| ObjectiveTo Observe the results of drainage fluid bacterial culture and the variation in blood inflammatory markers at different time points after vacuum sealing drainage (VSD) for lower limb skin defects, to acquire the risk of infection, bacteria and the peak time point of infection after VSD treatment for lower limb skin defects, finding the optimal replacement time of vacuum sealing drainage device.Methods40 patients with trauma or chronic ulcer were enrolled prospectively and self-controlled in Department of Surgery, Foshan Hospital of TCM from 2015.01.01 to 2016.01.31. Wound excretion were cultured before operation, and the makers of blood inflammation were gathered, including White blood cell count (WBC), percentage of neutrophils (NEUT%), serum C-reactive protein (CRP), serum amyloid A (SAA) and procalcitonin (PCT). after the VSD treatment, (negative pressure value-125mmHg),the drainage fluids right after the surgery,3,5,7,9,11 days postoperatively were cultured for bacteria identification, and blood inflammatory markers were detected at the same time point. All cases vaccumed for 11 days, the positive rate of bacteria culture, species composition and changes of blood inflammatory markers were analyzed in different time points. Results1. In this study, all patients completed single target VSD, all patients with lower limb skin defect were healed through the VSD or VSD combined with autologous skin grafting, there were no obvious scars and dysfunction in repair lesions.2. The results of Drainage fluid bacteria culture and drug sensitivity:2.1 Preoperative wound secretion samples of 40 patients,38 cases(95%) of which were positive results,,46 cultured bacteria, gram-negative bacteria 69.6%(32/46), with mainly pseudomonas aeruginosa bacteria, escherichia coli, gram-positive bacteria 28.3%(13/46), staphylococcus aureus, which anaerobes 2.2%(1/46) as clostridium perfringens, fungal not detected.2.2 all culture results of immediate drainage fluid after VSD were negative.2.3 240 samples of drainage fluid were sent for detection after VSD, of which 143 parts culture results were positive, positive rate of 59.6%(143/240), 182 strains bacteria cultivation,78.6% of gram-negative bacteria (143/182), mianly with pseudomonas aeruginosa, enterobacter cloacae, serratiamarcescens,. klebsiella pneumoniae,19.2%(35/182)of gram positive bacteria.mainly with staphylococcus aureus, anaerobic bacteria were 1.6%(3/182) for fragilis, peptostreptococcus anaerobius, fungi were 0.5%(1/182) for filamentous fungi. With the passage of time, gradually multiplied the number and kind of bacteria, the different time nodes in the positive rate of bacteria compared with statistical significance (x2=24.32,P＜0.01), at the 3rd day,5th day,7th day and 9th day bacterial culture positive rate were compared with the preoperative low, compared with a significant difference (P＜0.05); the 9th、11th day bacteria culture positive rate significantly higher than the 3rd day, compared with statistically significant difference (P＜0.05); the 11th day bacteria culture positive rate significantly higher than the 3rd＞5th day, compared with statistically significant difference (P＜0.05).2.4 Before the operation,27 strains of drug-resistant bacteria were detected,50 strains of drug-resistant bacteria were detected after operation, and the rate of bacterial resistance (35%,50/143) compared with preoperative (69.2%,27/39) lower, the difference statistics significance (P＜0.05).3. The results of blood inflammatory markers:3.1 PCT has been maintained in the normal range, no significant change.3.2 Exclusion of surgical trauma factors, the overall trend of postoperative patients tended to decline, but at the 9th day after VSD, WBC, NEUT%, CRP, SAA showed a turning point, showing an upward trend. WBC, NEUT% consistent performance, at the3rd day,5th day,7th day,9th day and the 11th day after VSD compared with preoperative statistically significant difference (P＜0.05); on day 9 showed rising, compared with the 7th day statistically significant difference(P＜0.05); CRP is consistent with the SAA performance, in postoperative 3 days showed a transient increase, and then decreased gradually,7 days to resume to normal levels, the 9th and 11th day showed gradually rising trend, compared with the 7th day statistically significant difference(P＜0.05).Conclusion:1. It’s not enough to clear all bacteria with VSD in 11 days of a single continuous VSD for treatment of lower limb skin defect, along with the advance of time, the bacterial species and number is increasing, overall positive rate of bacteria showed increasing trend, the bacteria mainly are gram negative bacteria, there are anaerobic bacteria and fungal growth in negative pressure environment.2. Surgical trauma can cause transient elevation of CRP and SAA, return to normal value in the 7th days, at the 9th days, with the increase of bacteria, the body presents a mild inflammatory reaction.3. VSD though not completely remove bacteria in 9 days, but can inhibit wound bacteria to avoid the occurrence of severe systemic inflammatory response, thus avoiding the use of antibiotics and reduce body resistance and reduce costs, can effectively promote the growth of granulation tissue, VSD combined with autologous skin graft in the treatment of lower limb with soft-tissue defect is safe and effective, it is recommended the optimal replacement time on the 9th day after operation if the VSD device still under the condition of normal function. |
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