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Objective:To investigate the efficacy of vacuum sealing drainage (VSD) in the treatment of severe maxillofacial and neck space infection.Methods:9 patients (6 males,3 females) with severe maxillofacial and neck space infection were treated with VSD.After incision of abscess,the incision was covered by VSD material and 40-60 KPa continuous negative pressure drainage was given.Results:Swelling and pain of the patients reduced rapidly.The period of VSD treatment was 4 to 10 days (mean 5.8 days).9 patients were all cured without mediastinitis.Conclusion:VSD ehhance the dranage efficiency and prevent infection spreading.
RESUMO
Objective To probe into the application of vacuum sealing drainage (VSD) in flap with slender narrow pedicle and to observe the survival,the shaping of blood vessel,congested edema and the expression of CD34 in the flap,and to analyze the underlying mechanism of VSD on the flap survival.Methods 64 SD rats were randomly divided into 8 groups:4-hour group,8-hour group,1-day group,2-day group,3-day group,4-day group,and 6-day group.A flap was designed and put on either side of a rat's back.The both width and length of the flap were 0.8 cm and the pedicle sized in the diameter of 3.5 cm.Both sides of the flaps on the rats' backs were randomly arranged into control side and experimental side.VSD was fixed sideways to each group after the shaping of flaps.Each of the equipments was dismantled respectively in the corresponding time after the operation.Afterwards the color and swelling degree of the flaps were observed,a sample was cut and the flap survival area was measured altogether on the 7th day.Flap histology and the expression of CD34 were observed mainly through HE dyeing and immunohistochemistry.The statistical data were treated to figure out the flap survival rate and to determine whether statistical differences existed in the microvessel density (MVD).Results As the time of the negative pressure suction went on,the survival area of the experimental side flap was increasing day by day and came to the maximum on the third day (95±4)％,but no statistical difference was discerned between on the third day and on the sixth day (P＞0.05).As the time of the negative pressure suction went on,the MVD in the flap was also increasing.Statistical differences (P＜0.05) existed between the experimental side of the instant group,4-hour group and the 8-hour group and those of 3-day group,4-day group,and 6-day group.Conclusions The application of VSD can advance the survival of the flap,whose survival area can reach its maximum within 3 days under application.Besides,it can promote the increase of MVD in the flap.
RESUMO
Objective To investigate the operative techniques and clinical significance in the treatment of large area soft tissue defect in children limbs by sequential vacuum-assisted closure and free flaps. Methods Twenty-two cases of children patients, with a range between 3 and 10 years, were treated by sequential vacum-assisted closure (VSD) and free flaps. All the patients suffered from large area soft tissue defect after severe trauma of limbs, with bone, tendon and other deep tissues exposed or partial defected. The wound area varied from 12 cm × 8 cm to 34 cm × 25 cm, and among the wound 9 cases were fresh and the other 13 were necrotizing infection. After strictly cleaned, the wound was covered with VSD according to the condition of the soft tissue defect and its underlying tissue damage. For the patients complicated with unsteady fracture, the fracture was fixed with outside-fixed frame or inside-Kirschner nails. The VSD negative pressure membrane was removed after 5 to 9 days, then the wound was repaired by free flaps grafting in 8 cases and by free flap combined with skin grafting in the other 14 cases. The survival and recovery conditions were followed up after the operation. Results After treatment by VSD, no obvious infection was seen in 22 cases of children patient with large area soft tissue defect complicated by underlying tissue exposure, and granulation tissue surrounding tendons and bone exposure area grew well. The survival rate of the free flaps was 100% whithout vascular crisis.The infection was well controlled, and no fistula tract was seen. The patients were followed up for 6-24 months and the flaps had soft texture and good appearance with satisfactory functional recovery of the affected limbs.Conclusion For pediatric patients with large area soft tissue defect complicated by underlying tissue exposure, after strict debridement, the treatment circle will be obviously shortened by the application of sequential vacuan seding dranage and microsurgical technique, and the success rate of the operation is improved. Therefore, function of the affected limbs in children will be recovered as far as possible.