| Background and ObjectiveWith the arrival of aging in our country, the population of coronary heart disease and other heart disease were increasing significantly, the number of cardiac surgery are also increasing year by year in the major hospitals nationwide. In the operation of valve replacement and bypass surgery, the traditional surgical approach was median sternotomy incision.Consequently,operative incision totally or partially disunion and incision infection, ulceration and rupturing were common complications [1]. If it was treated improperly or not treated for a long time, it was very easy to cause infection, and osteomyelitis of sternum. What's worse, it might cause retrosternal abscess, mediastinal abscess and septicemia, which would seriously affect the life quality of patients and even threaten patients 'life. The number of patients with incision infection after thoracotomy was rising in recent years, it was reported that its incidence rate was 0.5%-3.6%[2-4], and if the patient concurred with sternum osteomyelitis, the mortality rate was as high as 15% ~ 40% [3,4]. Because of the relatively low incidence of complications above, Clinicians has not yet formed a unified treatment specification, and various treatment methods have different curative effect[5,6].The common methods applied in the treatment of sternal incision non-healing were conventional dressing change, vacuum sealing drainage after debridement and transfer of skin flap. If it was combined with sternal infection, the most commonly method was to transfer of skin flap after surgical debridement. The commonly used operation methods included locally advanced flap, pectoralis major myocutaneous flap, rectus muscle flap, transplantation of greater omentum, combined muscle flap and so on. However, there are some defects in the transfer of the muscle flap, such as the large areas and wide separation range of the free flap, which made damage to the patients. In some patients, incision non-healing might be caused by suture rejection. However, the transfer of skin flap was still need to be stitched again, and even if the line is absorbable, there was also a possibility of reemergence of the suture rejection, which would lead to the failure of surgical repair. Vacuum sealing drainage technology was initiated by Fieischmann in trauma surgery hospital of ULM University of Germany[7].In recent years, it was widely used in burn and plastic surgery, orthopaedic and so on, it not only can remove the necrotic tissue, promote the blood circulation, relieve edema, and inhibit bacteria reproduction, but also can produce mechanical traction on the wound and reduce immune suppression after trauma [8].Rich platelet gel was a gelatinous substance, which was made from the mixture of concentrated platelet solution and activator according to a certain proportion. Since rich platelet gel was applied for oral and maxillofacial surgery by Whiteman for the first time in 1997, the field of wound repair had already begun to carry out a wide range of basic and clinical research on platelet rich gel. Rich platelet gel contained multiple growth factors which were released by platelets activated by calcium/thrombin.This topic is aimed at exploring the clinical application value of autologous rich platelet gel combined with vacuum sealing drainage technique in the treatment of incision non-healing after thoracotomy and striving to find a more comprehensive treatment program, which was to provide a scientific basis for the treatment of non-healing of incision after thoracotomy.methods1 clinical dataDuring the period from January 2015 to august 2016, 40 patients with incision non-healing after thoracotomy were collected from wound repair center of the first affiliated hospital of PLA general hospital, in which 34 male and 6 female were included and age ranging was from 50 to 78 years. According to the random number table method, the patients were divided into two groups and each group included 20 cases. one group were treated with the platelet rich gel combined with vacuum sealing drainage, and the other group were only treated with vacuum sealing drainage. The clinical data of patients in two groups were not statistically significant(P > 0.05).2 methodsPatients were randomly divided into PRP combined with vacuum sealing drainage treatment group(Group A) and simple vacuum sealing drainage treatment group(Group B). Two groups of patients underwent routine preoperative preparation. In group A, after debridement platelet gel was used to filling chest sinus and lacuna, wound was covered by silver dressing and then was closed by vacuum sealing drainage. According to the wounds exudation condition, negative pressure closed drainage device was replaced every 6 days, and the platelet rich gel was once again filled in the gap at the same time. In group B, after surgical debridement wound was covered directly with the silver dressing and was closed by vacuum sealing drainage. According to the wounds exudation condition, negative pressure closed drainage device was replaced every 6 days.3 outcome measureOutcome measures included bone exposure time, wound healing time, possibility of reoperation, duration of hospitalization, recurrence condition in 1 months after wound healing.4 statistical methodAll data was analyzed with SPSS 22.0 statistical software. Measurement data and count data were represented with numerical value and number of cases respectively.Measurement data were subjected to Fisher's exact test and enumeration data to t test, with P<0.05 as statistically significant difference.ResultsIn the combined treatment group(group A), patients' bone exposure time, wound healing time and duration of hospitalization were significantly shorter than the simple vacuum sealing drainage treatment group(group B)(P < 0.01); In the combined treatment group(group A), the number of patients who underwent reoperation was significantly less than that of the simple vacuum sealing drainage treatment group(group B)(P < 0.01); There was no statistically significant difference in the rate of recurrence and cost of hospitalization between the two groups(P > 0.05).Conclusion Platelet rich gel combined with vacuum sealing drainage technique was simple, minimally invasive, safe and reliable. Compared with the simple vacuum sealing drainage technique, it not only can be effective in the treatment of patients with incision non-healing and infection after median sternotomy operation, but also shorten the wound healing time and hospitalization time, as well as reducing rate of reoperation. |
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