Asz-Sigall J, López-Eslava G, Córdova-Ortega JA, Medina-Vega FA, Ortega-Salgado JA

Language: Spanish
References: 6
Page: 138-142
PDF size: 147.65 Kb.

ABSTRACT

Introduction: Since 1995 the system of vacuum wound closure has shown efficacy and safety in the management of complex acute and chronic wounds, helping to protect the environment by removing exudate and necrotic material and granulation promoting perfusion, as well as helping contracting the edges of them.Despite this, their diffusion and acceptance in our country has been poor, particularly in children.We present a patient with complex perineal trauma injury, treated successfully with the system of vacuum-assisted closure.
Case report: Men’s three years that was hit by a trailer. He moved to the emergency room where he was resuscitated aggressively in a state of hypovolemic shock. Complex fracture of the pelvis showed extensive retroperitoneal hematoma, urethral suspected fracture, splenic injury grade I and complex perineal injury that extended to the right leg, with significant soft tissue loss from abrasion and bursting of the rectum.
The lesion measuring 30x24x18 cm.He underwent exp oratory laparotomy sigmoidostomy separate mouths.The perineal wound was managed initially with silver sulfadiazine.To outline the area of necrosis, and extensive debridement was done cleaning, finding bursting of the year, and significant loss of skin, subcutaneous tissue and muscles, including the anal sphincter.In the days following a dressing was applied consisting of a hidrofibra of sodium carboxymethylcellulose and ionized silverbased gel of calcium alginate to control the exudate and promote debridement of necrotic areas remaining.
Although improved wound part, the difficult management of exudate motivated us to place the system of vacuum-assisted closure (VAC, KCI San Antonio, Tx.)
Marked improvement was obtained with significant reduction of exudate, granulation tissue formation and contraction of the edges of it.During therapy V.A.C. tissue expanders were placed in the posterior chest and underwent partial anoplasty rotation flaps.After inspecting the exudate and a granulation tissue, placed an array of epidermis obtained from pig small intestine, combined with the base dressing and silver carboxymethylcellulose hidrofibra ionized, with the aim of reducing the grafted area.
A few days later was made full-thickness skin grafting of 20x8 cm, which is incorporated in its entirety.The patient was discharged from hospital in good condition.Currently wander and get rehabilitation therapy for fecal continence.Require vesicostomy colostomy closure and repair of the urethral injury.
Discussion: This case serves to realize the difficulty and complexity involved in handling serious injury.It is important to understand the pathophysiology of scarring and all the tools we have to accelerate its process.Although we used a variety of substances and products for the management of this injury, the system of vacuum-assisted closure dramatically changed the course of it, allowed us to control the exudate and infection, significantly reducing its size by promoting rapid vascularization and granulation tissue formation that gave us a bed suitable for grafting, significantly reducing recovery time.

REFERENCES

1. Timmers MS, Le Cessie S, Banwell P, Jukema GN. The effects of varying degrees of pressure delivered by negative-pressure wound therapy on skin perfusion. Ann Plast Surg 2005;55(6):665-71.

2. deLange MY, Schasfoort RA, Obdeijn MC,van Der Werff JFA, Nicolai JPA. Vacuum-assisted closure: indications and clinical experience. Eur J Plast Surg 2000;23(4):178-82.

3. Morykwas MJ, Faler BJ, Pearce DJ, ArgentaLC. Effects of varying levels of subatmospheric pressure on the rate of granulation tissue formation in experimental wounds in swine. Ann Plast Surg 2001;47(5):547-51.

4. Tsuji Y, Terashi H, Tahara S, Kitano I. Utilizing vacuum-assisted closure (V.A.C.) as one of the methods for wound bed preparation (WBP). Wound Repair & Regen 2006;14(1):A10.

5. Norton SE, De Souza B, Marsh D, Moir G. Vacuum-assisted closure (VAC Therapy) and the risk of fluid loss in acute trauma. Ann Plast Surg 2006;56(2):194-5.

6. Bookout K, McCord S, McLane K. Case studies of an infant, a toddler, and an adolescent treated with a negative pressure wound treatment system. JWOCN 2004;31(4):184-92.