Comparison of vacuum sealing drainage and shoelace technique for leg fasciotomy wounds

doi:10.3969/j.issn.2095-4344.2014.39.028

Abstract

Abstract:

BACKGROUND: Vacuum sealing drainage is currently considered as a safe and effective for fasciotomy wounds in the treatment of compartment syndrome. But the wounds after treatment are often not self-closed, which needs skin grafts that can cause secondary injury. Studies have shown that shoelaces technology is useful for leg fasciotomy wounds in the surgical treatment of lower leg compartment syndrome, but so far there are few domestic reports.

OBJECTIVE: To compare the vacuum sealing drainage and shoelace technique for treatment of leg fasciotomy wounds.

METHODS: A total of 36 patients, with 46 leg fasciotomy wounds, were randomized into vacuum sealing drainage and shoelace technique groups, 23 wounds in each group. In the vacuum sealing drainage group, patients were subjected to vacuum sealing drainage after fasciotomy based on fracture reduction and external fixation; in the shoelace technique group, the fasciotomy wounds were covered with polyethylene/ethanol hydrated seaweed salt foam followed by shoelace technique. After 1 month, wound size, wound closure time, infection, further intervention and daily treatment cost were compared between the two groups.

RESULTS AND CONCLUSION: Wound closure time was significantly higher in the vacuum sealing drainage group compared to the shoelace technique group (P < 0.05). Eight wounds in the vacuum sealing drainage group required skin grafts; while, no skin graft was necessary in the shoelace technique group. In the shoelace technique group, the vessel loops had to be replaced in five wounds. There was no wound infection, increased compartment pressure and skin flap necrosis postoperatively in both two groups. Both vacuum sealing drainage and the shoelace technique are safe, reliable and effective methods for closure of leg fasciotomy wounds. Vacuum sealing drainage requires longer time to definite wound closure and is far more expensive than the shoelace technique, especially when additional skin grafting is required.

中国组织工程研究杂志出版内容重点：生物材料；骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性；组织工程

全文链接：

Key words: drainage, leg bones, decompression, fascia

CLC Number:

R318

Mahmud Yakufu, Alimujiang Abulaiti, Ahmatjiang Yusufu,Yang Guang-zhong, Xu Zheng-Li, Li Ping. Comparison of vacuum sealing drainage and shoelace technique for leg fasciotomy wounds[J]. Chinese Journal of Tissue Engineering Research, 2014, 18(39): 6392-6396.

Figures/Tables 1

2.1 参与者数量分析按意向性分析，纳入36例患者(46个减张切口)，根据治疗方案分为2组，负压吸引组及绑鞋带组各23个减张切口，全部进入结果分析，无脱落。 2.2 患者基线资料对比两组患者在性别、年龄和并发症等方面基本一致，差异均无显著性意义(P > 0.05，表1)。 2.3 真空负压吸引技术与绑鞋带技术治疗小腿骨筋膜间室综合征切开减张切口的住院时间、感染情况、创面愈合情况比较(表1) 负压吸引组伤口长度(20.6±2.1) cm，绑鞋带组伤口长度(20.4±2.3) cm。两组患者之间切口长度差异无显著性意义(P=0.617)。负压吸引组伤口闭合时间(19.3± 6.2) d，绑鞋带组伤口闭合时间(15.5±3.7) d，负压吸引组伤口闭合时间比绑鞋带组伤口闭合时间明显长，差异有显著性意义(P=0.01)。负压吸引组8个减张切口(34.8%)需进一步行植皮，住院时间明显延长，所有绑鞋带组伤口边缘逐渐靠近，无需进一步行植皮，最后局麻下完全闭合伤口。绑鞋带组中5个减张切口(21.7%)需要更换硅橡胶袢。两组中创面感染率差异无显著性意义(P=0.743)，分别为负压吸引组7个减张切口，绑鞋带组6个减张切口，均未出现治疗后筋膜间室压力增高及皮缘坏死。两组患者第1，2次更换负压封闭吸引敷料所需费用基本相同，之后因为绑鞋带组无需使用负压封闭吸引敷料，仅单纯使用硅橡胶袢，手术费用明显减少。此外负压吸引组病程较长(P < 0.05)，如需进一步行植皮术闭合伤口则费用增加(P=0.002)，平均治疗费用较绑鞋带组高。随访过程中两组患者均未出现过度增生瘢痕形成，骨髓炎等并发症。 2.4 典型病例(图2) 男，51岁，车祸外伤后右小腿疼痛、出血、活动受限。入院后急诊行清创、骨折复位外固定、筋膜间室切开减张，创面敷贴负压封闭吸引材料，皮缘用皮肤吻合器作扣环采用硅橡胶袢充当缚带采用切口绑鞋带治疗技术。 2.5 不良反应分析负压吸引组4个减张切口和绑鞋带组3个减张切口因引流管堵塞而导致伤肢肿胀，疼痛，经及时发现并采用50 mL注射器吸取生理盐水反复冲洗、抽吸直至通畅，症状消失。 2.6 聚乙烯乙醇水化海藻盐泡沫覆盖负压封闭引流材料宿主反应两组患者未发生刺激、过敏、免疫等局部及全身反应。"

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