Contreras-Ruiz José, Ramos-Cadena Angeles, Solis-Arias Patricia, Lozano-Platonoff Adriana, Lopez-García Lirio A, Contreras-Barrera Martha E, Saenz-Corral Claudia, de-la-Cruz-Garcia Isabel, Cárdenas-Mejía Alexander, Lopez-Oliver Rubén
* Interdisciplinary wound and ostomy care center; †Division of ophthalmology; ‡Division of dermatology; §Division of plastic surgery; and ‖Oculoplastics section, Division of ophthalmology, "Dr. Manuel Gea Gonzalez" General Hospital, Mexico City, Mexico.
Ophthalmic Plast Reconstr Surg. 2015 Jan-Feb;31(1):23-8. doi: 10.1097/IOP.0000000000000163.
Preseptal cellulitis (PC) may be locally complicated with abscess formation and necrotizing fasciitis. If not treated promptly and adequately, it may result in further complications. The authors report a series of patients where negative pressure wound therapy (NPWT) proved a safe and valuable adjunct therapy in avoiding complications of PC and in accelerating wound healing.
A 4 patient case series. Four male patients (11 months to 58 years old) with unilateral complicated PC.
Patients were admitted with PC and treated initially with specific intravenous antibiotic therapy. These patients did not respond adequately; therefore, surgical drainage and/or debridement were performed. After surgery, persistent edema and purulent discharge was observed prompting the need for adjunct NPWT every 48 to 72 hours. NPWT is the use of vacuum through a wound filler material covered with an airtight drape connected to a pump. Complete ophthalmologic examination was performed after each 48-hour cycle. Length of hospital stay, days from surgery to discharge, days from start of NPWT to discharge, clinical improvement, and safety.
Four patients were diagnosed with PC between 2 and 5 days of evolution. Two diabetic adults developed the condition secondary to trauma, the adolescent as a result of a cosmetic piercing, and the infant associated to sinusitis. NPWT reached -125 mm·Hg, except for the infant who received -75 mm·Hg. The average number of days necessary for improvement with NPWT was 6.7 days. Only 2 patients required surgical reconstruction. Time from debridement to discharge was in average 13.5 days. No ocular complications were observed, and follow up was satisfactory with normal eyelid function and aesthetics and preserved visual acuity.
NPWT proved to be safe and effective for treating locally complicated PC as an adjuvant therapy to antibiotic and surgical treatment that decreased the length of hospital stay, and the time for recovery in patients that were slow responders. No ocular complications were observed in any of these patients' follow up ranging from 1 to 4 years.
眶隔前蜂窝织炎（PC）可能局部并发脓肿形成及坏死性筋膜炎。若未及时、充分治疗，可能导致进一步并发症。作者报告了一系列患者，负压伤口治疗（NPWT）被证明是一种安全且有价值的辅助治疗方法，可避免PC的并发症并加速伤口愈合。
一个4例患者的病例系列。4例男性患者（年龄从11个月至58岁），均为单侧复杂性PC。
患者因PC入院，最初接受特定的静脉抗生素治疗。这些患者反应不佳；因此，进行了手术引流和/或清创术。术后观察到持续水肿和脓性分泌物，促使每48至72小时需要辅助NPWT。NPWT是通过覆盖有气密单并连接到泵的伤口填充材料施加负压。每48小时周期后进行完整的眼科检查。记录住院时间、从手术到出院的天数、从开始NPWT到出院的天数、临床改善情况及安全性。
4例患者在病程2至5天被诊断为PC。2例成年糖尿病患者因创伤继发该病，青少年因美容穿孔引发，婴儿与鼻窦炎相关。除婴儿接受-75 mmHg外，NPWT达到-125 mmHg。NPWT改善病情所需的平均天数为6.7天。仅2例患者需要手术重建。从清创到出院的平均时间为13.5天。未观察到眼部并发症，随访结果令人满意，眼睑功能和美观正常，视力保留。
NPWT被证明作为抗生素和手术治疗的辅助疗法，对于治疗局部复杂性PC是安全有效的，可缩短住院时间，并减少反应迟缓患者的恢复时间。在这些患者1至4年的随访中，未观察到任何眼部并发症。
