Heller W A, Gottlieb L J, Zachary L S, Finn H A
Department of Surgery, University of Chicago, Ill, USA.
Plast Reconstr Surg. 1997 Aug;100(2):397-401. doi: 10.1097/00006534-199708000-00019.
The purpose of this paper was to examine whether quantitative bacteriologic assessment of bone is a reliable indicator of the adequacy of debridement of draining wounds involving bone. This is a retrospective review of 31 consecutive patients treated for draining posttraumatic/ surgical wounds involving bone. Nineteen patients met the necessary criteria and were included in the study. These patients underwent radical debridement of bone and soft tissue, intraoperative assessment of the debrided wound by rapid slide quantitative bacteriologic assessment, and closure with well-vascularized tissue. Clinical assessment of vascularity and rapid slide quantitative bacteriologic assessment of cancellous bone and soft tissue were the only prerequisites used in determining the appropriateness of wound closure in this study. At the time of most recent follow-up, none of the 19 patients had recurrent wound drainage. Two patients required a second procedure to partially elevate their flaps and drain recurrent soft-tissue infections. None of the patients had recurrence of bony infection. Seventeen patients who presented initially with fractures or osteotomies all had successful bone unions. This study demonstrates that the technique of rapid slide quantitative bacteriologic assessment of cancellous bone is a useful adjunct to surgical judgment and allows one to close draining wounds (frequently with complex wound closure options) with a high level of confidence.
本文的目的是检验对骨组织进行定量细菌学评估是否是涉及骨组织的引流伤口清创是否充分的可靠指标。这是一项对31例连续接受治疗的涉及骨组织的创伤后/手术后引流伤口患者的回顾性研究。19例患者符合必要标准并被纳入研究。这些患者接受了骨组织和软组织的彻底清创，术中通过快速玻片定量细菌学评估对清创后的伤口进行评估，并用血运良好的组织进行缝合。在本研究中，血管状况的临床评估以及松质骨和软组织的快速玻片定量细菌学评估是确定伤口缝合是否合适的唯一前提条件。在最近一次随访时，19例患者中无一例伤口再次引流。2例患者需要再次手术以部分掀起皮瓣并引流复发性软组织感染。无一例患者发生骨感染复发。最初表现为骨折或截骨的17例患者均成功实现了骨愈合。本研究表明，松质骨快速玻片定量细菌学评估技术是手术判断的有用辅助手段，能够让人满怀信心地缝合引流伤口（通常采用复杂的伤口闭合方法）。
