Zhang Ming-Shi, Sun Peng-Yu, Liu Ming-Zhuo, Jiang Zheng-Ying, Fu Zhong-Hua, Min Ding-Hong, Guo Guang-Hua, Liao Xin-Cheng
Department of Burns, First People's Hospital of Wenling, Wenling 317500, China.
Department of Burn, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China.
Ann Palliat Med. 2020 Mar;9(2):493-496. doi: 10.21037/apm.2020.03.15. Epub 2020 Mar 17.
Recently high-frequency electric knife and abdominal binder are widely used in the abdominal operation in China. Nevertheless, with the high occurrence of the abdominal wound, we think that whether both these operations could be used or not. Here, we report the case of a 40-year-old female patient where negative pressure wound therapy (NPWT) was applied to her dehisced abdominal wound as well as fat liquefaction and large skin necrosis with pleasing results. The patient with high fever was referred to our department from her earlier hospital for 6 days after cesarean delivery. During the surgery, her earlier doctor used a high-frequency electric knife for convenient-using, and after the operation, the patient immediately used an abdominal binder for good shape. However, the abdominal surgical incision was opened at postoperative day 3, with fat liquefaction releasing large fatty acids along both abdominal sides with penetration under the abdominal binder. After admitted at postoperative day 6 with aggravating wound, surgery was considered because of no reduction in the size of the wound. A series of vacuum sealing drainage (VSD) or vacuum-assisted closure (VAC) as well as others, were operated. In the admitted 25th day, the wound was completely closed. NPWT is a practical and effective therapy for the treatment of numerous refractory and intractable wounds. Therefore, we suggest that the high-frequency electric knife and an abdominal binder should be avoided using an abdominal operation. This case is the first report of the use of NPWT over a dehisced abdominal wound with fat liquefaction and large skin necrosis on a postpartum patient in China.
近年来，高频电刀和腹带在中国腹部手术中被广泛应用。然而，鉴于腹部伤口的高发生率，我们思考这两种操作是否都可使用。在此，我们报告一例40岁女性患者的病例，其腹部伤口裂开并伴有脂肪液化和大面积皮肤坏死，采用负压伤口治疗（NPWT）后效果良好。该患者剖宫产术后6天因高热被从外院转至我科。手术过程中，其原主治医生为操作方便使用了高频电刀，术后患者立即使用腹带以塑形。然而，术后第3天腹部手术切口裂开，脂肪液化，大量脂肪酸沿腹部两侧渗出，并渗透至腹带下方。术后第6天因伤口加重入院，考虑到伤口未缩小，遂行手术。进行了一系列的封闭负压引流（VSD）或真空辅助闭合（VAC）等操作。入院第25天，伤口完全愈合。NPWT是治疗多种难治性和顽固性伤口的一种实用且有效的疗法。因此，我们建议在腹部手术中应避免使用高频电刀和腹带。该病例是中国国内首例关于NPWT应用于产后患者腹部伤口裂开伴脂肪液化和大面积皮肤坏死的报道。
