Joubert Christophe, Sellier A, Morvan J-B, Beucler N, Bordes J, Dagain A
Neurosurgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France
Neurosurgery, Military Teaching Hospital Sainte Anne, Toulon Armees, France.
J R Army Med Corps. 2019 Dec;165(6):e1. doi: 10.1136/jramc-2019-001201. Epub 2019 Apr 16.
The management of a craniocerebral wound (CCW) remains challenging, particularly in a severely injured patient. Considering the complexity of the multilayer insult and damage control care in an unstable patient, every procedure performed should promptly benefit the patient. We report an illustrative case of a patient with a gunshot wound to the head that resulted in a CCW for which we applied vacuum-assisted closure (VAC) therapy according to damage control principles. We describe the technical approach and discuss the indications, results and technique by considering the literature available. VAC can be used for CCWs, particularly for large defects in selected patients according to clinical and CT evaluations following immediate resuscitation. In severely injured and unstable patients, VAC aims to delay definitive reconstructive and time-consuming treatment. Interestingly, it appears to be a safe treatment based on the previously described-but not exclusively trauma-cases with no secondary cerebrospinal fluid leakage encountered.
颅脑创伤（CCW）的处理仍然具有挑战性，尤其是对于重伤患者。考虑到不稳定患者多层损伤和损伤控制护理的复杂性，所进行的每一项操作都应能迅速使患者受益。我们报告了一例头部枪伤导致颅脑创伤的患者的典型病例，我们根据损伤控制原则对其应用了负压封闭引流（VAC）治疗。我们描述了技术方法，并结合现有文献讨论了适应症、结果和技术。VAC可用于颅脑创伤，特别是对于经立即复苏后根据临床和CT评估选择的有大缺损的患者。在重伤和不稳定患者中，VAC旨在延迟确定性重建和耗时的治疗。有趣的是，基于先前描述的（但不仅限于创伤）病例且未遇到继发性脑脊液漏，它似乎是一种安全的治疗方法。
