Werner H P
Hygieneinstitut der Universität Mainz, BRD.
Z Gesamte Hyg. 1990 Feb;36(2):94-9.
After the introduction of Redon high-vacuum drainage, a considerable decrease in post-operative haematomas has been noted. But some of the complications could not be prevented by using the Redon system. They were in fact the result of it. The Redon system cannot be classified as a "closed" wound drainage. During bottle replacement, the system must be disconnected. An effective closed system must remain absolutely tight from application to removal of the drain so no possibility exists of contamination infection from the outside. After introduction of a continuously absolutely closed system in a prospective study with 3 different systems the influence after hip joint arthroplasty operations on wound healing was investigated. The wounds were drained with the Redon high-vacuum system or the newly developed, permanently closed drainage system with maximum obtainable low pressure of 80% vacuum and 50% vacuum. Here the maximum obtainable vacuum builds up slowly in relation to the accumulated amount of wound fluids. The loss of low pressure in Redon systems differs between the drains. In the intra-articular drains the mixture of air and blood results in a linear decrease and follows not a hyperbola like in subcutaneous drains. Because of the high suction at the beginning of the Redon drainage necrotic muscle cells adhere to the outside of the drain openings and clogs them up mechanically. The stronger the suction effect on the tissue, the more fatty live cells and small vessels enter the lumen of the drain in the Redon system and 80% vacuum. This mechanisms result in bleeding from the drain canal after removal of the drain and "secondary" haematomas. In the absolutely continuously closed system with maximum obtainable low pressure of 50% vacuum increased suction, lowered bleeding after removal of the drain and best healing results were observed. The 9.8% Cfu occurrence on Redon drains after removal found in the study is within the lower average figures given in literature while the 0.9% figure with both closed systems was never reached before.
引入雷东高负压引流后，已注意到术后血肿明显减少。但使用雷东系统并不能预防所有并发症。事实上，有些并发症正是该系统导致的。雷东系统不能归类为“封闭式”伤口引流。更换引流瓶时，必须断开该系统。有效的封闭系统从放置引流管到拔除都必须保持绝对密封，这样就不存在外部污染感染的可能性。在一项对三种不同系统的前瞻性研究中引入持续绝对封闭系统后，研究了其对髋关节置换术后伤口愈合的影响。伤口分别用雷东高负压系统或新开发的永久封闭引流系统进行引流，后者的最大可获得负压为80%真空度和50%真空度。在此，最大可获得真空度相对于伤口积液量缓慢上升。雷东系统中负压的损失在不同引流管之间有所不同。关节内引流管中空气和血液的混合导致负压呈线性下降，不像皮下引流管那样呈双曲线下降。由于雷东引流开始时吸力较大，坏死的肌肉细胞会附着在引流管开口外部并造成机械堵塞。对组织的吸力越强，在雷东系统和80%真空度下，进入引流管腔的脂肪活细胞和小血管就越多。这些机制导致拔除引流管后引流管通道出血和“继发性”血肿。在最大可获得负压为50%真空度的绝对持续封闭系统中，吸力增加，拔除引流管后出血减少，观察到的愈合效果最佳。该研究中拔除雷东引流管后9.8%的菌落形成单位发生率在文献给出的较低平均数据范围内，而两种封闭系统0.9%的发生率此前从未达到过。
