RESUMO
Objetivo: Mapear a produção científica a respeito do uso da terapia de pressão negativa no tratamento de queimaduras, em pacientes adultos e idosos hospitalizados. Método: Revisão de escopo seguindo o método da JBI com busca da produção científica na PubMed, Scientific Electronic Library Online, Biblioteca Virtual de Saúde e Banco de Teses da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior nos meses de março a maio de 2021. Foram incluídos estudos com pacientes adultos e idosos com queimaduras, submetidos à terapia por pressão negativa no hospital. Não houve restrição de idioma, nem período de tempo. Resultados: Foram identificadas 106 publicações e, após o processo de seleção, cinco estudos compuseram a amostra final. Os resultados demonstraram que a aplicação da terapia por pressão negativa em queimaduras constituiu-se como uma ferramenta efetiva na cicatrização de queimaduras térmicas, químicas e elétricas, destacando-se a otimização do tempo de cicatrização, formação de um tecido de granulação saudável, diminuição do edema, redução da infecção, drenagem e monitorização do edema. Conclusão: O tratamento de queimaduras utilizando a pressão negativa tem se mostrado um método efetivo, visto os benefícios que promove no processo cicatricial. Sugere-se que a temática seja mais difundida, aprofundando-se o conhecimento sobre o uso desta tecnologia. (AU)
Objective: To map the scientific production regarding the use of negative pressure wound therapy in burn treatment of hospitalized adult and aged patients. Method: Scope review following the JBI method with a search for scientific production in PubMed, the Scientific Electronic Library Online, the Virtual Health Library, and the Thesis Database of the Coordination for the Improvement of Higher Education Personnel from March to May 2021. Studies with adult and aged burn patients undergoing negative pressure wound therapy in hospitals were included. There was no language or time frame restriction. Results: 106 publications were identified and 5 studies made up the final sample after the selection process. The results demonstrated that applying negative pressure wound therapy to burns was effective in healing thermal, chemical, and electrical burns, esoecially regarding healing time optimization, healthy granulation tissue formation, edema and infection reduction, and edema drainage and monitoring. Conclusion: Burn treatment using negative pressure has proven effective, given the benefits it promotes in the healing process. The theme should be more widely spread to deepen the knowledge about the use of this technology. (AU)
Objetivo: Mapear la producción científica sobre el uso de la terapia de presión negativa en el tratamiento de quemaduras en pacientes adultos y ancianos hospitalizados. Método: Revisión de alcance siguiendo el método JBI con búsqueda de producción científica en PubMed, Biblioteca Científica Electrónica en Línea, Biblioteca Virtual en Salud y Banco de Tesis de la Coordinación para el Perfeccionamiento del Personal de Educación Superior en los meses de marzo a mayo de 2021. Se incluyeron estudios con adultos y pacientes ancianos quemados sometidos a terapia de presión negativa en el hospital. No hubo restricción de idioma ni período de tiempo. Resultados: Se identificaron 106 publicaciones y luego del proceso de selección, 5 estudios conformaron la muestra final. Los resultados demostraron que la aplicación de la terapia de presión negativa en quemaduras constituyó una herramienta eficaz en la curación de quemaduras térmicas, químicas y eléctricas, destacándose la optimización del tiempo de curación, formación de tejido de granulación sano, reducción de edema, reducción de infección, drenaje y seguimiento del edema. Conclusión: El tratamiento de quemaduras mediante presión negativa ha demostrado ser un método efectivo, dados los beneficios que promueve en el proceso de cicatrización. Se sugiere que el tema sea más difundido, profundizando el conocimiento sobre el uso de esta tecnología. (AU)
Assuntos
Humanos , Queimaduras/terapia , Tratamento de Ferimentos com Pressão Negativa , Estomaterapia , Cuidados de EnfermagemRESUMO
Introducción: Se presenta un caso clínico de sistema de presión negativa como tratamiento de ventana torácica derecha, realizado en la clínica de heridas. Se describe el tiempo y proceso de cicatrización, desde la llegada del paciente hasta la cicatrización total. Caso: Hombre de 24 años, postoperado de toracotomía, se le colocó terapia de presión negativa inicial a -75mmHg con intensidad media y modalidad continua; se aplicó esponja blanca para proteger el pulmón expuesto y esponja de plata, con tres cambios cada siete días. Posteriormente, se realizaron diez cambios de esponjas cada cuatro días, identificando disminución de las dimensiones de la ventana torácica. En la semana once inició tratamiento con terapia húmeda y fibrina rica en plaquetas, la cual se colocó en el lecho de la herida, aplicándose una vez por semana durante un mes. A partir de la semana quince se realizó curación diaria con aplicación de sulfadiazina de plata. El paciente fue dado de alta en la semana veinte con la herida 100% epitelizada. Conclusiones: El uso de la terapia de presión negativa acelera el proceso de curación, reduce las complicaciones y la carga bacteriana del tejido, debido a que la esponja de plata actúa como barrera antimicrobiana.
Introduction: A clinical case of negative pressure system as a right thoracic window treatment, performed in the wound clinic, is presented. The time and healing process from patient arrival to complete healing is described. Case: A 24-year-old man, postoperative thoracotomy, was placed on negative pressure therapy at -75mmHg with medium intensity and continuous mode; white sponge was applied to protect the exposed lung and silver sponge, with three changes every seven days. Subsequently, ten sponge changes were performed every four days, identifying a decrease in the dimensions of the thoracic window. In week eleven, the patient started treatment with wet therapy and platelet-rich fibrin, which was placed in the wound bed and applied once a week for a month. From week fifteen onwards, daily healing was performed with silver sulfadiazine application. The patient was discharged at week twenty with the wound 100% epithelialized. Conclusions: The use of negative pressure therapy accelerates the healing process, reduces complications and tissue bacterial load, due to the silver sponge acting as an antimicrobial barrier.
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Tratamento de Ferimentos com Pressão Negativa , Terapêutica , Toracotomia , Técnicas de Fechamento de Ferimentos , Cuidados de EnfermagemRESUMO
Open abdomen therapy is an effective treatment to deal with severe abdominal infections, abdominal hypertension and other critical abdominal diseases. However, this therapy is difficult to implement and has many uncertainties in the timing, manners, and follow-up treatment, which leads to the fact that open abdomen therapy is not very accessible and standardized in medical systems of China. This consensus aims to provide guiding principles for indications and implementation of open abdomen, classification methods of open abdomen wounds, technologies for abdominal closure, and management of enteroatmospheric fistula, so as to improve the accessibility and success rate of open abdomen in China.
Assuntos
Humanos , Abdome/cirurgia , Consenso , Fístula Intestinal/terapia , Tratamento de Ferimentos com Pressão Negativa , Técnicas de Abdome AbertoRESUMO
The aim of this pilot study is to obtain preliminary results comparing topical oxygen therapy (TOT) and vacuum assisted closure (VAC) in terms of its ability to accelerate wound healing. METHODS: This non-randomised prospective study included patients with age 16-50 years, wound size ≥ 16cm2 and present below knee joint within seven days of occurrence. Bates-Jensen wound assessment tool (BWAT) was used for evaluation at 8-day interval along with percent area reduction at final follow up. RESULTS: Mean number of cycles required in VAC and TOT group were 1.97 (range 1-3) and 2.1 (range 1-3) (each cycle of 5 days) per patient respectively. Percent area reduction was significantly higher in the VAC group (34±9.7%) than TOT (11.3±3.8%) group at final follow up (p<0.05). TOT patients had better improvement in epithelialization compared to VAC at last follow up. More extensive debridement was needed in patients of TOT than VAC. There was no significant difference between final score in both groups. CONCLUSION: TOT appears to be comparable to well-established VAC in treatment of fresh traumatic wounds below the knee joint. Further large scale, multicentric and randomised studies comparing both these modalities of treatment should be the way forward
Assuntos
Tratamento de Ferimentos com Pressão Negativa , Avaliação do Impacto na Saúde , Oxigenoterapia Hiperbárica , Anestésicos Locais , Pacientes , Cicatrização , Articulação do JoelhoRESUMO
Purpose: Negative pressure wound therapy (NPWT) has revolutionized wound care, but its high cost reduces the procedure's availability. To solve the problem, streamlined vacuum dressings systems have been proposed, but the utility of these devices has been poorly studied. The objective of this study was to evaluate a simplified vacuum dressing system model (SVDM). Methods: Randomized clinical trial in which wounds were treated with SVDM compared to a complex occlusive dressing (silver hydrofiber, SHF). The analyzed outcomes were cleaning, presence of granulation tissue, clinical appearance, and indication for surgical closure of wounds. Results: Fifty injuries were treated (25 in each group), most located on lower limbs. SVDM proved to be more effective than SHF in the evaluated outcomes. Wound recalcitrance reduced the effectiveness of the equipment used. Despite its efficacy, complications occurred, the most frequent related to dressing changes: minor bleeding, foam adherence to a wound bed, and pain. Only for bleeding no favorable risk-benefit ratio was found. There were no severe complications, worsening conditions of injuries, or deaths. Conclusions: SVDM proved to be an effective and acceptably safe device for managing studied wounds.
Assuntos
Humanos , Ferimentos e Lesões/terapia , Compostos de Prata/análise , Tratamento de Ferimentos com Pressão Negativa/métodos , Curativos OclusivosRESUMO
Wound repair has always been one of the key issues of clinical concern. In recent years, negative pressure wound therapy (NPWT) has played an increasingly active role in promoting various wound repairs, not only for the treatment of common acute and chronic wounds, but also for closure of surgical incisions, preparation of wounds before skin transplantation, fixation of skin grafts after transplantation, and treatment of some complex thoracic and abdominal trauma. This review aims to summarize the clinical application of NPWT in wound treatment and the related latest research progress, and to preliminarily discuss its future development prospects.
Assuntos
Humanos , Tratamento de Ferimentos com Pressão Negativa , Transplante de Pele , Ferida Cirúrgica , CicatrizaçãoRESUMO
On November 17, 2013, the Second Affiliated Hospital of Kunming Medical University admitted a 23-year-old male patient with a high-temperature steel bar penetration injury from scrotum to buttocks who was transferred from another hospital. Expanded debridement, suture, and drainage of the perineum, right thigh, and right hip were performed as soon as possible after admission. A sputum suction tube was used as the guide mark for expanded debridement during the operation to ensure the accuracy of the direction and scope of expanded debridement. The incision was treated with vacuum sealing drainage (VSD) and full drainage. On the 20th day after the operation (the 25th day after admission), the unhealed wound was transplanted with split-thickness skin graft from the right thigh, and the drainage of the operation area and dressing change were strengthened. On the 53rd day after injury, the patient was discharged after complete wound healing. This case suggests that VSD after early debridement is an effective means to treat high-temperature steel bar penetration injuries.
Assuntos
Adulto , Humanos , Masculino , Adulto Jovem , Nádegas , Desbridamento , Drenagem , Tratamento de Ferimentos com Pressão Negativa , Escroto/cirurgia , Transplante de Pele , Aço , Temperatura , Resultado do TratamentoRESUMO
Objective: To investigate the clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns. Methods: A retrospective observational study was used. From June 2017 to June 2019, 33 patients (24 males and 9 females, aged 8-50 years) who met the inclusion criteria with hypertrophic scars in non-functional sites outside the face after burns were treated in General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients underwent scalp transplantation after perforation of retained split scar matrix in situ (with scar thinning area of 90-500 cm2), and then the vacuum sealing drainage was performed. The hematoma and infection of wounds were observed on the 7th day after operation. At the same time, the survival rate of skin grafting was observed and calculated. The flatness and thickness of the scar in the operative area were observed in 12 months after operation, and the itching and pain of the patients were recorded. Vancouver Scar Scale was used to score the scar of patients before operation and at 3, 6 and 12 months after operation. The healing time and hair growth of donor site were observed. Data were statistically analyzed with repeated analysis of variance, paired sample t test and bonferroni correction. Results: On the 7th day after operation, local subcutaneous hematoma appeared in the wound of 2 patients, which healed after dressing change; no infection occurred. On the 7th day after operation, the survival rate of skin grafting of patients was 94.6%-99.0%(96.8±1.2)%. Scar flatness was well, the thickness of scar was not significantly higher than that of normal skin in 12 months after operation, and the symptoms of itching pain of patients disappeared or significantly relieved. Vancouver Scar Scale scores of patients before operation and at 3, 6, and 12 months after operation were 12.1±2.8, 8.5±1.5, 7.6±1.6, 6.7±1.3, respectively, and the scores of 3, 6, and 12 months after operation were all significantly lower than that before operation (with t values of 4.48, 4.06, and 3.97, respectively, P<0.01). All the donor sites of the head healed well in 4-7 days after operation. By 3-6 months after operation, all patients had good hair growth in the donor site and achieved no scar healing. Conclusions: The treatment of hypertrophic scar in non-functional sites outside the face after burns by in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage can effectively improve the appearance of hypertrophic scar in non-functional areas after burn and reduce its degree of hyperplasia, with scar-free donor site healing.
Assuntos
Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Queimaduras/cirurgia , Cicatriz Hipertrófica/cirurgia , Tratamento de Ferimentos com Pressão Negativa , Couro Cabeludo/cirurgia , Transplante de PeleRESUMO
El objetivo de este trabajo es normatizar el uso de la terapia de presión negativa de heridas complejas en neonatos. La iniciativa surge a partir de la negativa de nuestros proveedores locales de proporcionarnos el material del sistema VAC (cicatrización asistida por vacío), por temor a las posibles complicaciones por su uso en neonatos y escasa bibliografía al respecto. Se presentan 2 casos tratados en neonatos entre 2018 y 2021, y se acompaña de revisión bibliográfica encontrada, de diferente etiología. Con las conclusiones obtenidas, se pretende establecer al VAC como una herramienta terapéutica eficaz en neonatos, de igual manera que se aplica, en toda herida compleja que lo requiera, sin importar la edad del paciente
The goal of this work is to standardize the use of negative pressure therapy for complex wounds in newborns. The initiative arises from the refusal of our local suppliers to provide us with the VAC (vacuum-assisted healing) system material, for fear of possible complications from its use in newborns and little literature about it. There are 2 cases treated in neonates between 2018 and 2021, and it is accompanied by found bibliographic review of different etiology. With the conclusions obtained, it is intended to establish the VAC as an effective therapeutic tool in neonates, just as it is applied, in any complex wound that requires it, regardless of the age of the patient
Assuntos
Humanos , Recém-Nascido , Cicatrização , Ferimentos e Lesões/terapia , Tratamento de Ferimentos com Pressão Negativa/métodos , Técnicas de Fechamento de FerimentosRESUMO
Negative pressure wound therapy has become an important technology in the global field of wound care, and the development of this technology is inseparable from the development and application of negative pressure wound care products. Based on the characteristics of the negative pressure wound therapy products, this paper discusses the key contents that should be considered in the design and evaluation of the negative pressure wound protection products from the aspects of physical and chemical properties, biocompatibility, intended use and risk warning information, in order to provide reference for the development and technical review of such products.
Assuntos
Bandagens , Tratamento de Ferimentos com Pressão NegativaRESUMO
OBJECTIVES: To evaluate the efficacy of autologous platelet-rich plasma (PRP) gel in the treatment of refractory pressure injuries and its effect on wound healing time and quality of life of patients. METHODS: A random number table method was used to group 102 patients with refractory pressure injuries into either a control group (CG) (51 cases) receiving negative pressure wound therapy (NPWT) or a study group (SG) (51 cases) receiving NPWT+PRP gel. RESULTS: The total efficacy rate in the SG (92.16%) was higher than that in the CG (76.47%) (p<0.05). The SG exhibited lower visual analog scale (VAS) scores and pressure ulcer scale for healing (PUSH) scores, smaller wound sizes and depths, and shorter wound healing times than the CG after 21 days of treatment (p<0.05). After 6 months of treatment, the SG scored higher than the CG on the psychological, physiological, social functions, and daily activity domains on the World Health Organization Quality of Life (WHOQOL-BREF) scale (p<0.05). The incidence of postoperative complications in the SG (13.73%) was not significantly different from that of the CG (7.84%) (p>0.05). CONCLUSION: In the treatment of refractory pressure injuries, PRP gel can accelerate wound healing, reduce wound pain, shorten the treatment cycle, regulate tissue inhibitor matrix metalloproteinase-1 (TIMP-1) and matrix metalloproteinase-9 (MMP-9) levels and the expression of specific proteins in granulation tissue, reduce the levels of the inflammatory factors interleukin-1β (IL-1β), IL-8, and tumor necrosis factor-α (TNF-α), and improve the quality of life of patients without increasing complications.
Assuntos
Humanos , Úlcera por Pressão , Plasma Rico em Plaquetas , Tratamento de Ferimentos com Pressão Negativa , Qualidade de Vida , CicatrizaçãoRESUMO
Resumen Objetivo: Reportar un caso sobre el uso de la terapia de presión negativa como tratamiento alternativo en el manejo de una úlcera vascular arterial de miembros inferiores. Métodos: Por medio de la historia clínica, se revisó los registros previos de una paciente en un centro de atención médica de tercer nivel en Popayán, Colombia. Posteriormente, se realizó una revisión sistemática bibliográfica a través de las bases de datos de Pubmed, ScienceDirect y Scielo. Resultados: La terapia de presión negativa favoreció el proceso de cicatrización, permitiendo el cierre de la herida. Conclusiones: Actualmente, este sistema se considera un apoyo fundamental en el tratamiento de las heridas complejas, las cuales suponen un reto terapéutico importante.
Abstract Objective: To report a case about the use of the Negative-pressure wound therapy as an alternative treatment for arterial vascular ulcers presented in the lower limbs. Methods: The patient's records were reviewed based on her medical history in a tertiary referral care center in Popayan, Colombia. Subsequently, a systematic literature review was conducted through the Pubmed database, ScienceDirect, and Scielo. Results: The use of Negative-pressure wound therapy favored the lesion healing process. Conclusions: Nowadays, this system is considered as an essential treatment for complex wounds, which represent a major therapeutic challenge.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Úlcera , Extremidade Inferior , Tratamento de Ferimentos com Pressão Negativa , Pressão , Terapêutica , Ferimentos e Lesões , Atenção Terciária à Saúde , ÁlcalisRESUMO
Abstract Introduction: Negative pressure wound therapy (NPWT) has significantly improved outcomes in individuals with superficial and deep sternal wound dehiscence (SWD). We report our experience with NPWT to evaluate factors influencing effectiveness, duration of treatment and postoperative hospital stay. Methods: We reviewed 92 patients with postoperative SWD following a median sternotomy. Patients were divided into 2 groups: those with a superficial SWD (Group 1; 72, 78%) and those with a deep SWD (Group 2; 20, 28%). Group 1 was further divided into 3 subgroups based on NPWT duration. Results: In both groups, none of the preoperative characteristics examined showed a significant association with longer NPWT duration. In Group 2, there was a trend for postoperative bleeding and neurological complications to be associated with longer treatment duration. In the entire series, staph infection resulted a weak predictor of NPWT duration. In each Group 1 subgroup and in Group 2, treatment days were compared with duration of hospitalization until discharge. Mean post-NPWT hospital stay was 6 days in subgroup 1, 12 days in subgroup 2 and 20 days in subgroup 3 (P<0.0001). At a median 3-year follow-up, there were 4 late deaths, none related to wound complications. No cases of SWD recurrence were observed. Conclusion: Our results confirm the effectiveness of NPWT in SWD management, while excessive treatment duration might have a negative impact on the length of hospital stay. Further studies are needed to define an optimal use of NPWT protocol.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Tratamento de Ferimentos com Pressão Negativa , Staphylococcus aureus , Infecção da Ferida Cirúrgica , Estudos Retrospectivos , Resultado do Tratamento , EsternotomiaRESUMO
Pressure ulcers are quite distressing, and they cut across all age groups. Aside from increasingmortality, it results in protracted hospital stay and an upsurge in the consumption of healthcare resourcesPressure ulcers are considered to be essentially preventable, but in order to prevent them it is important to identify the people most at risk and deliver timely preventative care. In case of severe acute respiratory distress syndrome (ARDS), as in coronavirus disease 2019 (COVID-19) affected patients, prone position and invasive ventilation improve the clinical status of this group of patients. This form of therapy is associated with an increased risk of facial pressure ulcers. When pressure ulcer occurs, appropriate documentation of each ulcer and staging of the ulcer are essential for good wound assessment.Treatment involves, assessing the nutritional needs of the patient, management of infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery
Assuntos
Lesões por Esmagamento , Desbridamento , Tratamento de Ferimentos com Pressão Negativa , Ciências da Nutrição , Úlcera por PressãoRESUMO
Introducción. La terapia de presión negativa es un recurso utilizado cada vez con mayor frecuencia en el manejo de heridas complejas en pediatría. El objetivo de este estudio fue describir la experiencia con esta terapia en diferentes situaciones clínicas. Métodos. Se llevó a cabo un estudio descriptivo retrospectivo en un grupo de pacientes pediátricos en quienes se utilizó la terapia de presión negativa entre el año 2010 y el 2015. Se analizaron las variables sociodemográficas, los diagnósticos que indicaron la terapia, el tiempo de uso, sus complicaciones y la mortalidad. Resultados. Se incluyeron 41 pacientes. La terapia se indicó en 39 casos con heridas localizadas en el abdomen, en uno con infección de los tejidos blandos perianales y en otro con una herida de esternotomía infectada. De las heridas abdominales, 14 fueron por complicaciones relacionadas con apendicitis aguda, 6 por enfermedades relacionadas con megacolon, 5 por obstrucción intestinal, 4 para el manejo de fístulas, 4 por enterocolitis necrosante del recién nacido, 3 por pancreatitis aguda y 3 por otras causas. El tiempo promedio de uso de la terapia fue de 7 días. Se presentaron fallas en el sistema de vacío en dos pacientes, pero no hubo complicaciones por el uso de la terapia. Dos pacientes fallecieron por complicaciones relacionadas con su enfermedad de base. Conclusión. La terapia de presión negativa es un recurso efectivo en el manejo de heridas complejas en la población pediátrica
Introduction. Negative pressure therapy is an increasingly used resource in the management of complex wounds in pediatrics. The objective of this study was to describe the experience with this therapy in different clinical situations. Methods. A retrospective descriptive study was conducted in a group of pediatric patients who received negative pressure therapy between 2010 and 2015. We analyzed the sociodemographic variables, the diagnoses that indi-cated the therapy, the time of use of the therapy, complications and mortality. Results. A total of 41 patients were included. Therapy was indicated in 39 cases with wounds located in the ab-domen, in one with infection of the perianal soft tissues, and in another with an infected sternotomy wound. Of the abdominal wounds, 14 were due to complications related to acute appendicitis, six due to diseases related to megacolon, five due to intestinal obstruction, four for the management of fistulas, four due to necrotizing enterocolitis of the newborn, three due to acute pancreatitis, and three due to other causes. The average time of use of the therapy was 7 days. Vacuum system failures occurred in two patients, but there were no complications from the use of therapy. Two patients died of complications related to their underlying disease.Conclusion. Negative pressure therapy is an effective resource in the management of complex wounds in the pediatric population
Assuntos
Humanos , Tratamento de Ferimentos com Pressão Negativa , Pediatria , Apendicite , Enterocolite NecrosanteRESUMO
SUMMARY OBJECTIVE To investigate the clinical efficacy of cefazolin sodium pentahydrate combined with vacuum sealing drainage (VSD) in the treatment of open fracture complicated with soft tissue injury. METHODS Sixty-three patients with open fracture complicated with soft tissue injury were divided into observation (n = 33) and control (n = 30) groups. After surgical reduction, fixation, and repair of the fractures, the control group was treated with VSD for 10 days, and the observation group was treated with cefazolin sodium pentahydrate based on VSD for 10 days. The infection control time was recorded. After treatment, the pain of patients was evaluated. Before and after treatment, the serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α), cortisol, epinephrine, norepinephrine, and glucose were detected. After 6 months of treatment, the total effective rate of the treatment was evaluated. RESULTS The infection control time and Visual Analogue Scale score after treatment in the observation group were significantly lower than in the control group, respectively (P < 0.05). After the treatment, the serum levels of CRP, IL-6, IL-8, TNF-α, cortisol, epinephrine, norepinephrine, and glucose in each group were significantly lower than before the treatment (P < 0.05), and each index in observation was significantly lower than in the control group (P < 0.05). CONCLUSIONS In the treatment of open fractures complicated with soft tissue injury, cefazolin sodium pentahydrate combined with VSD can effectively reduce inflammation and stress, thus improving the treatment efficacy.
RESUMO OBJETIVO Investigar a eficácia clínica do cefazolin penta-hidrato de sódio combinado com drenagem por vedação a vácuo (VSD) no tratamento da fratura exposta complicada com lesão nos tecidos moles. MÉTODOS Sessenta e três doentes com fratura exposta complicada com lesões nos tecidos moles foram divididos em grupos de observação (n=33) e controle (n=30). Após redução cirúrgica, fixação e reparação da fratura, o grupo de controle foi tratado com VSD durante dez dias e o grupo de observação foi tratado com cefazolina penta-hidrato de sódio com base no VSD durante dez dias. O tempo de controle de infecção foi gravado. Após o tratamento, a dor dos doentes foi avaliada. Antes e após o tratamento, foram detectados os níveis séricos de proteína C-reativa (CRP), interleucina (IL)-6, IL -8, fator de necrose tumoral alfa (TNF-α), cortisol, epinefrina, norepinefrina e glicose. Após seis meses de tratamento, a taxa efetiva total de tratamento foi avaliada. RESULTADOS O tempo de controle da infecção e a pontuação da Escala Visual Analógica após o tratamento no grupo de observação foram significativamente inferiores ao do grupo de controle, respectivamente (P<0,05). Após o tratamento, os níveis séricos de CRP, IL-6, IL-8, TNF-α, cortisol, epinefrina, norepinefrina e glicose em cada grupo foram significativamente menores do que antes do tratamento, respectivamente (P<0,05), e cada índice de observação foi significativamente inferior ao do grupo de controle (P<0,05). CONCLUSÃO No tratamento da fratura exposta complicada com lesões nos tecidos moles, o cefazolin penta-hidrato de sódio combinado com VSD pode efetivamente reduzir a inflamação e o estresse, melhorando assim a eficácia do tratamento.
Assuntos
Humanos , Cefazolina/uso terapêutico , Lesões dos Tecidos Moles , Tratamento de Ferimentos com Pressão Negativa , Fraturas Expostas/terapia , Antibacterianos/uso terapêutico , Cicatrização , Drenagem , Resultado do TratamentoRESUMO
OBJECTIVE@#To explore the clinical effect of vacuum sealing drainage (VSD) technique and Ointment in the treatment of foot skin defect.@*METHODS@#From November 2017 to April 2019, 21 patients (21 feet) with foot skin defect were treated with VSD technique and Ointment. There were 17 males and 4 females, aged from 24 to 60 years old with an average of (37.8±11.2) years, 9 cases caused by traffic accident injury, 6 cases by heavy injury, 6 cases by falling injury. The time from injury to operation was for 3 to 36 (8.6±7.2) h, and the area of foot skin defect was for 20.35 to 83.43(47.2±19.5) cm. All patients underwent debridement or phaseⅠtemporary fixation in emergency, and three-dimensional imagingof the foot was performed by using Mimics software, and the defect area was rendered. The quality of wound healing and complications were observed, and the clinical effect was evaluated by Maryland foot function score.@*RESULTS@#All the 21 patients were followed up for 7 to 17 (10.8±2.7) months. There was no infection or nonunion in all patients. At the final follow-up, the skin margin of the healing site grew tightly, the skin was elastic, the texture was tough, the appearance was no obvious carbuncle. The time of wound healing was for 18 to 63 (41.2±13.3) days. Eight patients underwent stageⅡfixation or/and fusion, and all incisions healed by stageⅠ. According to Maryland's foot scoring, 9 cases got excellent results, 11 good, and 1 middle.@*CONCLUSION@#VSD can effectively remove the necrotic tissue of the wound, provide a smooth drainage of the wound, combine with Ointment to prevent infection and promote the rapid growth of granulation tissue, whose whole treatment cycle was short, the wound healing site was highquality, the limb function was good, and the clinical effect was satisfactory.
Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Drenagem , Tratamento de Ferimentos com Pressão Negativa , Transplante de Pele , Lesões dos Tecidos Moles , Cirurgia Geral , Resultado do TratamentoRESUMO
OBJECTIVE@#To investigate the therapeutic effects of vacuum sealing drainage (VSD) combined with antibiotics in treating acute periprosthetic joint infection (PJI).@*METHODS@#From March 2012 to December 2018, there were 11 patients with acute PJI underwent debridement, VSD, antibiotics and retention of implant, including 7 males and 4 females, with an average age of 72.5 years old (ranged, 58 to 88 years old). There were 8 hips and 3 knees. Three patients had sinus tract.@*RESULTS@#There were 2 patients with negative culture result and 9 patients with positive culture result, including 5 cases of methicillin sensitive staphylococcus aureus, 2 cases of methicillin-resistant staphylococcus aureus (MRSA), 2 cases of staphylococcus epidermidis. The mean follow up duration was 28 months (ranged from 8 to 52 months). One case of infection around hip prosthesis failed to be debrided. The time of debridement and replacement of the calcar joint was 84 days. Debridement was successful in 10 cases. At the latest follow up, Harris score of patients with successful debridement of hip periprosthetic infection ranged from 74 to 93, with an average score of 84.1;Knee Society scores of patients with periprosthetic infection were 84, 84, 89.@*CONCLUSION@#For acute infection around the prosthesis within 1 month after knee replacement and 6 weeks after hip replacement, and for bleeding around the prosthesis with acute infection caused by anticoagulant drugs, satisfactory results can be obtained by debridement, VSD and sensitive antibiotics.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antibacterianos , Artroplastia de Quadril , Desbridamento , Drenagem , Prótese de Quadril , Staphylococcus aureus Resistente à Meticilina , Tratamento de Ferimentos com Pressão Negativa , Infecções Relacionadas à Prótese , Estudos Retrospectivos , Resultado do TratamentoRESUMO
ABSTRACT Objectives: to describe the relationship between epidemiological and clinical characteristics of postoperative cardiac surgery patients undergoing negative pressure wound therapy for the treatment of surgical site infection. Methods: an observational, cross-sectional analytical study including a convenience sample consisting of medical records of patients undergoing sternal cardiac surgery with surgical site infection diagnosed in medical records treated by negative pressure wound therapy. Results: medical records of 117 patients, mainly submitted to myocardial revascularization surgery and with deep incisional surgical site infection (88; 75.2%). Negative pressure wound therapy was used on mean for 16 (±9.5) days/patient; 1.7% had complications associated with therapy and 53.8% had discomfort, especially pain (93.6%). The duration of therapy was related to the severity of SSI (p=0.010) and the number of exchanges performed (p=0.045). Conclusions: negative pressure wound therapy has few complications, but with discomfort to patients.
RESUMEN Objetivos: describir la relación entre las características epidemiológicas y clínicas de los pacientes con cirugía cardíaca postoperatoria sometidos a terapia de presión negativa para el tratamiento de la infección del sitio quirúrgico. Métodos: estudio analítico observacional transversal que incluye una muestra de conveniencia que consiste en registros médicos de pacientes sometidos a cirugía cardíaca esternal con infección del sitio quirúrgico diagnosticada en registros médicos tratados con terapia de presión negativa. Resultados: se incluyeron registros médicos de 117 pacientes, que se sometieron principalmente a cirugía de revascularización miocárdica e infección del sitio quirúrgico incisional profundo (88; 75.2%). La terapia de presión negativa se usó en promedio durante 16 (± 9.5) días/paciente; El 1.7% tuvo complicaciones asociadas con la terapia y el 53.8% tuvo molestias, especialmente dolor (93.6%). La duración de la terapia se relacionó con la gravedad de SSI (p=0.010) y el número de intercambios realizados (p=0.045). Conclusiones: la terapia de presión negativa presenta pocas complicaciones, pero con molestias para los pacientes.
RESUMO Objetivos: descrever as relações entre as características epidemiológicas e clínicas de pacientes no pós-operatório de cirurgia cardíaca submetidos à terapia por pressão negativa para o tratamento de infecção do sítio cirúrgico. Métodos: estudo observacional, transversal analítico, incluindo uma amostra por conveniência composta por prontuários de pacientes submetidos à cirurgia cardíaca esternal com infecção do sítio cirúrgico diagnosticada em prontuário, tratada pela terapia por pressão negativa. Resultados: foram incluídos prontuários de 117 pacientes, submetidos principalmente à cirurgia de revascularização do miocárdio e com infecção do sítio cirúrgico incisional profunda (88; 75.2%). A terapia por pressão negativa foi utilizada em média por 16 (±9.5) dias/paciente; 1.7% tiveram complicações associadas à terapia e 53.8% apresentaram desconforto, principalmente dor (93.6%). O tempo de uso da terapia esteve relacionado à gravidade da ISC (p=0.010) e à quantidade de trocas realizadas (p=0.045). Conclusões: a terapia por pressão negativa apresenta poucas complicações, porém com desconforto aos pacientes.