Objective To observe the effect of radiofrequency ablation technology for the treatment of infected wounds in minipigs. Methods Infected wounds of full-thickness skin defects (about 6.15 cm2/wound) were prepared in 8 6-month-old minipigs (weighing, 30-35 kg) using the method of Davis et al. The 160 wounds were randomly divided into 4 groups (n=40). Infected wounds were debrided with the radiofrequency ablation technology in group A, with the electric knife in group B, and with the scalpel in group C; no treatment was done in group D as a control. The healing rate, healing time, and tissue filling rate were observed; bacterial quantitative examination and histological examination were done at 0, 2, 7, and 14 days after operation. Results All infected wounds were successfully established after 48 hours when Staphylococcus aureus dilution were inoculated. The wounds after radiofrequency ablation technology treatment were fresh and flat with slight bleeding; the healing time of group A was significantly shorter than that of groups B, C, and D (P lt; 0.05), and the healing rate of group A was significantly higher than that of groups B, C, and D at 7 and 14 days after operation (P lt; 0.05). The tissue filling rate of group A was significantly higher than that of groups B, C, and D at 2 days after operation (P lt; 0.05); the tissue filling rates of groups A, B, and C were significantly higher than that of group D at 7 and 14 days after operation (P lt; 0.05). At 0, 2, 7, and 14 days, there were significant differences in the bacterial count per gram tissue among 4 groups (P lt; 0.05), the order from low to high was groups A, B, C, and D. The histological observation showed that the surface of wound was smooth in group A at 0 day, and group A was better than the other groups in wound healing; at 2 days, some exudates were observed in 4 groups, but it was least in group A. There was inflammatory cell infiltration in various degrees in 4 groups at 7 and 14 days; it was lightest in group A with thick epithelium and dense collagen bundles, followed by groups B and C, and it was severe in group D. Conclusion The radiofrequency ablation technology can effectively remove the necrotic tissues of infected wounds, remarkably reduce the number of bacteria, improve the healing rate, and shorten the healing time of wounds.
Objective To investigate the method and effectiveness of vacuum seal ing drainage (VSD) combined with debridement for treatment of deep infection after hip or knee replacement. Methods Between September 2006 and May 2010, 13 cases of deep infection after joint replacement surgery were treated, including 5 males and 8 females with an average ageof 62.5 years (range, 56-78 years). Infection occurred at 7 days to 1 year and 2 months (median, 14 days) after joint replacement surgery. The time from infection to admission was 8 days to 4 years and 6 months (median, 21 days). Purulent secretion with or without blood were observed in all patients; sinus formed in 5 cases; and unhealing of incision or drainage opening disunion were observed in 8 cases. The size of skin defect at secretion drainage or sinus opening site was 5 mm × 3 mm to 36 mm × 6 mm; the depth of drainage tunnel or sinus was 21-60 mm. The histopathological examination in 11 patients showed acute infection or chronic infection with acute onset in 10 cases, and tuberculosis in 1 case. In 6 cases of secretion culture, Staphylococcus aureus was isolated from 5 cases. After thorough debridement, wound irrigation was performed during the day and VSD during the night in 10 cases. VSD was merely performed in 3 cases. Results In 1 case after revision total hip arthroplasty, the wound bled profusely with VSD, then VSD stopped and associated with compression bandage, VSD proceeded again 3 days later with no heavy bleeding. All the patient were followed up 1 year to 4 years and 5 months (mean, 2 years and 11 months). Infection were controlled 7-75 days (mean, 43 days) after VSD in 10 cases. In these cases, prosthesis were reserved, no recurrent infection was observed, wound were healed, limb function were reserved. VSD was refused in 1 case because of hypersensitive of the pain at the vacuum site, infection control was failed and amputation at the thigh was proceeded. The effect was not evident in 1 case with tuberculosis infection, then the prosthesis was removed and arthrodesis was proceeded followed by complete union. In 1 case, infection was cured with VSD, recurrent infection happened after 9 months, antibiotic-impregnated cement spacer was used at end, and no recurrence was observed 1 year and 4 months later. Conclusion VSD combined with debridement can drainage deep infection sufficiently, promote wound healing, reduce recurrent infection rate, maximize the possibil ity of prosthesis preservation.
Objective To summarize the effect of one-stage anterior debridement of infection in function reconstruction of anterior and middle column for the treatment of thoracolumbar spinal tuberculosis. Methods From January 2001 to January 2007, 65 patients with thoracolumbar spinal tuberculosis were treated with one-stage anterior debridement, decompression, autogenous bone grafts and internal fixation. There were 43 males and 22 females with an average age of 40.2 years (range, 19-64 years), including 18 cases of thoracic tuberculosis (T4-10), 44 cases of thoracolumbar tuberculosis (T11-L2) and 3 cases of lumbar tuberculosis (L3-5). The disease course was 3 months to 10 years (median 10 months). One segment was involved in 7 cases, two segments in 54 cases and three segments in 4 cases. In 14 cases with spinalcord injury, there were 5 cases of grade C and 9 cases of grade D according to Frankel classification. The kyphotic Cobb angle was 20-65° (41° on average). Results The operative time was 120-210 minutes (170 minutes on average), and the blood loss was 300-1 500 mL (600 mL on average). Fifty-eight patients were followed up for 1-6 years (23 months on average). Abscess occurred in 2 cases at 40 days and 3 months, and healed after symptomatic management. The other incisions achieved heal ing by first intention. The X-ray films showed bony fusion 4-12 months (6 months on average) after operation. No tuberculosis recurred. At 12 months after operation, pain disappeared, and there were 7 cases of grade D and 7 cases of grade E according to Frankel classification. The kyphotic Cobb angle was 0-33° (24° on average), showing statistically significant difference (P lt; 0.05) when compared with preoperation. Conclusion Early reconstruction of load-bearing function and stabil ity of anterior and middle column in the treatment of spinal tuberculosis is great significant. The appl ication of one-stage anterior surgery with debridement, decompression, autogenous bone grafts and internal fixation in the operative treatment of thoracolumbar tuberculosis is safe and effective after a rigorous anti-tuberculosis treatment.
Objective To overview the effect of bacterial biofilms (BBF) on the formation of chronic osteomyel itis and the treatment measure. Methods The original articles in recent years about the relationship between BBF and chronic osteomyel itis were reviewed. Results The diagnosis and treatment of chronic osteomyel itis was very difficult, besides hyperplasia oflocal scar, poor blood supply, drug-resistant, forming of BBF also was an important reason. BBF formed on the surface of necrosis soft tissue and dead bone. Due to the protection of BBF, the bacterium were far more resistant to antimicrobial agents, which caused the recurrence of chronic osteomyel itis. The forming of BBF included three processes which were adhesion, development and maturity. As the major pathogens of chronic osteomyel itis, staphylococcus had its own characteristic. Designing therapeutic programmes according to these characteristics had become the trend of anti-infection treatment of BBF. Conclusion Although there are lots of studies on anti-biofilm due to the key factors during the forming of BBF, the most effective way of anti-biofilm is still debridement.
Objective To investigate the cl inical outcomes of one stage debridement and closed-suction drainage for treatment of infection after lumbar instrumentation. Methods Between June 2002 and March 2008, 12 patients with infection after lumbar instrumentation were treated with one stage debridement and closed-suction drainage, including 9 males and 3females and aging 35-68 years (48.5 years on average). The disease duration varied from 7 days to 183 days (56 days on average). The segments of internal fixation included 7 cases single segment at levels of L4, 5, 4 cases of double segments at levels of L 4, 5, L5, S1 (2 cases), and L3, 4, L4, 5 (2 cases), and 1 case of three segments at levels of L3, 4, L4, 5, L5, S1. Two patients were treated with internal fixator removal. Results The bacterial culture results of intervertebral discs were positive in 8 cases for Staphylococcus aureus and in 3 cases for Enterobacter cloacae, negative in 1 case. Primary healing of incisions were achieved in all cases. Twelve patients were followed up 18-53 months (34.7 months on average). The white blood cell count, erythrocyte sedimentation rate, and C reactive protein significantly decreased after operation, showing significant differences at 15 days after operation when compared with those before operation (P lt; 0.05). No obvious low back pain was observed. Pathological-changed vertebra-space fused. No displacement and breakage of internal fixator occurred; in 2 patients who were given internal fixator removal, no removal of the instrumentation was performed again. The X-ray films showed that the average kyphosis decreased 0.8° at 18 months after operation. At last follow-up, the visual analogue scale score was 2 ± 1, showing significant difference (P lt; 0.05) when compared with that (10 ± 2) before operation. Conclusion One stage debridement and closed-suction drainage therapy is an effective method for treating infection after lumbar instrumentation. The operation is easy and can reduce hospitalization days.
Objective To investigate the effect of arthroscopy debridement and drainage on treating septic arthritis of the knee. Methods Twenty-one cases of acute knee septic arthritis were treated by debridement and synovectomy under arthroscopy and combined with intravenous antibiotics and systematic postoperative rehabilitation. Results The temperature resumed to normal after 3 days of operation. All the knees achieved the normal extension and more than 120 degree of flexion 8 weeks after operation. The clinical results were evaluated through examination of temperature and range of motion of the knee joint. All patients had excellent result. All the cases were followed for 1 to 3 years. No majorcomplications related to the arthroscopy of the knee resulted. According to theNoyes, the rate of excellence and the good was 95.2%. Conclusion Early diagnosis and treatment are mandatory for patients with septic arthritis of the knee. The success of arthroscopy treatment of septic arthritis with diminished morbidity makes arthroscopy an excellent alternative to open surgery.
Objective To expand the utilization of minimally invasive technologies for parapancreatic abscess, and summarize the application experience of choledochoscope for treatment of parapancreatic abscess. Methods The clinical data and treatment effectiveness of 36 patients with parapancreatic abscess from Dec. 2000 to Dec. 2008 were analyzed retrospectively. These patients had experienced percutaneous puncture and been placed drainage tube under the ultrasound guidance first, then expanded the sinus tract gradually, and performed debridement by choledochoscope. The flexibility of choledochoscope was used to remove the necrotic tissue and pyogenic membrane repeatedly by clamping, netting and vacuum aspiration in every domain. Results Thirty-six patients were performed percutaneous puncture and placed drainage tube, 3 cases were given canalis singularis, 7 cases were double tube, 26 cases were over three tube. The debridement times were 3-14 by choledochoscope, average 5.6 times. There were 6 cases with improving systemic symptoms, blood routine and temperature recovering normal, and drink and food recovering, then discharged from hospital with tube after 1-2 times of debridement. Length of stay was 25-132 d, average 76 d. The curing rate was 91.7% (33/36). Two cases were turned into open surgery because of broad necrotic tissue range combined with many abdominal cavity abscess with good postoperative recovery and cured. One case was dead of severe multiple organ failure combination. There were 2 patients with hemorrhage, 3 patients with external intestinal fistula. Conclusions The debridement of choledochoscope for parapancreatic abscess treatment is a simple, flexible and effective method. It changes the viewpoint that parapancreatic abscess can be cured only by operation drainage, decreases the patients’ trauma and accomplishes the idea of damage control by minimally invasive technologies.
Objective To explore and summarize the application of minimally invasive technique to every stage of severe acute pancreatitis (SAP). Methods The treatment of 101 SAP patients admitted to our hospital between January 1995 and December 2008 were retrospectively analyzed. After calculi were removed by endoscopic retrograde cholangiopancreatograpy (ERCP) and endoscopic sphincterotomy (EST), endoscopic nasobiliary drainage (ENBD) were applied, then rhubarb liquid was perfused into gut with a nutrient canal and ultrasound-guided abdominal drainage tube were simultaneously placed at the early stage. Some patients received continuous renal replacement therapy (CRRT) at the same time. Laparoscopic cholecystectomy (LC) was performed at the subacute stage, and choledochoscope was introduced to remove parapancreatic necrotic tissues at the late stage of SAP.Results Of all the 101 cases treated by the method mentioned above, 75 cases received ERCP (or EST) and ENBD, and 31 cases underwent rhubarb liquid perfusion with a nutrient canal. Eight cases underwent continuous renal replacement therapy (CRRT). Forty-eight cases underwent LC and ultrasoundguided abdominal drainage. Thirtysix cases with infected peripancreatic tissue or abscess underwent debridement under choledochoscope 3 to 14 times at the later stage. Five cases died of multiple organ failure (MOF) and acute respiratory distress syndrome (ARDS). The hemobilia ocurred in 2 patients during choledochoscopy and was cured under direct visualization by electric coagulation. Intestinal fistula happened in 3 cases and cured by drainage. Pancreatic pseudocyst was latterly seen in 3 cases and treated by the anastomosis of cyst with jejunum through selective operation. After the hospitalization of 9-132 d (mean 24 d), 96 cases completely recovered. Conclusion Timely application of minimally invasive technique to every stage of SAP can avoid the defects of traditional operations, decrease the injury and interference to the maximum, and raise the cure rate.
ObjectiveTo explore the application of 10% sodium chloride for stage-Ⅲ pressure ulcer debridement. MethodsAccording to the standard, 68 stage-Ⅲ pressure ulcer cases were selected from January 2011 to December 2014. All the patients had yellow surface and positive bacterium cultivation suggesting wound infection. They were randomly divided into control group and trial group. The control group used traditional treatment for debridement, while the trial group used 10% sodium chloride, until the end of debridement where the granulation became fresh and bacterium cultivation negative. Then we compared these two groups in terms of debridement time, wound drainage, wound smell, granulation growth, pain score and cost. ResultsThe control group debridement time was 18-32 days, averaging (22.4±10.8) days, and the trial group debridement time was 5-13 days, averaging (11.6±4.0) days (P<0.05). The control group wound drainage ratings score was 6.70±2.87, while the trial group wound drainage ratings score was 3.65±1.23 (P<0.05). In terms of the wound smell, the control group had a score of 2.74±1.62, and the score for the experimental group was 1.26±0.51 (P<0.05). The average cost of the control group was (975.00±10.29) yuan, while the experimental group was (626.00±8.18) yuan (P<0.05). ConclusionThe application of 10% sodium chloride for stage-Ⅲ pressure ulcer debridement can shorten debridement time, promote the growth of granulation and reduce the economic burden, which is worth clinical promotion.
ObjectiveTo summarize the experiences of surgical treatment of sternal dehiscence after cardiac surgery. MethodsFrom January 2011 to January 2014, 7 patients with sternal dehiscence after cardiac surgery were admitted to our hospital. There were 4 male patients and 3 females with an age of 35-72 (52.5±13.4) years old. Two patients accepted coronary artery bypass, 4 underwent mechanical valve replacement and 1 underwent Sun’s procedure. The necrotic bones were debrided and sternal wires completely removed. After the original wires were completely extracted, the infected tissues behind the sternum were removed. Part of the pectoralis major was released with free tension on both sides when suturing was carried out over the sternal defect. Negative pressure drainage tube was used for full drainage. ResultsAll the patients were discharged from hospital with very good recovery. The sternal wound was healing well with normal thoracic appearance, and none of the patients had recurrent infections. ConclusionsPatients with sternal dehiscence after cardiac surgical procedure should undergo surgical debridement. Stabilizing the sternum, rich blood supply and improvement of overall condition of the patients are very important for recovery.