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Objective To examine the effect of ultrasonic debridement combined with continuous skin stretching to repair refractory infective wound bed.Methods From January 2016 to July 2016,we treated 15 cases of chronic,refractory infective wound beds using ultrasonic debridement combined with skin stretching technique.Results All the 15 (100％) cases were cured without necrosis of the stretched skin edges.Conclusions Ultrasonic debridement combined with continuous skin stretching is an appropriate technique for repairing the refractory wound bed in the patients who are older,in poor general condition,or poor condition of local skin and soft tissue,or have poor postoperative effect,or surgical contraindication or at higher risk of surgery.
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Healthy granulation tissue played an important role in the wound healing process. However, some factors which interfered the process would result in unhealthy granulation tissue. Unhealthy granulation tissue may affect wound repairing. This article would focus on the concept, mechanisms, interventions of unhealthy granulation tissue.
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Objective To explore the clinical efficacy of ebridement and suturing combined with double vacuum sealing drainage (VSD) technology for the treatment of pressure ulcer. Methods Totally 32 patients of pressure ulcer (from July 2011 to October 2015) re-ceived debridement and suturing after infection control. Then F14 silicone ventricular drainage tube was placed in the wound for drainage while VSD was placed outside the wound. Both tubes inside and outside wound were connected to the central vacuum (20~40 kPa). Three days after the drainage,F14 silicone ventricular drainage tube was removed,and VSD material outside wound was replaced to continuous vacu-um treatment for another 3 to 4 days. Results All of 32 cases were healed up without hematoma,dead space and flap margin necrosis,inclu-ding 4 cases of poor healing,which were healed after active dressing. Conclusion Small area of the pressure ulcer can be closed up by de-bridement and suturing combined with double VSD technology,which is a simple operation with little injury and high clinical application value.
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The ageing of our population and rise in chronic diseases has resulted in the complex profile of the patients in the community. Complex wounds such as diabetic foot ulcers, infected pressure ulcers and other complications of non-healing wounds are common encounters in the primary health settings. The challenges of these complex wounds lie in its multi-factorial nature of the person, the wound and the environment. This requires a team approach to care within the limited resources boundary. As part of the care continuum, it is essential for primary care physicians to be familiarized with the approach to care of complex wounds and the adjunct therapy. This article seeks to provide a broad framework using the systematic assessment framework via T.I.M.E (Tissue, Inflammation/Infection, Moisture imbalance, Epithelial edge of wound) for wound bed preparation to guide primary care physicians/clinicians in their approach to complex wounds. It also highlighted the complexities of chronic wound management pertaining to the person, the wound and the environment as well as the recent advances adjunct therapy in chronic wound care. In addition, it seeks to enable primary care physician and wound clinicians to translate wound-healing principles into effective management strategies to provide better clinical care to our patients.
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Objective To explore the treatment of chronic infective wounds .Methods A retrospective analysis of clinical data in 225 patients were admitted from 2000 to 2010 .Results (1) They were mainly traumatic ulcers ,pressure ulcers ,postoperative ul-cers ,diabetes ulcers ,vascular ulcers in the group ,accounted for 80 .4% (181/225) .(2) Bacterial culture positive rate was 87 .1%(196/225) ,a total of 46 kinds with 342 pathogens were cultured ,gram-positive bacteria 40 .6% (139/342);gram-negative bacteria 57 .6% (197/342);Fungi 1 .8% (6/342) .The main pathogens were S .aureus(52) ,E .coli(43) ,P .aeruginosa(44) ,Klebsiella .SPP (27) ,which were highly resistant to penicillin ,erythromycin ,ampicillin ,gentamicin ,cotrimoxazole and the multidrug resistance rate was 37 .1% (127/342) .Chronic wounds and multidrug resistant bacteria showed rapidly increasing trend from 2007 .(3) 201 pa-tients with topical antibiotic treatment ,208 patients(49 patiens underwent re-operation)underwent operations to close wounds ;213 patiens were recovery ,12 patiens had to leave hospital because economic burden .Conclusion Chronic infective wounds were affect-ed by many factors .emphasizing on debriding ,reasonablechoice ,circulative ,alternate use of antibiotics and wound bed preparation , appling surgery to close wounds in early stage could effectively control wound infection and promote wound healing .
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Objective To get the experience of surgical treatment for diabetic foot (DF) ulcer.Methods Clinical data of 85 patiems (108 limbs in total) admitted in Department of Bum and Plastic Surgery in The First Affiliated Hospital of Chongqing Medical University from Jan 2010 to Dec 2012 were retrospectively analyzed.Results Wound culture results of the 85 patients were:bacteria in 142 limbs,and fungi in 7 limbs.The main bacteria cultured were staphylococcus aureus,escherichia coli,coagulase negative staphylococcus,enterococcus,pseudomonas aeruginosa,and acinetobacter baumannii.DF healing and Wagner classification was negatively correlated:the higher the class,the less the primary healing rate.The higher amputation rate were found in the higher class patients.The more delayed healing,and the longer the healing time and average hospital stay were also found in the higher class patients.85 patients underwent surgery:skin grafting in 45 cases (52.9％),flap in 8 cases (9.4％),skin repair + flap grafting in 7 cases,toe (limb) amputation in 28 cases,2 cases were sutured after debridement.All cases were cured after one or multiple surgeries.No recurrence was found during the follow-up of 10 days to 2 months.No delayed infection occurred to the repairments.The shape and weight bearing walking function were good.Conclusions The treatment of DF need to follow the principle of multidisciplinary cooperation,professional treatmem,systemic and local treatment.We need to pay attention to the etiology and prevention of the disease,focus on wound bed preparation,choose the best treatment.Early operation can significandy fascilitate wound healing.
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Moist wound healing for wound treatment has been becoming wide-spread for several years. Open wet-dressing therapy (OWT) is one of the useful therapies at a hospital in a mountainous area where many elderly find it difficult to go to hospital frequently the past. At our department of surgery we also heal pressure ulcers, so we regard Wound bed preparation as important, too. Choice of appropriate types of dressing materials based on concept of Wound bed preparation and Moist wound healing, OWT and information of them enable us to decrease the frequency of hospital visits by the elderly in the mountainous area. It is important for the community in the mountainous area to inform Wound bed preparation, Moist wound healing and OWT for the purpose of safety management of OWT.
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Objective To study the clinical efficacy of recombinant human epidermal growth factor (rhEGF) in the treatment of sacrococcygeal decubitus ulcers grade Ⅲ with direct polymerizing suture after appling rhEGF to reinforce wound bed preparation (WBP). Methods From January 2007 to October 2009, 60 patients with sacrococcygeal decubitus ulcers Grade Ⅲ, were divided into control group and treatment group. The ulcer size was 3 cm × 4 cm to 10 cm × 12 cm and all ulcers were infected for 15-70 d. Treatment group received traditional dressing change and appling rhEGF to reinforce wound bed preparation. Control group received traditional dressing change only. The operative technique that we used in two groups was direct polymerizing suture. Cure rate of stage Ⅰ and complication morbidities were analyzed. Results Cure rate of stage Ⅰ was 87% in treatment group and 70% in control group. Complication morbidities were 13% in treatment group and 30% in control group. The difference between these two groups was statistically significant (P ＜ 0.05). Conclusion Appling rhEGF to reinforce wound bed preparation before operation could make subsequent treatment more effective and improve the cure ratio of operation with decreasing complications and morbidities. And more, dissecting under fascia possesses the advantages of easiness to perform and rich blood supply.The method of appling rhEGF with direct polymerizing suture is a simple, high efficient approach for the first repairment of sacrococcygeal decubitus ulcers grade Ⅲ, especially desirable for the elderly.
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We employed vacuum-assisted closure (VAC) as a treatment modality for wound complications after cardiovasular surgery. Between March and December 2004, 9 patients were treated with VAC, 8 of whom were men, and the mean age was 69.6 years old. Seven patients underwent off-pump coronary artery bypass, and 2 underwent a valve replacement. Six of them had diabetes, 5 had renal dysfunction (4 were dialysis patients), and 2 had chronic obstructive lung disease. Six cases were classified as superficial sternal infection (Superficial) and 3 as a deep sternal infection (Deep). Superficial cases were healed with wound closure after a short period of VAC treatment. However, Deep cases required long duration of VAC treatment and wound closure with a myocutaneous flap in 2 cases, although all of them did not develop mediastinitis requiring closed irrigation and drainage. In 9 cases, with numerous risk factors for poor healing, we found that VAC treatment facilitated wound healing and reduced frequent painful wound care.