| Objective:To investigate the vacuum sealing drainage (VSD) in the management of open pelvic fractures wounds.Methods:This retrospective involved 26 patients of open pelvic fractures treated with vacuum sealing drainage(VSD) admitted to Shandong Provincial Hospital during the period between April 2007 and November 2010, including 21 males and 5 females, who are 37.2 years old on average (range from 16 to 56 years). The causes were followed below:21 were traffic accidents,2 were falling injuries,2 were machinery injuries and 1 was crush injury. The fractures is classified according to Tile classifications:2 were type A,13 were type B and 11 were type C. And according to Gustilo classifications,26 cases of patients included 4 cases of type III A,16 cases of type III B,6 cases of type III C. The locations of soft tissue injuries near the pelvic were as followed:8 cases on perineum region,6 cases on inguinal region,6 cases on gluteal region, and 3 cases with serious avulsion of skin in large area covering perineum region, inguinal region and the proximate of thigh,1 case with amputated injury of hip joint, and 2 cases with widespread contused wound of hemipelvis and homonymy thigh. Cases complicated by injuries in other systems:4 of brain trauma,12 of chest trauma,2 of traumatic diaphragmatic hernia,3 of spleen rupture,13 of retroperitoneal hematoma,2 of jejunum or ileum rupture,7 of injuries in rectum,sigmoid colon and canal,9 of 9 of injuries in the urinary system,6 of injury of sacral plexus, and 3 of vascular injury.11 cases with slight infection and large area of soft tissue loss in which debridement could be performed thoroughly (including 8 cases in which hemodynamics were unstable at first and have good vital sign after 6-8 hours'salvage) were treated with debridement and VSD emergently, and then 0-3 times dressings changing after debridement, leading to a amelioration of the wound surface. Subsequently 4 cases were sutured after decompression,5 cases were performed dermoplasty,2 cases were performed local flaps transplantation; 10 cases with severe injury, large area of soft tissue loss, deep location, and heavy infection in which debridement could not be performed thoroughly and 5 cases in which patients could not bear debridement because of unstable vital sign were treated with open drainage in early stage, hemostasis with packs subsequently, and change of dressing regularly. Secondary debridement were performed when the pathogenetic condition got better with less exudation and clear necrosis line, followed with VSD and 2-5 times dressings changing, in which 2 patients were sutured after decompression,7 patients were performed dermoplasty,6 patients were performed local flaps transplantation. Preoperative bacterial culture were conducted in every stage.Results:25 patients were cured.1 patients with widespread contused wound of hemipelvis and homonymy thigh died from multiple organ failure. Survival patients underwent 2-6 operation (3.6 on average), and the length of stay vary from 36 to 96 days (46.4 days on average).68% of the bacterial cultures were positive before the first surgical debridement and none before the closure surgery. All the 25 cases received satisfactory follow-up, and the length for follow-up ranged from 4 to 24 months with an average length of 2.8 months.17 cases underwent external fixation for pelvic fracture during debridement or salvage, and 10 of them changed into internal fixation.Conclusion:The complex wound surface of open pelvic fractures require the cooperation and coordination of multi-field. VSD can provide satisfactory conditions for secondary healing of complex wound of open pelvic fracture by temporary lutation of wound, successful drainage, inhibition of bacterial and promotion of granulation tissue growth, in which there are serious infection and large area of soft tissue loss. Therefore VSD is very effective for the management of complex wound which can shorten the time of therapy and reduce the infection rate and death rate of open pelvic fractures. |
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