Yang Chao, Wang Shan, Li Chang-Chun, Kong Xiang-Ru, Zhao Zhenzhen, Deng Xiao-Bin, Peng Liang, Zhang Jun
Department of Pediatric Surgical Oncology, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Yuzhong District, Chongqing, 400014, China.
Ministry of Education Key Laboratory of Child Development and Disorders, The Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
Eur J Pediatr. 2017 Feb;176(2):261-267. doi: 10.1007/s00431-016-2835-2. Epub 2016 Dec 24.
Open incision and drainage (I&D) and wound packing is accepted as the standard treatment for soft tissue abscesses. However, conventional I&D has a number of problems in practice which prompt us to improve the I&D methods that would minimize the pain associated with packing during dressing changes. In order to compare the pain associated with dressing changes in the conventional I&D group to the vacuum system group and the treatment time of both groups, we performed a randomized trial in pediatric patients between 0 and 18 years of age who are undergoing abscess drainage in the operating room from April 2011 to April 2015. Patients treated with open I&D (n = 648) were compared to those treated with placement of high-vacuum wound drainage system (n = 776) through the abscess cavities. Both groups received equivalent antibiotic treatment, and all patients were followed up in the outpatient clinics until the infection has been resolved. The mean FACES scale pain scores were significantly higher in the open I&D group than in the vacuum system group. The vacuum system group had a shorter length of stay and less need for community doctor or outpatient dressing changes than the open I&D group (p < 0.001). No recurrent abscesses were observed in the vacuum system group, and 10 patients in the open I&D group required another drainage at the exact same location.
High-vacuum wound drainage system was an efficient and safe alternative to the traditional I&D for community-acquired soft tissue abscesses with few complications in short term. What is Known: • Open incision and drainage (I&D) followed by irrigation and wound packing is the standard treatment for soft tissue abscesses. • The painful daily packing may cause emotional trauma to the child and lead to an unwelcoming challenge to the caretakers and health care providers. What is New: • We modified the method of I&D by adding primary suturing of the wound and placement of a high-vacuum wound drainage system. • This technique was proved to be an efficient and safe alternative to the traditional I&D method for soft tissue abscesses with small complications in short term.
开放切开引流术（I&D）及伤口填塞被公认为软组织脓肿的标准治疗方法。然而，传统的切开引流术在实际操作中存在诸多问题，这促使我们改进切开引流术方法，以尽量减少换药时与填塞相关的疼痛。为比较传统切开引流术组与负压系统组换药时的疼痛情况以及两组的治疗时间，我们对2011年4月至2015年4月在手术室接受脓肿引流的0至18岁儿科患者进行了一项随机试验。将接受开放切开引流术治疗的患者（n = 648）与通过脓肿腔放置高负压伤口引流系统治疗的患者（n = 776）进行比较。两组均接受等效的抗生素治疗，所有患者均在门诊随访直至感染治愈。开放切开引流术组的平均面部疼痛评分量表疼痛评分显著高于负压系统组。与开放切开引流术组相比，负压系统组住院时间更短，社区医生或门诊换药需求更少（p < 0.001）。负压系统组未观察到复发性脓肿，开放切开引流术组有10例患者在同一部位需要再次引流。
对于社区获得性软组织脓肿，高负压伤口引流系统是传统切开引流术的一种有效且安全的替代方法，短期内并发症较少。已知信息：• 开放切开引流术（I&D）后冲洗及伤口填塞是软组织脓肿的标准治疗方法。• 每日疼痛的填塞可能给儿童带来情感创伤，并给护理人员和医护人员带来棘手的挑战。新发现：• 我们通过增加伤口一期缝合及放置高负压伤口引流系统来改进切开引流术方法。• 对于软组织脓肿，该技术被证明是传统切开引流术方法的一种有效且安全的替代方法，短期内并发症较少。
