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负压伤口治疗在伴有大量软组织缺损的开放性胫骨骨折IIIB型和IIIC型综合治疗中的应用

[Application of negative-pressure wound therapy in complex therapy of open tibia fractures IIIB and IIIC with massive soft tissue loss].

作者信息

Babiak Ireneusz, Zakiewicz Wojciech, Luterek Maciej

机构信息

Katedra i Klinika Ortopedii i Traumatologii Narzadu Ruchu, Warszawski Uniwersytet Medyczny w Warszawie.

出版信息

Chir Narzadow Ruchu Ortop Pol. 2011 May-Jun;76(3):154-60.

Abstract

Patients with high-grade open tibia fractures and massive soft tissue damage pose a demanding clinical challenge, requiring a complex inter-disciplinary approach and multiple orthopedic, vascular and plastic-reconstructive procedures. These types of fractures still have a 50% risk of loss, although amputation remains a treatment method of last resort. In our experience negative-pressure wound therapy (NPWT), used in the form of the vacuum assisted closure - VAC System (KCI, USA) improves healing of excessive soft tissue damage with exposure of the bone accompanying open fracture of the tibia. VAC seals the wound with a foam dressing and applies negative pressure to the wound bed. The removal of exudate and infectious material supports the cleaning of the wound. Together with the reduction of oedema and the increase in blood flow, this promotes formation of granulation tissue and eventually wound closure by split skin graft. Utilizing this method as part of a multi directional approach VAC System not only helps the patient to recover faster but also in some cases can replace microsurgical soft-tissue transfer and thus allows salvage of the leg in orthopaedic teams lacking advanced reconstructive experience.

摘要

伴有严重软组织损伤的高能量开放性胫骨骨折患者面临着严峻的临床挑战,需要采用复杂的多学科方法以及多次骨科、血管和整形重建手术。尽管截肢仍是最后一种治疗手段,但这类骨折仍有50%的肢体丧失风险。根据我们的经验,以真空辅助闭合-VAC系统(美国KCI公司)形式使用的负压伤口治疗(NPWT)可改善伴有胫骨开放性骨折且骨外露的严重软组织损伤的愈合情况。VAC系统用泡沫敷料封闭伤口,并对伤口床施加负压。清除渗出物和感染物质有助于伤口清洁。再加上水肿减轻和血流量增加,这促进了肉芽组织的形成,并最终通过植皮实现伤口闭合。将这种方法作为多方向治疗方法的一部分,VAC系统不仅有助于患者更快康复,而且在某些情况下可以替代显微外科软组织转移,从而使缺乏先进重建经验的骨科团队能够保住患者的下肢。

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