Lee Priscilla
Vascular Surgery, UCLA Medical Center.
Cureus. 2016 Oct 28;8(10):e852. doi: 10.7759/cureus.852.
Acute compartment syndrome (ACS) is a serious complication of lower-extremity trauma caused by accidents or post-procedure complications. ACS is characterized by increased pressure within the compartment, resulting in reduced blood flow, tissue hypoxia, and tissue necrosis. Fasciotomies to relieve pressure and debridement of necrotic tissue comprise primary treatment. My purpose is to present initial experience using negative pressure wound therapy with instillation and dwell time (NPWTi-d)* to treat fasciotomy wounds in two patients. NPWTi-d provides automated, volumetric control of instilled topical wound solutions with a dwell time in combination with negative pressure wound therapy (NPWT). Patient 1, a 33-year-old male injured in a motorcycle accident, developed ACS within 24 hours of hospitalization. Prior treatments included wet-to-dry dressings and NPWT. In the latter course of treatment, NPWTi-d was applied; 40 ml of normal saline (NS) were instilled with a ten-minute dwell time, followed by four hours of NPWT at ‑125 mmHg. After five days of NPWTi‑d, granulation tissue covered the bone. Four days later, the patient was discharged home. The wound continued to improve and, at the last recorded visit, was completely closed. Patient 2, a 44-year-old male, developed right lower extremity ACS due to complications post cardiac surgery. NPWT was initiated in the hospital and continued post-discharge to a nursing home. The patient was readmitted to the hospital with a right leg wound infection that was surgically debrided. NPWTi-d was then applied; 60 ml of NS were instilled with a ten-minute dwell time, followed by 3.5 hours of NPWT at -125 mmHg. After ten days of NPWTi-d, granulation tissue covered the bone. In Patient 2, NPWTi-d improved the likelihood of healing in a malnourished patient who had been critically ill by promoting granulation tissue over exposed bone. The use of NPWTi-d with NS contributed to positive outcomes for both patients. *V.A.C. VeraFlo™ Therapy, V.A.C.® Therapy (KCI, an Acelity company, San Antonio, TX).
急性骨筋膜室综合征（ACS）是由事故或术后并发症引起的下肢创伤的严重并发症。ACS的特征是骨筋膜室内压力升高，导致血流减少、组织缺氧和组织坏死。切开筋膜减压和清创坏死组织是主要治疗方法。我的目的是介绍使用带有灌注和停留时间的负压伤口治疗（NPWTi-d）*治疗两名患者筋膜切开伤口的初步经验。NPWTi-d结合负压伤口治疗（NPWT），能对灌注的局部伤口溶液进行自动定量控制，并设定停留时间。患者1是一名33岁男性，在摩托车事故中受伤，住院后24小时内发生ACS。先前的治疗包括湿-干敷料和NPWT。在治疗后期，应用了NPWTi-d；灌注40毫升生理盐水（NS），停留时间为10分钟，然后在-125 mmHg下进行4小时的NPWT。NPWTi-d治疗5天后，肉芽组织覆盖了骨头。4天后，患者出院回家。伤口持续好转，在最后一次记录的随访中，伤口完全愈合。患者2是一名44岁男性，因心脏手术后的并发症出现右下肢ACS。在医院开始进行NPWT，并在出院后转至疗养院继续进行。患者因右腿伤口感染再次入院，接受了手术清创。然后应用NPWTi-d；灌注60毫升NS，停留时间为10分钟，然后在-125 mmHg下进行3.5小时的NPWT。NPWTi-d治疗10天后，肉芽组织覆盖了骨头。在患者2中，NPWTi-d通过促进暴露骨上的肉芽组织生长，提高了一名重症营养不良患者的愈合可能性。使用NPWTi-d和NS对两名患者都产生了积极的治疗效果。*V.A.C. VeraFlo™ 治疗系统，V.A.C.® 治疗系统（KCI公司，阿塞利蒂公司旗下，得克萨斯州圣安东尼奥）
