Department of Surgery, St Luke's-Roosevelt Hospital, Columbia University, New York, NY, USA.
Int Wound J. 2010 Apr;7(2):81-5. doi: 10.1111/j.1742-481X.2010.00658.x.
Patients with massive venous stasis ulcers that have very high bacterial burdens represent some of the most difficult wounds to manage. The vacuum-assisted closure (VAC) device is known to optimise wound bed preparation; however, these patients have too high a bacterial burden for simple VAC application to facilitate this function. We present the application of the VAC with instillation of dilute Dakins solution as a way of bacterial eradication in these patients. Five patients with venous stasis ulcers greater than 200 cm(2) that were colonised with greater than 10(5) bacteria were treated with the VAC instill for 10 days with 12.5% Dakins solution, instilled for 10 minutes every hour. Two patients had multi-drug-resistant pseudomonas, three with MRSA. All the five had negative quantitative cultures, prior to split thickness skin graft with 100% take and complete healing at 1 year. Adequate delivery of bactericidal agents to the infected tissue can be very difficult, especially while promoting tissue growth. By providing a single delivery system for a bactericidal agent for a short period of time followed by a growth stimulating therapy, the VAC instill provides a unique combination that appears to maximise wound bed preparation.
患有高细菌负荷量的大量静脉淤滞性溃疡的患者是最难处理的一些伤口。真空辅助闭合（VAC）装置以优化伤口床准备而闻名；然而，这些患者的细菌负荷过高，简单的 VAC 应用无法促进这一功能。我们介绍了在这些患者中应用 VAC 灌洗稀释达金溶液来消除细菌的方法。5 例静脉淤滞性溃疡面积大于 200cm²且细菌定植大于 10⁵的患者，用 12.5%达金溶液持续 10 天进行 VAC 灌洗，每小时灌洗 10 分钟。其中 2 例患者为多重耐药铜绿假单胞菌，3 例为耐甲氧西林金黄色葡萄球菌（MRSA）。所有 5 例患者在接受 100%取皮的断层皮片移植和 1 年完全愈合之前，均进行了定量培养，结果均为阴性。将杀菌剂充分输送到感染组织可能非常困难，特别是在促进组织生长的同时。通过在短时间内提供单一的杀菌剂输送系统，然后进行促进生长的治疗，VAC 灌洗提供了一种独特的组合，似乎最大限度地促进了伤口床准备。
