暴露硬件治疗下肢骨科创伤

摘要

手术伤口与矫形硬件很难处理。采用切开复位内固定(ORIF)治疗胫骨骨折术后并发症的发生率可高达16%使用矫形器械最常见的并发症之一是感染，可导致截肢或死亡矫形器械感染的常见治疗包括使用抗生素，清创，在某些情况下移除器械。负压灌注和停留时间创面治疗(NPWTi-d*)提供伤口清洁，以帮助清除碎片、感染性物质和渗出物，已被报道有助于骨科器械感染创面患者的治疗，且无并发症我们介绍了我们的经验，使用NPWTi-d帮助处理两例暴露骨科硬件的下肢非愈合创面。两名女性(69岁和81岁)在ORIF术后4周因骨科伤口未愈合而就诊。患者的合并症包括既往手术、既往骨折、糖尿病、高血压和阿片类药物使用。静脉注射抗生素，然后手术清创非活组织。用NPWTi-d清洗创面。 A hypochlorous topical wound solution was instilled into the wound with a 20-minute dwell time, followed by 2 hours of continuous negative pressure wound therapy at -125 mmHg. Dressings were changed every 3 days. After 3 days of NPWTi-d, patients either underwent surgical closure, or surgical debridement followed by 3 days of negative pressure wound therapy† and surgical closure with split-thickness skin graft placement. Closed incision negative pressure therapy‡ was applied over the closed surgical incisions and left in place for 7 days. The wounds remained closed without complications 2.5 to 4 weeks after surgical closure. In these 2 patients, the use of antibiotics and NPWTi-d successfully prepared the wound for surgical closure.

* V.A.C.VERAFLO™治疗与V.A.C. VERAFLO清洁™敷料或V.A.C. VERAFLO清洁选择™敷料;†V.A.C.®疗法;‡preventa™切口管理系统;KCI现在是德克萨斯州圣安东尼奥3M公司的一部分

参考文献
1.Gaunder CL, Zhao Z, Henderson C, McKinney BR, Stahel PF, Zelle BA。老年人胫骨平台骨折切开复位内固定后的伤口并发症:一项多中心研究。43 Int .。2019;(2):461 - 465。
2.Kaufman MG, Meaike JD, Izaddoost SA。矫形修复体感染:诊断和矫形修复。Semin Plast surgery . 2016;30:66-72。
3.采用负压伤口灌注和停留时间治疗感染骨科植入物:4例病例系列。创伤管理预防。2016;62(9):30-40。