Mosser Philipp, Kelm Jens, Anagnostakos Konstantinos
Resident, Klinik für Orthopädie und Orthopädische Chirurgie, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany.
Orthopaedic Surgeon and Assistant Professor, Chirurgisch-orthopädisches Zentrum Illingen, Illingen, Germany.
J Foot Ankle Surg. 2015 Jan-Feb;54(1):2-6. doi: 10.1053/j.jfas.2014.09.040. Epub 2014 Nov 4.
Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series.
感染是跟腱开放性重建术后的主要并发症。我们报告了负压封闭引流（VAC）疗法在开放性跟腱重建术后晚期深部感染治疗中的应用。6例患者（5例男性[83.33%]，1例女性[16.67%]；平均年龄52.8岁[范围37至66岁]）接受了相同方案的治疗。手术处理包括对感染的肌腱部分进行清创、冲洗和坏死组织切除。VAC疗法用于局部伤口预处理和感染管理。每个伤口施加125毫米汞柱的持续负压。为进行最终伤口闭合，实施了中厚皮片移植。在最初5天，中厚皮片愈合过程也得到VAC疗法的支持。VAC敷料平均更换3次（范围1至4次），直至能够进行中厚皮片移植。VAC疗法的平均总持续时间为13.6±5.9天。平均住院时间为31.2±15.9天。未观察到皮片下出血、血清肿或血肿形成等并发症。在平均随访29.9个月（范围4至65个月）时，未观察到再次感染或感染持续存在。VAC装置似乎是治疗感染肌腱的一种有价值的工具。这些结论的推广应等待未来更大患者系列研究的结果。
