摘要目的 探讨封闭负压引流(VSD)技术治疗地震伤后四肢复杂感染创面的效果. 方法 2008年5月采用VSD技术治疗地震伤后继发感染的四肢复杂感染创面共8例(10个创面),男6例,女2例;年龄20～62岁,平均35.8岁.手术分为两个阶段进行:以应用VSD技术为主的创面预备性手术和关闭创面的终末手术.每阶段手术前对每个创面进行细菌培养. 结果 术后均随访至所有创面完全愈合后1个月,无感染复发.自使用VSD至手术关闭创面时间平均20 d(7～32 d),此期间患者平均经历3.5次(2～5次)手术.第一次清创前细菌培养阳性率为90%(9个创面),而终末手术前无一例阳性.最终4个创面直接缝合,5个采用游离植皮关闭,1个行局部转移皮瓣. 结论 VSD技术能明显促进创面肉芽生长,帮助控制创面感染,是治疗四肢复杂感染创面安全有效的方法.

abstractsObjective To evaluate the vacuum sealing drainage (VSD) therapy for management of complex infective extremity wounds following an earthquake. Methods From May 2008, we treated 10 complex infective extremity wounds in 8 cases (6 males and 2 females) following an earthquake. Their mean age was 35.8 years (range, 20 to 62 years). Two-stage operations, preparative VSD therapy followed by closure surgery, were performed for every patient. Preoperative bacterial cultures were conducted at each stage. Results The follow-up persisted till one month after every wound healed completely and none had evidence of infection recurrence. The mean operative duration was 20 days (range, 7 to 32 days) from the preparative VSD therapy to the closure surgery and each patient underwent 3.5 times (range, 2 to 5 times) of operations averagely. Nine out of the 10 bacterial cultures were positive before the first surgical debridement and none before the closure surgery. Four wounds were closed by direct suture, 5 by free-skin grafting and one by local flap transplantation. Conclusion Since the VSD therapy can promote the growth of granulation tissues and help eradicate infection, it is safe and effective for management of complex infective extremity wounds.