Objective To investigate the changes of transforming growth factor β1 (TGF- β1) and type Ⅱ of TGF-β-receptor (TβRⅡ) expressions in wound tissue after the treatment of diabetic foot with vaccum sealing drainage (VSD), and to analyze the mechanism of accelerating wound healing. Methods Between May 2012 and May 2016, 80 patients with diabetic foot were randomly divided into 2 groups, 40 cases in each group. After the same basic treatment, the wounds of VSD group and control group were treated with VSD and external dressing, respectively. There was no significant difference in gender, age, disease duration, body mass, foot ulcer area, and Wagner grade between 2 groups (P>0.05). The time of foundation preparation and hospitalization stay of 2 groups were recorded. The wound tissue was collected before treatment and at 7 days after treatment, and the positive indexes of TGF-β1 and TβRⅡexpressions were measured by immunohistochemical staining. Results Before skin grafting, the patients in VSD group were treated with VSD for 1 to 3 times (mean, 2 times), and the patients in control group were treated with dressing change for 1 to 6 times (mean, 4 times). The time of foundation preparation and hospitalization stay in VSD group were significantly shorter than those in control group (t=–13.546, P=0.036; t=–12.831, P=0.041). The skin grafts of both groups survived smoothly and the wound healed well. Before treatment, immunohistochemical staining results showed that the positive indexes of TGF-β1 and TβRⅡ expressions in VSD group were 5.3±2.4 and 14.0±2.6, while those in control group were 4.4±2.3 and 14.7±3.1, respectively. There was no significant difference between 2 groups (t=1.137, P=0.263; t=1.231, P=0.409). At 7 days after treatment, the positive indexes of TGF-β1 and TβRⅡ expressions in VSD group were 34.3±2.9 and 41.7±3.7, respectively, and those in control group were 5.8±2.0 and 18.1±2.5. There were significant differences between 2 groups (t=–35.615, P=0.003; t=23.725, P=0.002). Conclusion VSD can increase the expressions of TGF-β1 and TβRⅡ in diabetic ulcer tissue, promote granulation tissue growth, and accelerate wound healing.
ObjectiveTo investigate the methods and effectiveness of one-stage operation for pelvis and acetabular fractures combined with Morel-Lavallée injury by internal fixation associated with vacuum sealing drainage (VSD). MethodsBetween June 2008 and October 2012, 15 cases of pelvis and acetabular fractures combined with Morel-Lavallée injury were treated. There were 5 males and 10 females, aged from 18 to 67 years (mean, 36.8 years). Fractures were caused by traffic accident in 11 cases and crashing injury of heavy object in 4 cases. The time from injury to hospitalization was 3 hours to 9 days (mean, 5.4 days). Morel-Lavallée injury located in the above posterior superior iliac spine in 4 cases, greater trochanter in 7 cases, and anterior proximal thigh in 4 cases. In 10 cases complicated by pelvic fracture, there were 1 case of anteroposterior compression type, 3 cases of lateral compression type, 5 cases of vertical shear type, and 1 case of compound injury type; in 5 cases complicated by acetabular fracture, there were 1 case of transverse fracture, 1 case of posterior wall and posterior column fracture, 1 case of transverse acetabulum plus posterior wall fracture, and 2 cases of both columns fracture. Open reduction and internal fixation were used to treat pelvic and acetabular fractures, and VSD to treat Morel-Lavallée injury. When the drainage volume was less than 20 mL/d, interrupted wound suture or free skin grafting was performed. ResultsThe hospitalization time was 16-31 days (mean, 20.8 days). Thirteen cases were followed up 4-16 months (mean, 7.8 months). The healing time of Morel-Lavallée injury was 16-36 days after operation (mean, 21.3 days). All the wounds had primary healing, and no infection occurred. The X-ray films showed that all fractures healed, with a mean healing time of 13.6 weeks (range, 11-18 weeks). At 6.5 months after operation, according to Majeed function scoring system in 8 cases of pelvic fracture, the results were excellent in 5 cases, good in 2 cases, and fair in 1 case; according to Harris hip scoring in 4 cases of acetabular fracture, the results were excellent in 2 cases, good in 1 case, and fair in 1 case. ConclusionTo pelvis-acetabular fractures combined with Morel-Lavallée injury, internal fixation treatment for fracture and VSD for Morel-Lavallée injury not only can cure merge Morel-Lavallée injury effectively, but also can guarantee the operation timing and incision safty of the pelvis-acetabular fractures.
ObjectiveTo summarize the effectiveness and experience of Wanger grade 3-5 diabetic foot treated with vacuum sealing drainage (VSD) combined with transverse tibial bone transport.MethodsBetween March 2015 and January 2018, 21 patients with refractory diabetic foot who failed conservative treatment were treated with VSD combined with transverse tibial bone transport. There were 15 males and 6 females, aged 55-88 years (mean, 65 years). The diabetes history was 8-15 years (mean, 12.2 years). The duration of diabetic foot ranged from 7 to 84 days (mean, 35.3 days). The size of diabetic foot ulcer before operation ranged from 2 cm×2 cm to 8 cm×5 cm. According to Wanger classification, 8 cases were rated as grade 3, 11 cases as grade 4, and 2 cases as grade 5. Among the 21 cases, angiography of lower extremity before operation was performed in 5 cases, CT angiography of lower extremity in 16 cases, all of which indicated that the arteries below the knee were narrowed to varying degrees and not completely blocked. Preoperative foot skin temperature was (29.28±0.77)℃, C-reactive protein was (38.03±31.23) mg/L, leukocyte count was (9.44±2.21)×109/L, and the visual analogue scale (VAS) score was 6.8±1.5, and ability of daily living (Barthel index) was 54.3±10.3.ResultsAfter operation, 2 patients with Wanger grade 4 and smoking history failed treatment and had an major amputation (amputation above ankle joint) at 30 days and 45 days after operation, respectively. One patient with Wanger grade 5 and chronic heart failure died of cardiac arrest at 60 days after operation. The remaining 18 patients were followed up 6-24 months (mean, 9.2 months). The external fixator was removed at 40-62 days after operation, with an average of 46 days. All the wounds healed, with a healing time of 50-120 days (mean, 62.5 days). The pain of 18 patients’ feet was relieved obviously, and there was no recurrence of ulcer in situ or other parts. There was no complication such as tibial fracture and ischemic necrosis of lower leg skin after operation. After ulcer healing, the foot skin temperature was (30.86±0.80)℃, C-reactive protein was (22.90±18.42) mg/L, VAS score was 2.4±1.2, and Barthel index was 77.3±4.6, all showing significant differences when compared with preoperative ones (P<0.05); the leukocyte count was (8.91±1.72)×109/L, showing no significant difference (t=1.090, P=0.291).ConclusionVSD combined with transverse tibial bone transport can effectively promote the healing of Wanger grade 3-5 diabetic foot wounds, but smokers, unstable blood glucose control, and chronic heart failure patients have the risk of failure.
Objective To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of mesh infection following inguinal hernia repair. Methods A total of 24 patients who suffered form mesh infection following inguinal hernia repair and got treatment in our hospital from February 2012 to December 2015 were collected and divided into 2 groups according to the type of treatment, 12 patients (13 sides) of VSD group received treatment of VSD, and 12 patients (13 sides) of conventional group received conventional treatment. Comparison between the 2 groups in mesh retention rate, the wound healing time, hospitalization cost, and hospital stay was performed. Results There was significant difference in mesh retention rate〔76.9% (10/13)vs. 30.8% (4/13)〕, the wound healing time〔(20.5±4.4) dvs. (29.7± 6.7) d〕, hospitalization cost〔(18 430.1±7 180.2) RMBvs. (12 201.1±6 453.2) RMB〕, and hospital stay〔(23.5±4.1) dvs. (30.7±6.5) d〕between the VSD group and conventional group (P<0.050). Compared with conventional group, the mesh retention rate and hospitalization cost were higher, the wound healing time and hospital stay were shorter in VSD group. Conclusions VSD can effectively control the mesh infection following hernia repair, improve the mesh retention rate. The VSD can also promote growth of granulation tissue in cavity, shorten the wound healing time and hospital stay, but has a high hospitalization cost than conventional treatment.
ObjectiveTo explore the effectiveness of open reduction and internal fixation through anterior and posterior approaches in treatment of open Tile type C pelvic fractures at early stage. MethodsBetween January 2009 and April 2012, 12 patients with open Tile C pelvic fractures were treated. There were 7 males and 5 females, aged 6-53 years (median, 31 years). Of 12 cases, 4 were classified as Tile type C1, 6 as Tile type C2, and 2 as Tile type C3; 5 were rated as Gustilo type Ⅱ and 7 as Gustilo type Ⅲ. The injury severity score was 18-57 (mean, 37.2). The interval of injury and admission ranged from 15 minutes to 3 days (median, 50 minutes). The debridement and external fixation were performed at first stage; then open reduction and internal fixation were used through anterior approach (reconstruction plate) and posterior approach (cannulated lag screws). The vacuum sealing drainage was performed during treatment until the wounds healed. ResultsDelayed healing of incison was obtained in 12 cases because of wound infection. Anatomical reduction or approximate anatomical reduction was achieved in all 12 cases. The patients were followed up 3-39 months (median, 18 months). No loosening of internal fixation or fracture displacement was observed during follow-up. The fracture healing time was 7-13 weeks (mean, 9.7 weeks). At last follow-up, according to the Matta standard, the outcome was excellent in 10 cases and good in 2 cases; according to Majeed score, the results were excellent in 9 cases, good in 1, and poor in 2. ConclusionEarly internal fixation operation of open Tile type C pelvic fractures can effectively restore the pelvic anatomical structure and stability, reduce the complication, and achieve satisfactory effectiveness.
ObjectiveTo explore the leakage management and skin care by improved homemade portable vacuum sealing drainage device used for enterocutaneous fistula, in order to solve such confusing problems as leakage collection and nursing for patients with inconvenient activity. MethodsThe homemade portable vacuum sealing drainage device was made by using hydrophilic fiber of silver ion antimicrobial dressings, leak-proof strings, skin protective film, transparent patches, sputum suction tube, bottle of portable infusion, and negative pressure drainage bottle. Between January 2011 and September 2013, patients with enterocutaneous fistula admitted into our hospital were divided into traditional treatment group and portable vacuum sealing treatment group according to the admission time, and traditional center negative pressure suction treatment and portable negative pressure drainage method were used respectively for the two groups of patients. We verified the effect of the mobile vacuum sealing drainage device through comparing these two groups in terms of wound healing time, redness, burst and impregnation of the skin. ResultsThe wound healing time was significantly shorter for patients in the portable vacuum sealing drainage treatment group (P<0.05), and patients in this group also had a lower occurrence of skin redness, impregnation and burst. ConclusionHomemade portable negative pressure drainage device for enterocutaneous fistula patients can reduce the incidence of skin complications such as redness, impregnation and burst, promote patients' activity, and reduce the patients' pain.
ObjectiveTo investigate the effectiveness of debridement-vacuum sealing drainage (VSD)-modified external fixation antibiotic-impregnated cement semi-open technique in treatment of chronic ulcer wounds. MethodsClinical data of 43 patients with chronic ulcer wounds who met the selection criteria and admitted between January 2019 and June 2023 were retrospectively analyzed. Among them, 23 cases were treated with debridement-VSD-modified external fixation antibiotic-impregnated cement semi-open technique (improved group), and 20 cases were treated with debridement-VSD-traditional antibiotic-impregnated cement technique (control group). There was no significant difference in gender, age, constituent ratio of patients with type 2 diabetes mellitus, constituent ratio of patients with smoking history, body mass index, wound site, and other baseline data between the two groups (P>0.05). The healing quality and healing time, the positive rate of bacterial culture after bone cement coating, the loosening rate of bone cement, the number of operations, the number of hospitalizations, the length of hospitalization, and the cost of hospitalization were recorded and compared between the two groups. Results Compared with the control group, the positive rate of bacterial culture after bone cement coating and the loosening rate of bone cement in the improved group was significantly lower, as well as the number of operations, the number of hospitalizations, the length of hospitalization, and hospitalization cost significantly reduced (P<0.05). Wound repair was completed in both groups without amputation. The wound healing quality of the improved group was better than that of the control group and the wound healing time was shorter, the differences were significant (P<0.05). All patients were followed up 1-5 years (mean 3.4 years), and no ulcers recurred during follow-up. ConclusionDebridement-VSD-modified external fixation antibiotic-impregnated cement semi-open technique in the treatment of chronic ulcer wounds can effectively reduce the loosening rate of bone cement, facilitate the induced membrane formation and wound healing, and significantly reduce the number of operations and shorten the length of hospital stay.
ObjectiveTo investigate the clinical characteristics of motorcycle spoke heel injury and the effectiveness of sequential therapy of vacuum sealing drainage (VSD) and pedicled flap transplantation for treating motorcycle spoke heel injury in children. MethodsBetween January 2010 and January 2014, 15 children (aged from 3 to 8 years, 5.7 years on average) with motorcycle spoke heel injury received sequential therapy of VSD and pedicled flap transplantation. The interval from injury to admission was 3-7 days, with an average of 4.9 days. The locations were the heel in 8 cases, the heel and lateral malleolus in 2 cases, and the medial malleolus and medial heel in 4 cases, and the medial and lateral malleolus and heel in 1 case. The patients had different degrees of defects of the skin, tendon, and bone. The skin defect size ranged from 3 cm×3 cm to 13 cm×6 cm. VSD was applied for twice in 13 cases and three times in 2 cases. Reversed flow sural flap was applied in 8 cases, lateral supramalleolar flap in 2 cases, medial supramalleolar perforator-based flaps in 4 cases, and posterior tibial artery flap in 1 case. Eight pedicled flaps with neuroanastomosis were selected according to the wound characteristics. The flap size ranged from 4 cm×4 cm to 14 cm×7 cm. ResultsOf 15 cases, 13 flaps survived well except that two had partial skin necrosis at the distal site. Primary healing was obtained, and skin graft at donor site survived. The patients were followed up 9-21 months (mean, 13 months). Mild and moderate bulky flaps were observed in 9 cases and 6 cases respectively. Of 15 cases, 13 could walk with weight loading, and 2 had slight limping. Superficial sensation recovered to S3 in 8 patients undergoing neuroanastomosis, and recovered to S2 in 7 patients not undergoing neuroanastomosis at 6 months after operation. According to AOFAS evaluation system for Ankle-Hindfoot, the results were excellent in 13 cases and good in 2 cases, with an excellent and good rate of 100% at 8 months after operation. ConclusionThe main characteristic of motorcycle spoke heel injury lies in a combination of high energy damage and thermal damage. Sequential therapy of VSD and pedicled flap transplantation can be regarded as a reliable option to obtain good outcome of wound healing and satisfactory functional recovery for the management of motorcycle spoke heel injury.
ObjectiveTo discuss nursing measures and experiences for children with extensive skin avulsion injury of lower limbs treated by vacuum sealing drainage (VSD). MethodsWe reviewed the perioperative nursing data of 48 child patients with extensive skin avulsion injury in lower limbs who underwent VSD treatment between December 2010 to October 2012. And the data were compared with those for 56 children with the same disease and treatment between January 2007 and November 2010. ResultsIn these 48 children, 19 received once, 23 received twice, and 6 received 3 times of vacuum sealing drainage. During the treatment, 5 drainage tubes were blocked and were solved with normal saline, and 3 drainage tubes had leakage and two of them were reconnected and the other one became normal after changing the dressing. For VSD, the time between being wounded and skin-grafting was 13.6 days, and the average hospitalization time was 24.3 days. Compared with the traditional method group, children in the VSD group had fewer drug changes during hospitalization, lower infection rate, and shorter hospitalization stay, and the differences were significant (P<0.05). ConclusionKeeping drainage tube airtight, normal and effective is as important as nutrition and mental nursing in the treatment of children's extensive skin avulsion injury in lower limbs, which can decrease infection rate, reduce average hospitalization time, and increase operative efficacy.
ObjectiveTo preliminary explore the effect of decellularized adipose tissue (DAT) combined with vacuum sealing drainage (VSD) on wound inflammation in pigs.MethodsThe DAT was prepared through the process of freeze-thaw, enzymatic digestion, organic solvent extraction, and vacuum freeze-drying. The appearance of DAT was observed before and after freeze-drying. HE staining was used to observe its structure and acellular effect. Eighteen male Bama minipigs were recruited, and four dorsal skin soft tissue wounds in diameter of 4 cm were made on each pig and randomly divided into 4 groups for different treatments. The wounds were treated with DAT combined with VSD in DAT/VSD group, DAT in DAT group, VSD in VSD group, and sterile gauze dressing in control group. HE staining was performed at 3, 7, 10, and 14 days after treatment. Moreover, the expressions of inflammatory factors [interleukin 1β (IL-1β), IL-6, and tumor necrosis factor α (TNF-α)], as well as the phenotypes of M1 and M2 macrophage phenotypic markers [inducible nitric oxide synthase (iNOS) and arginase 1 (ARG-1)] were detected by real-time fluorescence quantitative PCR (qRT-PCR). ELISA was used to determine the content of iNOS and ARG-1.ResultsGeneral observation and HE staining showed that DAT obtained in this study had a loose porous structure without cells. The neutrophils of wounds were significantly less in DAT/VSD group than in control group and DAT group (P<0.05) at 3 days after treatment, and the difference was not significant (P>0.05) between DAT/VSD group and VSD group. And the neutrophils were significantly less in DAT/VSD group than in other three groups (P<0.05) at 7, 10, and 14 days. The mRNA expressions of IL-1β, IL-6, TNF-α, and iNOS were significantly lower in DAT/VSD group than in other three groups at 3, 7, 10, and 14 days (P<0.05), while the mRNA expression of ARG-1 was significantly higher in DAT/VSD group than in other three groups (P<0.05). ELISA showed that the content of iNOS was significantly lower in DAT/VSD group than in other three groups at 3, 7, 10, and 14 days (P<0.05), while the content of ARG-1 was significantly higher in DAT/VSD group than in other three groups (P<0.05).ConclusionDAT combined with VSD can significantly reduce inflammatory cell infiltration during wound healing, regulate the expressions of inflammatory factors and macrophage phenotype, and the effect is better than single use of each and conventional dressing change.