Effectiveness of vacuum sealing drainage combined with modified external fixation antibiotic-impregnated cement semi-open technique in treating chronic ulcer wounds_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIN Jinluan ^1,2,3 , XIE Yun ^1,2,3 , ZHENG Lifeng ^1,2,3 , FANG Kaibin ⁴ ,  LIN Jianhua ^1,2,3

1. Department of Orthopaedics, the First Affiliated Hospital, Fujian Medical University, Fuzhou Fujian, 350005, P. R. China;
2. Department of Orthopaedics, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou Fujian, 350212, P. R. China;
3. Fujian Institute of Orthopaedics, Fuzhou Fujian, 350005, P. R. China;
4. Department of Orthopaedics, the Second Affiliated Hospital, Fujian Medical University, Quanzhou Fujian, 362000, P. R. China;

Corresponding?author：

LIN Jianhua, Email: jianhual@126.com

Keywords：

Chronic ulcer wound; sequential therapy; vacuum sealing drainage; modified antibiotic-impregnated cement technique; induced membrane

DOI：

10.7507/1002-1892.202404105

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Objective To investigate the effectiveness of debridement-vacuum sealing drainage (VSD)-modified external fixation antibiotic-impregnated cement semi-open technique in treatment of chronic ulcer wounds. Methods Clinical data of 43 patients with chronic ulcer wounds who met the selection criteria and admitted between January 2019 and June 2023 were retrospectively analyzed. Among them, 23 cases were treated with debridement-VSD-modified external fixation antibiotic-impregnated cement semi-open technique (improved group), and 20 cases were treated with debridement-VSD-traditional antibiotic-impregnated cement technique (control group). There was no significant difference in gender, age, constituent ratio of patients with type 2 diabetes mellitus, constituent ratio of patients with smoking history, body mass index, wound site, and other baseline data between the two groups (P>0.05). The healing quality and healing time, the positive rate of bacterial culture after bone cement coating, the loosening rate of bone cement, the number of operations, the number of hospitalizations, the length of hospitalization, and the cost of hospitalization were recorded and compared between the two groups. Results Compared with the control group, the positive rate of bacterial culture after bone cement coating and the loosening rate of bone cement in the improved group was significantly lower, as well as the number of operations, the number of hospitalizations, the length of hospitalization, and hospitalization cost significantly reduced (P<0.05). Wound repair was completed in both groups without amputation. The wound healing quality of the improved group was better than that of the control group and the wound healing time was shorter, the differences were significant (P<0.05). All patients were followed up 1-5 years (mean 3.4 years), and no ulcers recurred during follow-up. Conclusion Debridement-VSD-modified external fixation antibiotic-impregnated cement semi-open technique in the treatment of chronic ulcer wounds can effectively reduce the loosening rate of bone cement, facilitate the induced membrane formation and wound healing, and significantly reduce the number of operations and shorten the length of hospital stay.

Citation： LIN Jinluan, XIE Yun, ZHENG Lifeng, FANG Kaibin, LIN Jianhua. Effectiveness of vacuum sealing drainage combined with modified external fixation antibiotic-impregnated cement semi-open technique in treating chronic ulcer wounds. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(9): 1117-1122. doi: 10.7507/1002-1892.202404105 Copy

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2.	Ren Z, Cai W, Lu Y, et al. Debridement-reconstruction-docking management system versus Ilizarov technique for lower-extremity osteomyelitis. J Bone Joint Surg (Am), 2023, 105(19): 1527-1536.
3.	郭曉峰, 薛明宇, 鄧鑫鑫, 等. 自制抗生素骨水泥棒在脛骨釘道骨髓炎中的應用. 中國修復重建外科雜志, 2023, 37(2): 153-156.
4.	李嵩鵬, 鄭威, 徐振文, 等. 抗生素骨水泥覆蓋治療感染性創面的療效觀察. 創傷外科雜志, 2021, 23(7): 522-527.
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8.	Gruber HE, Riley FE, Hoelscher GL, et al. Osteogenic and chondrogenic potential of biomembrane cells from the PMMA-segmental defect rat model. J Orthop Res, 2012, 30(8): 1198-1212.
9.	Pelissier P, Masquelet AC, Bareille R, et al. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res, 2004, 22(1): 73-79.
10.	康永強, 吳永偉, 芮永軍, 等. 表面覆蓋抗生素骨水泥的鋼板內固定技術一期治療Gustilo ⅢB型脛腓骨開放性骨折療效分析. 中國修復重建外科雜志, 2024, 38(4): 426-431.
11.	Wang X, Wang S, Xu J, et al. Antibiotic cement plate composite structure internal fixation after debridement of bone infection. Sci Rep, 2021, 11(1): 16921. doi: 10.1038/s41598-021-96522-1.
12.	Metsemakers WJ, Fragomen AT, Moriarty TF, et al. Evidence-based recommendations for local antimicrobial strategies and dead space management in fracture-related infection. J Orthop Trauma, 2020, 34(1): 18-29.
13.	中國醫師協會創傷外科醫師分會創傷后特殊感染與咬蟄傷學組, 中國醫學救援協會動物傷害救治分會. 急診開放性傷口沖洗專家共識. 中華醫學雜志, 2023, 103(45): 3627-3634.
14.	Rathbone CR, Cross JD, Brown KV, et al. Effect of various concentrations of antibiotics on osteogenic cell viability and activity. J Orthop Res, 2011, 29(7): 1070-1074.
15.	Antoci V, Adams CS, Hickok NJ, et al. Antibiotics for local delivery systems cause skeletal cell toxicity in vitro. Clin Orthop Relat Res, 2007, 462: 200-206.
16.	康文磊, 孫鐵錚, 牛慧云, 等. 抗生素骨水泥治療骨科感染的利與弊. 中華關節外科雜志: 電子版, 2012, 6(5): 80-81.

1. Masquelet AC, Fitoussi F, Begue T, et al. Reconstruction of the long bones by the induced membrane and spongy autograft. Ann Chir Plast Esthet, 2000, 45(3): 346-353.
2. Ren Z, Cai W, Lu Y, et al. Debridement-reconstruction-docking management system versus Ilizarov technique for lower-extremity osteomyelitis. J Bone Joint Surg (Am), 2023, 105(19): 1527-1536.
3. 郭曉峰, 薛明宇, 鄧鑫鑫, 等. 自制抗生素骨水泥棒在脛骨釘道骨髓炎中的應用. 中國修復重建外科雜志, 2023, 37(2): 153-156.
4. 李嵩鵬, 鄭威, 徐振文, 等. 抗生素骨水泥覆蓋治療感染性創面的療效觀察. 創傷外科雜志, 2021, 23(7): 522-527.
5. Dong X, Luo H. The application of bilayer artificial dermis combined with VSD technology in chronic wounds. Journal of Biosciences and Medicines, 2024, 12(3): 238-244.
6. 左舒穎, 劉凱. 《膜誘導技術治療感染性骨缺損臨床循證指南》發布. 中華醫學信息導報, 2023, 38(6): 11.
7. Klaue K, Knothe U, Anton C, et al. Bone regeneration in long-bone defects: tissue compartmentalisation? In vivo study on bone defects in sheep. Injury, 2009, 40 Suppl 4: S95-S102.
8. Gruber HE, Riley FE, Hoelscher GL, et al. Osteogenic and chondrogenic potential of biomembrane cells from the PMMA-segmental defect rat model. J Orthop Res, 2012, 30(8): 1198-1212.
9. Pelissier P, Masquelet AC, Bareille R, et al. Induced membranes secrete growth factors including vascular and osteoinductive factors and could stimulate bone regeneration. J Orthop Res, 2004, 22(1): 73-79.
10. 康永強, 吳永偉, 芮永軍, 等. 表面覆蓋抗生素骨水泥的鋼板內固定技術一期治療Gustilo ⅢB型脛腓骨開放性骨折療效分析. 中國修復重建外科雜志, 2024, 38(4): 426-431.
11. Wang X, Wang S, Xu J, et al. Antibiotic cement plate composite structure internal fixation after debridement of bone infection. Sci Rep, 2021, 11(1): 16921. doi: 10.1038/s41598-021-96522-1.
12. Metsemakers WJ, Fragomen AT, Moriarty TF, et al. Evidence-based recommendations for local antimicrobial strategies and dead space management in fracture-related infection. J Orthop Trauma, 2020, 34(1): 18-29.
13. 中國醫師協會創傷外科醫師分會創傷后特殊感染與咬蟄傷學組, 中國醫學救援協會動物傷害救治分會. 急診開放性傷口沖洗專家共識. 中華醫學雜志, 2023, 103(45): 3627-3634.
14. Rathbone CR, Cross JD, Brown KV, et al. Effect of various concentrations of antibiotics on osteogenic cell viability and activity. J Orthop Res, 2011, 29(7): 1070-1074.
15. Antoci V, Adams CS, Hickok NJ, et al. Antibiotics for local delivery systems cause skeletal cell toxicity in vitro. Clin Orthop Relat Res, 2007, 462: 200-206.
16. 康文磊, 孫鐵錚, 牛慧云, 等. 抗生素骨水泥治療骨科感染的利與弊. 中華關節外科雜志: 電子版, 2012, 6(5): 80-81.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of vacuum sealing drainage combined with modified external fixation antibiotic-impregnated cement semi-open technique in treating chronic ulcer wounds

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