Abstract： Objective To introduce the early experience of using vacuum-assisted closure （VAC） in the treatment of wound dehiscence after thoracic and cardiovascular surgery. Methods This report retrospective1y analyzed the clinical data of 12 patients who underwent VAC in the treatment of wound dehiscence after thoracic and cardiovascular surgery in the Affiliated Hospital of the Logistics University of CAPF between October 2010 and October 2011. There were 7 male patients and 5 female patients with their mean age of 64.3 years （ranging from 39 to 80 years）. All patients underwent operation via median sternotomy or lateral thoracic incision. All the wound dehiscence was deep to sternum or rib. After debridement of necrotic tissue, the wound surfaces were covered with VAC sponges, and intermittent negative pressure therapy was used. The VAC sponges were changed every 7-10 days. Results All the patients underwent an average of 2 times to change the VAC sponges during VAC treatment. After VAC treatment, the edema around the surgical wounds gradually disappeared, and the granulation tissue was refreshed. The overall conditions of all the patients were improved. The patients could leave their bed, walk in the ward, and look after themselves. Antibiotic treatment was no longer used. The residents checked up the negative pressure system every day to see whether it worked well. The patients were no longer afraid of changing dressing and pain every day. All the patients were healed, discharged from the hospital and followed up at outpatient department for a mean time of 7 months. Their wounds all healed well during follow-up. Conclusion VACsystem is easy to use. It can facilitate the healing of wound dehiscence quickly, decrease the inflammatory reaction of local wound and the body, and shorten the rehabilitation time. It’s also helpful to reduce the residents’ work load. It is recommended in the treatment of wound dehiscence after thoracic and cardiovascular surgery.
Objective To evaluate outcomes of vacuum sealing drainage（VSD）for the treatment of wound infection after cardiac surgery.?Methods?We retrospectively analyzed clinical data of 70 patients（with valvular heart disease，congenital heart disease or coronary heart disease）who underwent cardiac surgery via mid-sternotomy and had postoperative wound infection from Jan. 2008 to Jan. 2012 in General Military Hospital of Guangzhou Command. According to different treatment strategy for wound infection, all the patients with wound infection （incision longer than 5 cm） were randomly divided into VSD group （n=35） and control group（n=35） by random number table，while VSD treatment was used for patients in VSD group and routine treatment was used for patients in control group. Treatment outcome，duration of wound infection, duration of antibiotic treatment and treatment cost were compared between the two groups.?Results?There was no in-hospital death in both groups. Wound exudate significantly decreased and fresh granulation tissue grew well in the wound in most VSD group patients after VSD treatment. The cure rate of VSD group was significantly higher than that of control group （94.3% vs. 60.0%，P＜0.05）. Duration of wound infection （12.9±3.4 d vs. 14.8±4.1 d；t=-2.094，P=0.040）and duration of antibiotic treatment （7.0±1.5 d vs. 8.3±1.9 d；t=-2.920，P=0.005） of VSD group were significantly shorter than those of control group. There was no statistical difference in treatment cost between the two groups. Fifteen patients in VSD group were followed up （42.9%） for 3 months with good wound healing, and 20 patients in VSD group were lost in follow-up.?Conclusion?VSD is effective for the treatment of wound infection after cardiac surgery with shortened treatment duration and similar treatment cost compared with routine treatment.
【Abstract】 Objective To investigate the effectiveness of the vacuum sealing drainage (VSD) technique with split middle thickness skin replantation for the treatment of severe skin closed internal degloving injury (CIDI). Methods Between July 2008 and April 2011, 16 patients with severe skin CIDI were treated. There were 11 males and 5 females, aged 17-56 years (mean, 28 years). Injury was caused by traffic accident in all cases. The time between injury and operation was 2-8 hours (mean, 5 hours). Peeling skin parts included the upper limb in 3 cases and the lower limb in 13 cases. The range of skin exfoliation was 5%-12% (mean, 7%) of the body surface area with different degree of skin contamination. After thorough debridement, exfoliative skin was made split middle thickness skin graft for in situ replantation, and then VSD was performed. Results After 7 days of VSD therapy, graft skin survived successfully in 14 cases; partial necrosis of graft skin occurred in 2 cases, and was cured after thorough debridement combined with antibiotics for 7 days. All patients were followed up 6-18 months (mean, 12 months). The appearance of the limb was satisfactory without obvious scar formation, and the blood supply and sensation were normal.The joint function was normal. Conclusion For patients with severe skin CIDI, VSD treatment combined with split middle thickness skin replantation can improve the local blood circulation of the limb, promote replantation skin survival, and shorten healing time of wound. The clinical effectiveness is satisfactory.