Natchitoches Regional Medical Center, Natchitoches, LA.
Wounds. 2020 Dec;32(12):364-368.
Aquatic propeller injuries can pose significant complications in the care of a patient including gross contamination, delayed onset of ischemia, and exposure to unusual water-associated organisms. This case study highlights a circumstance where source control was achieved in a patient that suffered from a polymicrobial necrotizing Aeromonas hydrophila infection following a traumatic aquatic amputation.
A 26-year-old female sustained a propeller injury in a lake with brackish water that resulted in multiple significant linear lacerations and avulsions as well as a Gustilo IIIB fracture. Due to the extent of injuries, the limb was deemed unsalvageable. Serial washouts began early in the hospital course, but the patient did not hemodynamically tolerate debridement well. Tissue cultures showed a polymicrobial A hydrophila infection. Achievement of source control was attempted through use of negative pressure wound therapy with instillation and dwell time (NPWTi-d) (instillation of 100 mL of 0.125% Dakin's solution, dwell time of 5 minutes, and 2-hour intervals of NPWTi-d at -125 mm Hg) in conjunction with traditional intravenous antibiotics; when this therapy was initiated, the wound measured 51.0 cm x 38 cm x 4 cm with 6.0 cm undermining along the superior border. Within 2 days of NPWTi-d initiation, lab values normalized, and the patient began to clinically improve. By day 17, the NPWTi-d settings were switched to instillation of 80 mL normal saline with a dwell time of 5 minutes and interval 2 hours of NPWT at -125 mm Hg. At day 25, the wound measured approximately 25.0 cm x 30.0 cm. The NPWTi-d was continued throughout hospitalization until grafting was able to be performed; on hospital day 51, nearly 100% take of split-thickness grafting was noted with no residual tissue loss. At 167 days after the initial injury, the patient took her first steps on the prosthetic limb.
Negative pressure wound therapy with instillation and dwell time gives clinicians the option to achieve source control in complex wounds with active, myonecrotic, polymicrobial infections through use of bactericidal solution instillation.
在患者的护理中，水上螺旋桨伤可能会导致严重的并发症，包括严重污染、缺血延迟发作和暴露于不常见的水相关生物。本病例研究强调了在一名患者中实现源头控制的情况，该患者在遭受创伤性水上截肢后，患有多微生物坏死性嗜水气单胞菌感染。
一名 26 岁女性在一个有咸水的湖中遭受螺旋桨伤，导致多处线性撕裂和撕脱伤，以及 Gustilo IIIB 骨折。由于损伤程度严重，该肢体被认为无法挽救。早期在医院开始进行多次冲洗，但患者的清创术耐受性不佳。组织培养显示多微生物嗜水气单胞菌感染。通过使用负压伤口治疗联合灌洗和停留时间（NPWTi-d）（灌洗 0.125%达金溶液 100 毫升，停留时间 5 分钟，2 小时间隔的 NPWTi-d 为-125mmHg）来尝试实现源头控制，同时使用传统的静脉抗生素；当开始这种治疗时，伤口测量为 51.0cm x 38cm x 4cm，沿上边界有 6.0cm 的潜行。在 NPWTi-d 开始后的 2 天内，实验室值正常化，患者开始临床改善。到第 17 天，NPWTi-d 设置切换为灌洗 80 毫升生理盐水，停留时间为 5 分钟，间隔 2 小时，NPWT 为-125mmHg。在第 25 天，伤口测量约为 25.0cm x 30.0cm。NPWTi-d 在整个住院期间一直持续，直到能够进行移植；在住院第 51 天，注意到分层皮片移植的几乎 100%成功率，没有残留的组织损失。在初始损伤后 167 天，患者在假肢上迈出了第一步。
通过使用杀菌溶液灌洗，负压伤口治疗联合灌洗和停留时间为临床医生提供了在具有活跃、肌肉坏死、多微生物感染的复杂伤口中实现源头控制的选择。
