| Objectives:To observe the vacuum sealing drainage in Gustilo Ⅲ open tibiofibula fracture ipplication effect in the treatment of postoperative infection. Methods:From June 2011 to December 2013 were Gustilo Ⅲ open tibiofibula fractures ipplication infections occurred after the VSD treatment of 32 cases of patients,including 31 nales and 1 females; age from 9 to 68 years,averaging out at (38.0±13.8)year,On the left ;ide of the 18 cases,On the right side of the 14 cases.Cause:traffic accident injury 18 cases,high falling injury in 7 cases,the weight crushing injury in 7 cases.According to Gustilo fracture classification:type ⅢA 16 cases,type ⅢB 10 cases,type ⅢC 6 caes.Remaining trauma surface or skin necrosis area ranging(2×5)-(11×40)cm2.Wound infection after routine disinfection,Remove skin and muscle of the obvious necrosis.If fiber interval form, cut fiber intervals to ensure that no pus residues.If sinus form,Open the sinus and removal of sinus wall.physiological saline,3% hydrogen peroxide and iodine cleaning the wound again and again。In the operation notice to protect blood vessels and nerves around the wound, If discovery of neurovascular exposed try to cover it vith the surrounding soft tissue.Then according to the size of the wound of cut or joining ogether into the shape of a right of dressings,need to dressing will be formed after Iebridement completely cover or filling of the wound,and fit surrounding skin closely over he wound edge,with semi-permeable membrane will be closed wounds and the iressings,The entire wound to the edge of the 3-4 cm area form a closed wound,Keep continuous pressure suction,maintaining negative pressure in the-50～-60kPa,the daily hysiological saline flushing pipe,timely processing tube blocking and membrane air eakage, and so on.5-7 days for a VSD treatment cycle,When the end of a VSD reatment,demolition of dressings,then wound samples etiology examination.If the wound is clean and small, granulation tissue grow plump,the wound can be closed with direct line suture.If the wound is larger,granulation tissue grow well can use skin grafting to close the vound,If the wound is still visible more necrotic tissue and deep,line of debridement and igain next the VSD treatment cycle,pay attention to gradually reduce the VSD dressings to idapt to the size of the wound,Repeat treatment until the wound can suture or skin graft or kin flap transplantation methods to closed.Results:32 cases of type GustiloⅢopen tibiofibula fractures with vacuum sealing drainage reat postoperative infection,wound infection degree are improved.The duration of clean rauma surface was7-48days, averaging out at (24.1±10.5)days.Line 24 patients of skin graft or skin flap transplantation methods.The duration of skin graft trauma surface vas11-61days,averaging out at(35.9±14.8)days.14 cases of skin graft curative effect for pptimal,7 cases of skin graft curative effect for favorable,2cases of skin graft curative effect for feasible, lcasesof skin graft curative effect for inferior.The success rate of skin grafting was 95.8%,The duration of union trauma surface was 18-137days,averaging out it(57.7±26.3)days.Three patients osteomyelitis,incidence rate 9.38%,1 case of fracture ionunion,incidence rate 3.13%,1 case of recurrence of wound infection after hospital lischarge,incidence rate 3.13%.Conclusion:Through clinical observation,The VSD in type GustiloIII open tibiofibula fracture complicated with infection of the treatment of patients with can effectively control the nfection,promote wound soft tissue growth,improve the therapeutic efficacy of skin graft,shorten the whole course of the disease,reduce the complications and infection recurred.lt is an effective method for treatment of open fractures of postoperative infection. |
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