| OBJECTIVE: To study the efficacy of three commonly used concentrations(0.5%,0.25%,and 0.1%)of povidone-iodine(PVP-I)in the prevention of wound infection after open wound debridement with Gustilo IIIA/B.METHODS: The patients in this study came from emergency open fractures in trauma orthopaedics and hand surgery at the Fourth Affiliated Hospital of Jishou University from January to December 2017.Among them,16 were Gustilo IIIA and 10 were Gustilo IIIB.The patients were randomly divided into A(0.5%)povidone-iodine group,B(0.25%)povidone-iodine group,and C(0.1%)povidone-iodine group.All patients received emergency debridement within 8 hours after admission.The infected tissue was taken from the wound to obtain appropriate specimens,and the debridement was performed after rinsing and soaking the wounds with povidone iodine at a corresponding concentration.Rinse the wound tissue with corresponding povidone iodine and immerse the same amount of specimen in the same site.According to the condition of the wound,fix the fracture end with external fixation and cover the wound with vacuum sealing drainage(VSD).Observe and compare the values of white blood cells,procalcitonin(PCT)before and after debridement,the positive rate of bacterial drug sensitivity culture before and after debridement,bacterial count before and after debridement,and Observed under the microscope pathological tissue specimens after debridement.Results: 1.There was no significant difference in the general parameters such as age,gender,injury time,and fracture classification between the three groups(P>0.05).2.The three groups of preoperative white blood cell values are similar,there is no statistically significant difference(P> 0.05)the first day after surgery,the value of white blood cells can be seen in the three groups of values have a decreasing trend,with statistical differences(P <0.05),each group There was no statistically significant difference in the number of interleukin cells(P>0.05),indicating that the experimental group can reduce the number of leukocytes in vivo,but there was no significant difference between the groups.3.The three groups of preoperative procalcitonin(PCT)values are similar,there is no statistically significant difference(P> 0.05);the three groups of preoperative serum procalcitonin values did not change significantly compared with the first postoperative day(P >0.05),there was no statistically significant difference between the groups(P>0.05).The results showed that each experimental group had no special effect on preoperative and postoperative calcitonin levels,and the first day after the operation There was no significant difference in procalcitonin.4.The positive rate of bacterial culture before debridement was not statistically significant(P>0.05);the positive rate of bacterial culture after debridement was significantly decreased(P<0.05),and the positive rate of debridement between the three groups was not significant.Statistical significance(P>0.05),indicating that all experimental groups can reduce the postoperative infection rate,but there was no significant difference in the postoperative infection rate among the groups.5.The number of bacteria in the preoperative specimens of the three groups was similar,and there was no statistically significant difference(P>0.05).The number of bacterial specimens in the three groups decreased significantly after surgery(P<0.05);Vs B(P>0.05),B vs C(P>0.05),A vs C(P<0.05),indicating that each experimental group could reduce the number of bacteria in the wound,and group A(0.5%)compared to group C(0.1%)can more effectively remove the bacteria in the wound.6.After observation of wound specimens,the A(0.5%)group was found to have more capillaries and tiny blood vessels dilating and congested than the other two groups.More inflammatory cell infiltration was seen between tissues,indicating that the higher the povidone iodine concentration,The greater the stimulus to the organization.Conclusions: 1.Three different concentrations of povidone-iodine(0.5%,0.25%,0.1%)can reduce the wound infection rate of open fractures during debridement.2.Three different concentrations of povidone iodine(0.5%,0.25%,0.1%)can reduce the number of bacteria in the wound after surgery.Among them,povidone-iodine in the high concentration group(0.5%)has the strongest bactericidal ability.3.Povidone-iodine in the high-concentration group(0.5%)stimulated most of the cellular tissue in the wound;the higher the povidone-iodine concentration,the greater the stimulation of the wound tissue.4.Through the comparative analysis of the results of this experiment,the use of low concentration(0.1%)povidone iodine in the open fracture debridement washing soak wound wounds,not only can reduce the postoperative infection rate,but also can reduce its on the wound cell tissue Stimulation. |
PDF Full Text Request