载万古霉素缓释系统治疗多重耐药软组织缺损创面的疗效观察  

Effects observation of vancomycin loaded sustained release system in the treatment of soft tissue defect wounds with multidrug-resistant infection

作　　者：陈佳 肖滋润 杨涛[1] 周树萍 张凯[1] 熊颖杰 宋科 张广超 幸超峰[1] CHEN Jia;XIAO Zirun;YANG Tao(Department of Orthopedics,No.988 Hospital of PLA Joint Logistics Support Force,Zhengzhou,Henan,450000,China)

机构地区：[1]中国人民解放军联勤保障部队第988医院全军创伤骨科中心,河南郑州450000

出　　处：《实用手外科杂志》2024年第2期185-189,共5页Journal of Practical Hand Surgery

基　　金：河南省医学科技攻关计划联合共建项目:(项目编号:LHGJ20220907、LHGJ20220908、LHGJ20220909、LHGJ20210805、LHGJ20200793)。

摘　　要：目的探究应用载万古霉素缓释系统治疗多重耐药菌等感染的软组织缺损创面的操作技巧及临床应用价值。方法回顾性分析2018年1月-2022年1月联勤保障部队第九八八医院全军创伤骨科中心收治的68例多重耐药菌感染的软组织缺损创面患者的临床资料,上肢创面32例,下肢创面36例。缺损面积:1.0 cm×2.0 cm~15.0 cm×30.0 cm。采用载万古霉素缓释系统联合负压封闭引流技术,待创面感染控制及诱导膜生长后,51例植皮修复良好后,17例皮瓣移植修复。结果术后均未发生全身并发症,感染均得到较好的控制,供区均一期愈合。51例行植皮修复,其中46例游离植皮全部一期成活,5例植皮边缘部分坏死经换药后瘢痕愈合;17例皮瓣移植修复病例中,3例行局部转移皮瓣修复,6例行带蒂轴型皮瓣修复,8例行游离股前外侧皮瓣修复。15例皮瓣均一期顺利成活,2例延迟愈合。术后随访6~15个月,平均(10.70±2.19)个月,60例痊愈,8例显效,总有效率为100%。结论应用载万古霉素骨水泥缓释系统联合负压封闭引流形成诱导膜后再手术修复创面,安全可靠,加速了创面愈合,提高了创面修复的成功率,对改善愈后有积极的临床意义。Objective To explore the application of vancomycin sustained-release system in the treatment of soft tissue defect wound with multidrug-resistant infections and conclude operation skills and clinical application value.Methods From January 2018 to January 2022,68 patients with multidrug-resistant infection of soft tissue defect were selected,including 32 cases of upper limb wounds and 36 cases of lower limb wounds.The area of the defect was 1.0 cm×2.0 cm~15.0 cm×30.0 cm.All of the wounds were skin and soft tissue defects with tendon or bone exposed.Vancomycin-loaded sustained release system combined with vacuum sealing drainage(VSD)was used.After infection was under control and induced membrane growth were well,51 cases were repaired by skin-grafting and 17 cases were repaired by flap transplantation.Results No systemic complications occured after the operation,infection was well controlled,and stage I healing was observed in all donor areas.46 cases of free skin-grafting survived in the stage I,and there were 5 cases of partial necrosis at the edge of skin-grafting healed after dressing change.Among 17 cases,3 cases were treated with local flap transfer,6 cases with pedicled axial flap,and 8 cases with free anterolateral thigh flap.All the flaps survived successfully in the first stage in 15 cases and delayed healing in 2 cases.Postoperative follow-up was conducted for 6~15 months,with an average of(10.70±2.19)months.60 cases recovered,8 cases showed significant effect,and the total effective rate was 100%.Conclusion It was safe and reliable to use vancomycin-loaded bone cement sustained-release system combined with VSD to form induced membrane and then to repair the wounds surgically.This treatment method not only speeds up wounds healing and improves the success rate of wounds healing,but also has positive clinical significance for the improvement of wounds healing.

关 键 词：多重耐药等感染 创面 抗生素 骨水泥 修复 

分 类 号：R658[医药卫生—外科学]