Machen Shaun
Pediatric Orthopaedic Service, William Beaumont Army Medical Center, Fort Bliss, Texas, USA.
US Army Med Dep J. 2007 Jan-Mar:17-23.
The study was undertaken to develop a protocol for the ongoing management of traumatic war wounds in the austere environment of a combat support hospital.
A total of 286 surgical procedures were performed by a single orthopaedic surgeon during a 5-month period at a combat support hospital in Iraq. Over 150 procedures were performed on Iraqi soldiers, detainees, and civilians who would receive their definitive care at the combat support hospital, and who would remain as inpatients until their wounds were healed enough for discharge. Initially, all extremity wounds were treated with surgical irrigation and debridement followed by twice daily dressing changes on the wards. As the ward census increased to 75 patients, it became necessary to develop alternate forms of wound management. Field expedient vacuum-assisted closure (VAC) dressings were instituted. These dressings were created with fluffs or prep sponges, suction tubing, Ioband, and portable suction machines. The VAC dressings were left in place for 3 to 4 days and then changed. Traumatic, contaminated, and infected wounds were rapidly debrided and granulation tissue was induced. The portable suction pumps, however, were extremely noisy and failed with continued use. Machines and sponges manufactured by KCI Inc. were purchased. The VAC dressing became an invaluable tool for managing, closing, and preparing wounds for skin grafting. Over 50 traumatic war wounds were treated with the VAC dressing. The clinical courses of 20 of these wounds were carefully documented with digital photography.
Over 50 traumatic war wounds were effectively treated with initial irrigation and debridement, followed by serial application of VAC dressings. VAC dressings rapidly debrided contaminated wounds, reduced edema, decreased wound size, and induced granulation tissue. Wounds were then treated by delayed primary closure, local flap coverage, or skin grafting.
An effective protocol utilizing VAC dressings was developed for the expeditious treatment of traumatic war injuries in an austere environment.
开展一项研究，以制定在战斗支援医院的严峻环境中对创伤性战伤进行持续管理的方案。
一名骨科医生在伊拉克一家战斗支援医院的5个月期间共进行了286例外科手术。超过150例手术针对的是伊拉克士兵、被拘留者和平民，他们将在战斗支援医院接受最终治疗，并将作为住院患者留院，直到伤口愈合到足以出院。最初，所有四肢伤口均通过手术冲洗和清创进行治疗，随后在病房每天换药两次。随着病房患者人数增加到75人，有必要开发替代的伤口管理形式。于是采用了现场应急真空辅助闭合（VAC）敷料。这些敷料由绒毛或手术巾、吸引管、Ioband和便携式吸引器制成。VAC敷料放置3至4天然后更换。对创伤性、污染性和感染性伤口进行快速清创并诱导肉芽组织生长。然而，便携式吸引泵噪音极大，持续使用时会出现故障。于是购买了KCI公司生产的机器和海绵。VAC敷料成为管理、闭合伤口以及为植皮准备伤口的宝贵工具。超过50例创伤性战伤使用了VAC敷料进行治疗。其中20例伤口的临床过程通过数码摄影进行了仔细记录。
超过50例创伤性战伤通过初始冲洗和清创，随后连续应用VAC敷料得到有效治疗。VAC敷料能快速清创污染伤口，减轻水肿，减小伤口尺寸，并诱导肉芽组织生长。然后通过延迟一期缝合、局部皮瓣覆盖或植皮对伤口进行治疗。
制定了一项利用VAC敷料的有效方案，用于在严峻环境中快速治疗创伤性战伤。
