Li Longzhu, Li Dawei, Shen Chuanan, Li Dongjie, Cai Jianhua, Tuo Xiaoye, Zhang Lin
Zhonghua Shao Shang Za Zhi. 2015 Apr;31(2):98-101.
To study the application of VSD in the treatment of severe necrotizing fasciitis in extremities of patients.
Eight patients, suffering from severe necrotizing fasciitis, who had been traditionally treated with iodophor-soaked gauze for 21 to 365 days in other hospitals, were transferred to our institute because of the nonhealing wounds and systemic toxic symptoms induced by infection, from January 2011 to August 2013. After admission, surgical debridement was performed timely, and the necrotic tissue was collected during the operation for pathological observation after HE staining. After the operation, VSD was started with negative pressure ranging from -100 to -80 kPa, and the furacilin solution (0.2 g/L) and oxygen (2 L/min) were continuously infused into the wound during the treatment. Surgical debridement was performed repeatedly according to the wound condition followed by change of VSD dressings to continue VSD treatment. The wounds were closed by suturing or with autologous skin grafts after being covered by fresh granulation tissue. The times of surgical debridement, times of change of VSD materials, wound healing status, and length of stay in our institute were recorded. All patients were followed up for a long time. Results HE staining showed that there were diffuse necrotic adipose and fibrous connective tissues in the necrotic tissue, and the normal tissue structure disappeared accompanied by significant infiltration of inflammatory cells. The number of surgical debridement was 2 to 10 (3.9 +/- 2.8) times. The number of VSD materials change was 2 to 10 (4.0 +/- 2.9) times. Wounds were closed by suturing and healed in two patients; wounds in the other six patients were partially sutured, their residual wounds were healed by autologous skin grafting. The length of stay in our institute was 20 to 49 (33 +/- 10) days. All patients were discharged after recovery. Patients were followed up for 2 to 24 months, and their wounds were found to be in good condition without ulceration or recurrence.
VSD can effectively remove the necrotic tissues and exudates from the fascial spaces and promote proliferation of granulation tissue. Therefore it serves as an effective approach to the treatment of severe necrotizing fasciitis in extremities.
探讨封闭式负压引流（VSD）在治疗患者四肢严重坏死性筋膜炎中的应用。
2011年1月至2013年8月，8例因伤口不愈合及感染引起全身中毒症状，在其他医院用碘伏纱布传统治疗21至365天的严重坏死性筋膜炎患者转入我院。入院后及时行手术清创，术中采集坏死组织行HE染色后做病理观察。术后采用VSD治疗，负压为-100至-80kPa，治疗期间持续向创腔内滴注含0.2g/L呋喃西林的溶液及2L/min氧气。根据创面情况反复行手术清创，更换VSD敷料继续治疗。创面被新鲜肉芽组织覆盖后，采用缝合或自体皮片移植封闭创面。记录手术清创次数、VSD材料更换次数、创面愈合情况及在我院住院时间。所有患者均进行长期随访。结果HE染色显示，坏死组织中有弥漫性坏死的脂肪及纤维结缔组织，正常组织结构消失，伴有大量炎性细胞浸润。手术清创次数为2至10次（3.9±2.8次）。VSD材料更换次数为2至10次（4.0±2.9次）。2例患者创面经缝合后愈合；其余6例患者创面部分缝合，残留创面经自体皮片移植愈合。在我院住院时间为20至49天（33±10天）。所有患者康复出院。随访2至24个月，创面情况良好，无溃疡及复发。
VSD能有效清除筋膜间隙内的坏死组织及渗出物，促进肉芽组织增生，是治疗四肢严重坏死性筋膜炎的有效方法。
