Department of General Surgery, Gulhane Military Medical Academy, Ankara, Etlik, Turkey.
Int Wound J. 2011 Dec;8(6):599-607. doi: 10.1111/j.1742-481X.2011.00835.x. Epub 2011 Aug 19.
Our study reviewed nine patients who were treated with the VAC™ Abdominal Dressing System after suffering pelvic fractures and soft tissue loss after high-energy pelvic trauma. Between March 2008 and August 2009, our clinic treated nine patients with complicated perineal injuries from high-energy pelvic trauma with multiple irrigation and debridement procedures and broad-spectrum antibiotics. Protective ostomies were created for all nine patients. Required interventions were made for associated injuries, and VAC™ application was started. All patients were male, with an average age of 24·3 (range 21-32) years, and a mean injury severity score of 36·4 (range 16-59). Wound diameters ranged from 15 to 30 cm, and wound depths ranged from 5 to 25 cm. The injuries included one traumatic bilateral hemipelvectomy, and three unilateral and two bilateral lower extremity amputations. Intensive care unit length of stay averaged 12 (6-19) days, and average hospital length of stay was 44·12 (31-64) days. Beginning at an average of day 17 (±5·9 days) post-injury, wound cultures detected no bacterial colonisation. One patient died on the sixth day after injury from septic complications. Two patients' wounds were closed by primary closure, and six patients' wounds were closed by split thickness grafts after an average of 31·4 (17-50) days. Optimal treatment of high-energy perineal injuries requires early and extensive debridement and rich irrigation. The application of the VAC™ system as temporary coverage of large complex wounds in the pelvic region enhances wound healing and facilitates an early grafting process.
我们的研究回顾了 9 例骨盆骨折和高能骨盆创伤后软组织缺失的患者，他们接受了 VAC™ 腹部敷贴系统治疗。2008 年 3 月至 2009 年 8 月，我们的诊所采用多次灌洗和清创术以及广谱抗生素治疗了 9 例因高能骨盆创伤所致复杂会阴部损伤的患者。所有患者均进行了保护性造口术。对相关损伤进行了必要的干预，并开始应用 VAC™。所有患者均为男性，平均年龄 24·3（21-32 岁）岁，平均损伤严重程度评分 36·4（16-59 分）。伤口直径为 15-30cm，伤口深度为 5-25cm。损伤包括 1 例创伤性双侧半骨盆切除术，3 例单侧和 2 例双侧下肢截肢术。重症监护病房住院时间平均为 12（6-19）天，平均住院时间为 44·12（31-64）天。受伤后平均 17 天（±5·9 天）开始，伤口培养未检出细菌定植。1 例患者因感染性并发症于伤后第 6 天死亡。2 例患者的伤口行一期缝合，6 例患者的伤口于平均 31·4（17-50）天后行断层皮片移植闭合。高能会阴部损伤的最佳治疗方法需要早期广泛清创和充分灌洗。VAC™ 系统作为骨盆区域大而复杂伤口的临时覆盖物，可促进伤口愈合并有助于早期植皮过程。
