Effects Of VSD Dressing Packing In The Treatment Of Deep Infection After The Operation Of Fracture

Objectives:Combined with the principles of vacuum sealing drainage (VSD) be able to control wound infection and promote wound healing, packing the VSD dressing innovatively in the deep fascia treatment of deep infection after operation of the fracture, to analyze retrospectively the clinical effect of the vacuum sealing drainage (VSD) dressing packing in the treatment of deep infection after operation of the fracture.Methods:26patients from the Second Affiliated Hospital of Dalian Medical University with infection under the deep fascia after operation of the fracture (from June2009to June2013) were chosen to be treated with VSD dressing packing and the clinical effects were observed, including18males and8females; aged from15to79years (46years on average); including20cases open fractures and6cases closed fractures. All of the26patients underwent open reduction and internal fixation after injury and deep fascia formation under abscess after operation of the fracture4days to6months (47.2days on average), including9patients had sinus formation,4patients into the period of chronic osteomyelitis and1patient with tuberculosis abscess formation. All patients puncture at the abscess or sinus pus specimens after admitted to hospital and take the sinus secretions to routine bacterial culture and sensitivity antibiotic anti-infective therapy or anti-TB treatment, application the broad-spectrum antibiotics before the result of bacterial culture. Adequate debridement surgery and completely remove the necrotic tissue in abscess and inflammatory granulation tissue, then cut the dressings into appropriate size of the wound cavity and filling it in the abscess, patients with chronic osteomyelitis need packing the part of VSD dressing in the canal, semi-permeable membrane closely attract to the VSD dressing and connect the drainage pipe to the center of negative pressure, negative pressure is adjusted to-450mmHg～-125mmHg (-0.060MPa～-0.017MPa) between. Anti-infective therapy use the sensitive antibiotics according to the results of bacterial culture, strengthening the supportive therapy at the same time, regular flushing tube to maintain vacuum suction drainage continuous and effective. Maintain suction drainage7to10days for a treatment period of VSD, removal of VSD dressing after each period of treatment and observed the growth of granulation tissue, give again debridement and replace the VSD dressing according to the growth of granulation tissue in abscess, suture of the wound after the wound cavity covered with granulation tissue. Bacterial culture was routinely checked of every debridement, adjusted antibiotics based on culture results. Strengthen the anti-TB treatment in tuberculosis patients during the negative drainage of the abscess. Transplantation the muscle flap and packing the VSD dressing into the marrow cavity after the inflammation is controlled, prevent the residual cavity abscess formed again in case of the abscess does not heal. Recording the used periods of VSD treatment when the bacteria were disappear and the surface skin of the wound cavity to heal.Results:26patients of deep infection after operation of the fracture with1to7periods (2.0periods on average) of VSD dressing therapy, the infection was controlled, wound bacterial culture return no bacterial growth; After1to8periods (3.6periods on average) VSD treatment, invasive cavity covered with granulation tissue, all of the wound cavities healed, the average of healing time is28.8days.2cases of patients with systemic infection sinus formation, at the first treatment period, infection control is not ideal, the abscess continues to expand, leading to skin necrosis area increases, completely debridement again and continue to apply VSD treatment, respectively in the5th periods and the7th periods the infection was controlled and skin graft healing underwent the thick flap transplantation. All of the patients were followed up for3to18months (12months on average), there was no recurrence of infection postoperative.Conclusions:VSD can control the infection of deep tissue after operation of the fracture, promote the growth of granulation tissue in the wound and shorten the course of disease. VSD is an effective method for the treatment of deep infection after the operation of fracture and is worthy of clinical use.