The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China.
J Wound Care. 2023 Feb 2;32(2):104-108. doi: 10.12968/jowc.2023.32.2.104.
To observe the clinical efficacy of vacuum sealing drainage (VSD) combined with antibiotic bone cement in the treatment of skin and soft tissue defects of the extremities with bone exposure in the older population.
From January 2016 to December 2018, VSD combined with antibiotic bone cement was used to treat 12 older patients with skin and soft tissue defects of the extremities and bone exposure. The study cohort consisted of eight male patients and four female patients aged between 60-95 years, with a median of 75 years. The injury sites included four cases of hand, one case of calf, one case of ankle and six cases of back of foot. The area of skin and soft tissue defects ranged from 2.7×4.1cm to 4.8×4.9cm. There were four infected wounds and eight contaminated wounds. The time from injury to operation was 1.5-6 hours, with a median of 5 hours. In the first stage of the treatment, the wound was covered with a VSD dressing; in the second stage the VSD dressing was replaced with antibiotic bone cement after infection control; and in the third stage, the bone cement was removed and the wound was transplanted with medium-thickness skin grafts according to the wound condition. The skin graft survival and wound healing were assessed.
After the first-stage debridement, three of the 12 patients had wound infections, including two cases of meticillin-resistant infection and one case of infection. After the bone cement was removed in the third stage, five of the 12 patients underwent free medium-thickness skin grafting on the wound surface (the area of the autologous skin ranged from 2.9×4.3cm to 4.9×5.0cm), and seven patients continued to change dressing routinely. All patients were followed up for 4-15 months, with a median of 10 months. All skin grafts survived and the wounds healed. The healing time was 48-115 days, with a median of 72 days. At the last follow-up, the skin of the affected limb was slightly darker than the surrounding skin, and the appearance was smooth, without obvious scar tissue formation.
VSD combined with antibiotic bone cement in the treatment of skin and soft tissue defects of the extremities with bone exposure in the older population has a high survival rate of skin grafts and good wound healing. It is worthy of clinical application.
观察封闭式负压引流（VSD）联合抗生素骨水泥治疗高龄人群四肢伴有骨外露的皮肤软组织缺损的临床疗效。
2016 年 1 月至 2018 年 12 月，采用 VSD 联合抗生素骨水泥治疗高龄人群四肢伴有骨外露的皮肤软组织缺损 12 例。研究对象为 8 例男性和 4 例女性患者，年龄 60-95 岁，中位数 75 岁。损伤部位：手部 4 例，小腿部 1 例，踝部 1 例，足跟部 6 例。皮肤软组织缺损面积 2.7×4.1cm 至 4.8×4.9cm。其中感染创面 4 例，污染创面 8 例。受伤至手术时间 1.5-6 小时，中位数 5 小时。治疗的第 1 阶段，创面覆盖 VSD 敷料；第 2 阶段，感染控制后更换 VSD 敷料为抗生素骨水泥；第 3 阶段，根据创面情况去除骨水泥，移植中厚皮片。评估皮片成活率和创面愈合情况。
12 例患者中，在第 1 阶段清创后有 3 例发生创面感染，其中耐甲氧西林金黄色葡萄球菌感染 2 例，普通细菌感染 1 例。在第 3 阶段去除骨水泥后，有 5 例患者在创面行游离中厚皮片移植（自体皮片面积 2.9×4.3cm 至 4.9×5.0cm），7 例患者继续常规换药。所有患者均获得随访，随访时间 4-15 个月，中位数 10 个月。所有皮片均成活，创面愈合。愈合时间 48-115 天，中位数 72 天。末次随访时，患侧肢体皮肤颜色略暗于周围皮肤，皮面平整，无明显瘢痕组织形成。
VSD 联合抗生素骨水泥治疗高龄人群四肢伴有骨外露的皮肤软组织缺损，皮片成活率高，创面愈合良好，值得临床应用。
