ObjectiveTo investigate the clinical characteristics of motorcycle spoke heel injury and the effectiveness of sequential therapy of vacuum sealing drainage (VSD) and pedicled flap transplantation for treating motorcycle spoke heel injury in children. MethodsBetween January 2010 and January 2014, 15 children (aged from 3 to 8 years, 5.7 years on average) with motorcycle spoke heel injury received sequential therapy of VSD and pedicled flap transplantation. The interval from injury to admission was 3-7 days, with an average of 4.9 days. The locations were the heel in 8 cases, the heel and lateral malleolus in 2 cases, and the medial malleolus and medial heel in 4 cases, and the medial and lateral malleolus and heel in 1 case. The patients had different degrees of defects of the skin, tendon, and bone. The skin defect size ranged from 3 cm×3 cm to 13 cm×6 cm. VSD was applied for twice in 13 cases and three times in 2 cases. Reversed flow sural flap was applied in 8 cases, lateral supramalleolar flap in 2 cases, medial supramalleolar perforator-based flaps in 4 cases, and posterior tibial artery flap in 1 case. Eight pedicled flaps with neuroanastomosis were selected according to the wound characteristics. The flap size ranged from 4 cm×4 cm to 14 cm×7 cm. ResultsOf 15 cases, 13 flaps survived well except that two had partial skin necrosis at the distal site. Primary healing was obtained, and skin graft at donor site survived. The patients were followed up 9-21 months (mean, 13 months). Mild and moderate bulky flaps were observed in 9 cases and 6 cases respectively. Of 15 cases, 13 could walk with weight loading, and 2 had slight limping. Superficial sensation recovered to S3 in 8 patients undergoing neuroanastomosis, and recovered to S2 in 7 patients not undergoing neuroanastomosis at 6 months after operation. According to AOFAS evaluation system for Ankle-Hindfoot, the results were excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100% at 8 months after operation. ConclusionThe main characteristic of motorcycle spoke heel injury lies in a combination of high energy damage and thermal damage. Sequential therapy of VSD and pedicled flap transplantation can be regarded as a reliable option to obtain good outcome of wound healing and satisfactory functional recovery for the management of motorcycle spoke heel injury.
Objective Gunshot wound spreads to the surrounding tissues and organs, it is difficult to debride and easy to infect. The conventional treatment is thorough, extensive debridement, fully open drainage, which often causes normal tissue damage and compl ications. To evaluate the effectiveness of vacuum seal ing drainage (VSD) treating thepenetrating wound in porcine extremity by MRI and pathological methods so as to provide theoretical basis for future cl inical use. Methods Eight healthy adult pigs, weighing (45 ± 5) kg, were selected. Eight pairs of hind l imb penetrating wounds (16 wounds) were made by using Chinese-made 95-type rifle at 25 meters distance, which were randomly divided into experimental group (left side, n=8) and the control group (right side, n=8). After debriding and disinfecting the penetrating wounds at 6 hours after injury, wounds were treated with VSD in experimental group. The ball istics exports of the wounds were covered with single-layer gauze and imports were directly sutured and covered with sterile gauze in control group. The trajectory and the general condition of the adjacent skin were observed. MRI and histological observation were taken at 5, 24, 48, and 72 hours after injury, bacterial counting analysis was done at 0, 12, 24, 48, and 72 hours after injury. Results The aperture of the trajectory exit and entry were (5.00 ± 2.50) cm and (0.30 ± 0.15) cm immediately after injury. The wound surface was clean, rosy without leakage and swell ing after 72 hours in experimental group; wound and adjacent tissue were swell ing obviously, pus, muscle necrosis and exfol iative tissue was observed, and deep defect cavity at the trajectory exit could be seen in control group. MRI showed that pairs of l inear low signal in T1WI and T2WI was seen in trajector of experimental group at 5 hours after injury, and signal in T1WI gradually increased at disrupted area and tissue deformation area at 24, 48, and 72 hours; in control group, low signal in T1WI was observed at 5 hours after injury, and signal in T2WI gradually increased and a clear boundari between edema and surrounding tissue, and the increase of signal in T1WI was not obvious at 24, 48, and 72 hours. The histological observation showed that wound was dominated by effusion at 5 hours after injury, granulation tissue gradually increased, muscle tissue dissolved and inflammatory cell infiltration was not obvious at 24, 48, and 72 hours in experimental group; in control group, the gradual dissolution of muscle fibers and inflammatory cell infiltration were observed at 5, 24, and 48 hours, muscle tissue became swell ing, dissolving and degeneration and a large number of inflammatory cell infiltration gathered into the bacteria group at 72 hours. There was no significant difference in the number of bacteria per gram of tissue (P gt; 0.05) between experimental group and control group at 0 hour after injury; the numbers of bacteria in control group were significantly higher than those in experimental group at 12, 24, 48, and 72 hours (P lt; 0.05). Conclusion MRI combined with pathology show diagnostic meaning in treatment of gunshot wound with VSD. MRI can accurately reflect the scope of l imb gunshot wound 72 hours after injury. VSD may be an approach to delay infective time, shorten wound heal ing time, and promote the growth of healthy granulation tissue.
Objective To observe the effectiveness of vacuum seal ing drainage (VSD) combined with anti-takenskin graft on open amputation wound by comparing with direct anti-taken skin graft. Methods Between March 2005 andJune 2010, 60 cases of amputation wounds for limbs open fractures were selected by using the random single-blind method.The amputation wounds were treated with VSD combined with anti-taken skin graft (test group, n=30) and direct anti-takenskin graft (control group, n=30). No significant difference was found in age, gender, injury cause, amputation level, defect size,preoperative albumin index, or injury time between 2 groups (P gt; 0.05). In test group, the redundant stump skin was usedto prepare reattached staggered-meshed middle-thickness skin flap by using a drum dermatome deal ing after amputation,which was transplanted amputation wounds, and then the skin surface was covered with VSD for continuous negative pressuredrainage for 7-10 days. In control group, wounds were covered by anti-taken thickness skin flap directly after amputation, andconventional dress changing was given. Results To observe the survival condition of the skin graft in test group, the VSDdevice was removed at 8 days after operation. The skin graft survival rate, wound infection rate, reamputation rate, times ofdressing change, and the hospital ization days in test group were significantly better than those in control group [ 90.0% vs.63.3%, 3.3% vs. 20.0%, 0 vs. 13.3%, (2.0 ± 0.5) times vs. (8.0 ± 1.5) times, and (12.0 ± 2.6) days vs. (18.0 ± 3.2) days, respectively](P lt; 0.05). The patients were followed up 1-3 years with an average of 2 years. At last follow-up, the scar area and grading, and twopointdiscrimination of wound in test group were better than those in control group, showing significant differences (P lt; 0.05).No obvious swelling occurred at the residual limbs in 2 groups. The limb pain incidence and the residual limb length were betterin test group than those in control group (P lt; 0.05). Whereas, no significant difference was found in the shape of the residual limbs between 2 groups (P gt; 0.05). In comparison with the contralateral limbs, the muscle had disuse atrophy and decreasedstrength in residual limbs of 2 groups. There was significant difference in the muscle strength between normal and affected limbs(P lt; 0.05), but no significant difference was found in affected limbs between 2 groups (P gt; 0.05). Conclusion Comparedwith direct anti-taken skin graft on amputation wound, the wound could be closed primarily by using the VSD combined withanti-taken skin graft. At the same time it could achieve better wound drainage, reduce infection rate, promote good adhesion ofwound, improve skin survival rate, and are beneficial to lower the amputation level, so it is an ideal way to deal with amputationwound in the phase I.
Ｔｏ ｆｉｎｄ ｏｕｔ ｔｈｅ ａｐｐｒｏｐｒｉａｔｅ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｆｏｒ ａｂｄｏｍｉｎａｌ ｄｒａｉｎａｇｅ ａｎｄ ａｐｐｌｙ ｉｔ ｔｏ ｔｈｅ ｐｏｓｔｏｐｅｒａｔｉｖｅ ａｂｄｏｍｉｎａｌ ｄｒａｉｎａｇｅ ｏｆ ｐａｔｉｅｎｔ ｗｉｔｈ ａｃｕｔｅ ｐａｎｃｒｅａｔｉｔｉｓ ａｒｅ ｒｅｐｏｒｔｅｄ．Ａｂｄｏｍｉｎａｌ ｔｕｂｅ ｗａｓ ｉｎｓｅｒｔｅｄ ｔｏ ｒａｂｂｉｔ ｆｏｒ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｄｒａｉｎａｇｅ ｍｏｎｉｔｏｒｉｎｇ ａｎｄ ａｎｏｔｈｅｒ ｔｕｂｅ ｗａｓ ｃｕｓｅｒｔｅｄ ｉｎｔｏ ｔｈｅ ａｂｄｏｍｅｎ ｆｏｒ ｃｏｎｔｉｎｕｏｕｓ ｎｏｒｍａｌ ｓａｌｉｎｅ ｉｎｓｔｉｌｌａｔｉｏｎ．Ｔｈｅ ｒｅｃｏｌｌｅｃｔｉｏｎｓ ｏｆ ｄｒａｉｎａｇｅ ｆｌｕｉｄ ｕｎｄｅｒ ｄｉｆｆｅｒｅｎｔ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｗｅｒｅ ｍｅａｓｕｒｅｄ．Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈａｔ ｔｈｅ ｆｌｕｉｄ ｄｅｐｌｅｔｉｏｎ ｒａｔｅ（７０％）ｏｆ ｔｈｅ ｌｏｗ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｇｒｏｕｐ（１．５ ｋＰａ）ｗａｓ ｈｉｇｅｈｅｒ ｔｈａｎ ｔｈａｔ ｏｔｈｅｒ ｉｎ ３ ｇｒｏｕｐｓ（ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ０ ｋＰａ，５ ｋＰａ ａｎｄ １５ ｋＰａ）（Ｐ＜０．０１）．Ｗｉｔｈ ｔｈｉｓ ｃｏｎｔｉｎｕｏｕｓ ｌｏｗ ｎｅｇａｔｉｖｅ ｐｒｅｓｓｕｒｅ ｄｒａｉｎａｇｅ ｉｎ ２０ ｐａｔｉｅｎｔｓ ａｆｔｅｒ ｓｅｖｅｒｅ ｐａｎｃｒｅａｔｉｔｉｓ ｏｐｅｒａｔｉｏｎ，ｗｅ ｆｏｕｎｄ ｔｈａｔ ｔｈｉｓ ｍｅｔｈｏｄ ｈａｖｅ ｍｏｒｅ ａｄｖａｎｔａｇｅｓ ｏｆ ｒｅｄｕｃｉｎｇ ｃｏｍｐｌｉｃａｔｉｏｎ，ｐｒｏｍｏｔｉｎｇ ｒｅｃｏｖｅｒｙ ａｎｄ ｒｅｄｕｃｉｎｇ ｄｅａｔｈ ｒａｔｅ．