White Terris L, Culliford Alfred T, Zomaya Martin, Freed Gary, Demas Christopher P
Division of Plastic and Reconstructive Surgery, Staten Island University Hospital, Staten Island, New York, USA.
Am Surg. 2016 Nov 1;82(11):1068-1072. doi: 10.1177/000313481608201121.
The treatment of complex wounds is commonplace for plastic surgeons. Standard management is debridement of infected and devitalized tissue and systemic antibiotic therapy. In cases where vital structures are exposed within the wound, coverage is obtained with the use of vascularized tissue using both muscle and fasciocutaneous flaps. The use of nondissolving polymethylmethacrylate and absorbable antibiotic-impregnated beads has been shown to deliver high concentrations of antibiotics with low systemic levels of the same antibiotic. We present a multicenter retrospective review of all cases that used absorbable antibiotic-impregnated beads for complex wound management from 2003 to 2013. A total of 104 cases were investigated, flap coverage was used in 97 cases (93.3%). Overall, 15 patients (14.4%) required reoperation with the highest groups involving orthopedic wounds and sternal wounds. The advantages of using absorbable antibiotic-impregnated beads in complex infected wounds have been demonstrated with minimal disadvantages. The utilization of these beads is expanding to a variety of complex infectious wounds requiring high concentrations of local antibiotics.
复杂伤口的治疗对整形外科医生来说很常见。标准的处理方法是清创感染和失活组织以及全身抗生素治疗。在伤口内重要结构暴露的情况下，使用带血管组织（肌肉瓣和筋膜皮瓣）进行覆盖。已证明使用不可溶解的聚甲基丙烯酸甲酯和含抗生素的可吸收珠粒能在全身抗生素水平较低的情况下提供高浓度的抗生素。我们对2003年至2013年期间所有使用含抗生素可吸收珠粒处理复杂伤口的病例进行了多中心回顾性研究。共调查了104例病例，其中97例（93.3%）使用了皮瓣覆盖。总体而言，15例患者（14.4%）需要再次手术，其中骨科伤口和胸骨伤口患者再次手术的比例最高。使用含抗生素可吸收珠粒处理复杂感染伤口的优点已得到证实，缺点极少。这些珠粒的应用正在扩展到各种需要高浓度局部抗生素的复杂感染伤口。
