soft-tissue management of extremity trauma in pediatric patients.
负压伤口治疗作为创伤性肢体伤口确定性闭合的桥梁，其在成人中的疗效已得到证实。基于纱布的负压伤口治疗已被用于促进多种伤口类型的肉芽组织形成并促进伤口闭合。在本研究中，作者评估了使用查里克-杰特技术的基于纱布的负压伤口治疗对需要延迟闭合的小儿肢体伤口的疗效。
对24例出现肢体损伤且伴有软组织缺损、不适于立即一期闭合的儿科患者进行回顾性研究。在初始冲洗、清创和抗生素治疗后，采用查里克-杰特技术进行负压伤口治疗，并在二期闭合或通过植皮、局部皮瓣或游离组织移植进行一期闭合前，每隔48至72小时更换敷料。
到第4天时，所有伤口均可见肉芽组织。伤口一期闭合的患者（n = 19）负压治疗的平均持续时间为10天，二期愈合的患者（n = 5）为17天。9例患者的伤口通过植皮和局部皮瓣闭合，8例仅通过局部皮瓣闭合，3例通过游离组织移植闭合。未发生植皮丢失或皮瓣失败的情况。伤口的随访评估平均为24个月，在此期间未发现并发症。
作为一种相对无创且并发症较少的伤口护理技术，采用查里克-杰特技术的基于纱布的负压伤口治疗为小儿患者肢体创伤的临时软组织处理提供了一种高效的选择。
