Treatment of traumatically cutaneous necrosis of buttocks using vacuum sealing drainage combined with ileostomy

Application and effect evaluation of nursing quality target management in free flap transplantation for hand injury

To explore application and effect of nursing quality target management in free flap transplantation for hand injury. 140 patients with free skin flap transplantation for hand injury admitted to the hand and foot surgery ward of the hospital from January 2017 to December 2019 were selected as the research objects. They were randomly divided into observation group and control group. There were 70 patients in each group, and both groups of patients received microscopic free flap transplantation. The observation group adopted traditional nursing mode and nursing quality target management mode to carry out nursing, while the control group adopted traditional nursing mode to carry out nursing. The treatment compliance, skin flap survival, occurrence of vascular crisis, occurrence of complications, VAS and Barthel comparison score of the two groups were compared. The treatment compliance of patients in the observation group was significantly higher than that in the control group (P < 0.05). The survival rate of skin flap in the observation group was higher than that in the control group (P < 0.05). The incidence of vascular crisis in the observation group was lower than that in the control group (P < 0.05). The postoperative pain in the observation group was better than that in the control group (P < 0.05). There was no significant difference in Barthel score between the observation group and the control group at admission (P > 0.05), but the improvement range of Barthel score in the observation group was higher than that in the control group at discharge (P < 0.05), The satisfaction of patients in the observation group to nurses was higher than that in the control group (p < 0.05). The application of nursing quality target management can improve the treatment compliance of patients, improve the survival rate of free skin flap transplantation for hand injury, reduce the incidence of vascular crisis within 48 hours after operation, reduce the occurrence of postoperative complications, relieve the pain of patients, improve self-care ability and ensure the quality of life.

Cefazolin sodium pentahydrate combined with vacuum sealing drainage in the treatment of open fracture complicated with soft tissue injury

OBJECTIVE

To investigate the clinical efficacy of cefazolin sodium pentahydrate combined with vacuum sealing drainage (VSD) in the treatment of open fracture complicated with soft tissue injury.

METHODS

Sixty-three patients with open fracture complicated with soft tissue injury were divided into observation (n = 33) and control (n = 30) groups. After surgical reduction, fixation, and repair of the fractures, the control group was treated with VSD for 10 days, and the observation group was treated with cefazolin sodium pentahydrate based on VSD for 10 days. The infection control time was recorded. After treatment, the pain of patients was evaluated. Before and after treatment, the serum levels of C-reactive protein (CRP), interleukin (IL)-6, IL-8, tumor necrosis factor α (TNF-α), cortisol, epinephrine, norepinephrine, and glucose were detected. After 6 months of treatment, the total effective rate of the treatment was evaluated.

RESULTS

The infection control time and Visual Analogue Scale score after treatment in the observation group were significantly lower than in the control group, respectively (P < 0.05). After the treatment, the serum levels of CRP, IL-6, IL-8, TNF-α, cortisol, epinephrine, norepinephrine, and glucose in each group were significantly lower than before the treatment (P < 0.05), and each index in observation was significantly lower than in the control group (P < 0.05).

CONCLUSIONS

In the treatment of open fractures complicated with soft tissue injury, cefazolin sodium pentahydrate combined with VSD can effectively reduce inflammation and stress, thus improving the treatment efficacy.

Treatment of large avulsion injury in perianal, sacral, and perineal regions by island flaps or skin graft combined with vacuum assisted closure

BACKGROUND

Traumatic avulsion injuries to the anus, although uncommon, can result in serious complications and even death. Management of anal avulsion injuries remains controversial and challenging. This study aimed to investigate the clinical effects of treating large skin and subcutaneous tissue avulsion injuries in the perianal, sacral, and perineal regions with island flaps or skin graft combined with vacuum assisted closure.

METHODS

Island flaps or skin graft combined with vacuum assisted closure, diverting ileostomy, the rectum packed with double-lumen tubes around Vaseline gauze, negative pressure drainage with continuous distal washing, wounds with skin grafting as well as specialized treatment were performed.

RESULTS

The injuries healed in all patients. Six cases had incomplete perianal avulsion without wound infection. Wound infection was seen in four cases with annular perianal avulsion and was controlled, and the separated prowl lacuna was closed. The survival rate in 10 patients who underwent skin grafting was higher than 90%. No anal stenosis was observed after surgery, and ileostomy closure was performed at 3 months (six cases) and 6 months (four cases) after surgery, respectively.

CONCLUSIONS

Covering a wound with an island flap or skin graft combined with vacuum assisted closure is successful in solving technical problems, protects the function of the anus and rapidly seals the wound at the same time.

Combined treatment with vacuum sealing drainage, TopClosure device, and Ilizarov technique for traumatic hemipelvectomy: A rare case report of successful repairing of large-size soft tissue defects

RATIONALE

Traumatic hemipelvectomy is a rare but lethal catastrophic injury.

PATIENT CONCERNS

A case of a very young child with open fracture of left sacroiliac joint dislocation and pubic symphysis diastasis, suffered from a severe large-size soft tissue defects.

DIAGNOSIS

Traumatic hemipelvectomy.

INTERVENTIONS

Complete amputation was performed and three kinds of surgical techniques including regulated negative pressure-assisted wound therapy (RNPT), TopClosure device, and Ilizarov technique were jointly utilized to secure closure in the further revisions of the soft tissue injury and reconstruct reconstructive surgery.

OUTCOMES

Six months after hospital discharge, the patient was able to ambulate with a single limb and a prosthesis and she is independent in many activities of daily living currently.

LESSONS

We report this case to share experience with other clinicians in the management of this deadly extensive defects after traumatic hemipelvectomy in patients.