| BackgroundCalcaneal fractures are common in feet fractures, accounting for about 60% of the tarsal bone fractures. Calcaneal fractures are often caused by intense power injury, and the most principal trauma mechanism is falls from heights. Calcaneal fractures are complicated, therapies varied and the most common treatment is surgery. Due to the anatomy complexity of calcaneus and the surrounding tissue, the poor condition of local tissue coverage, the probability of complications after surgery such as incision dehiscence, flap necrosis, infection and traumatic arthritis is high.Vacuum Sealing Drainage (VSD) was discovered in 1992 and has been a standard therapy for complex wound now. VSD can offer efficient and complete drainage under the environment of negative pressure compared with other drainage technology. It can not only drain out blood, exudates and necrotic tissue, but also fill in wound cavity and promote the closure of infected cavity. Currently, VSD has been widely used in complex tissue injury, open fractures, etc, but few researches have been reported in preventing incision complications after surgery.ObjectiveThis study is to explore and evaluate vacuum sealing drainage (VSD) therapeutic effect in preventing incision complications after the surgery of calcaneal fractures.MethodsWe selected 73 cases (81 feet) with adequate medical record from the patients suffered from calcaneal fractures who were treated in the orthopedics department of the second hospital of Shandong University from May,2012 to Dec,2014.These cases are divided into 3 groups:VSD group (11 cases,13 feet), homemade VSD group (27 cases,29 feet) and rubber drainage group (35 cases,39 feet). We compare the incision drainage time, incision healing time and complication probability among the three groups to evaluate the effect of VSD in preventing incision complications after the surgery of calcaneal fractures.ResultsIn terms of incision drainage time, VSD group is 5(4,5) days, homemade VSD group is 5(4,5) days, and rubber drainage group is 2(2,2) days. There is significant difference in incision drainage time among the three groups (H=66.703, p=0.000). There is no significant difference between the VSD group and homemade VSD group (H=2.589,p=1.000) but significant difference between the rubber drainage group and the other two groups (H=42.090, p=0.000; H=39.501, p=0.000). In terms of incision healing time, VSD group is 16(14,16) days, homemade VSD group is 15(15,18) days, and rubber drainage group is 18(15,24) days. There is significant difference in incision healing time among the three groups (H=8.622, p=0.0l3). There is no significant difference between the VSD group and homemade VSD group (H=-4.438, p=1.000), significant difference between the VSD group and rubber drainage group (H=-17.949, p=0.048), and no significant difference between the homemade VSD group and rubber drainage group (H=-13.511, p=0.053). In terms of postoperative complications, VSD group has 1 incision skin necrosis and the complication probability is 7.69%. The homemade VSD group has 2 incision skin necrosis,1 incision dehiscence, and the complication probability is 10.34%. The rubber drainage group has 8 incision skin necrosis and dehiscence and 3 infections, the complication probability is 28.21%. There is significant difference in postoperative complications among the three groups (x 2=6.591,p=0.031).There is no significant difference between the VSD group and homemade VSD group (x 2=0,459,p=1.000) but significant difference between the rubber drainage group and the other two groups (X2=10.686, p=0.013).ConclusionApplication of vacuum sealing drainage after the surgery of calcaneal fractures can prolong the drainage time and reduce incision complications, but needs more researches to prove if it can shorten the incision healing time. The homemade vacuum sealing drainage is a simulation of vacuum sealing drainage and it’s a good choice for the patients with poor economic condition. |
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