VAC®负压治疗与内侧双胞胎皮瓣下骨暴露的下肢功能

Enrique Antonio Chau Ramos
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摘要

目的:比较两种下肢骨外露损伤的重建手术技术,并证明VAC®(真空辅助封闭)负压伤口治疗是一种潜在恢复的替代方法,没有明显的变化可能导致功能损害。材料与方法:对2019年所有采用VAC®系统和小腿内侧皮瓣治疗的Clínica Stella Maris下肢外伤性损伤及胫骨中三分之一外露患者进行分析性、前瞻性、定量和纵向研究。结果:功能活动分类(FAC)量表显示,采用VAC®技术治疗的患者(50%达到V级)优于采用皮瓣技术治疗的患者(50%达到IV级),差异有统计学意义(p < 0.05)。我们观察到,由于渐进式再生过程包括完全填充或覆盖病变区域,使用VAC®技术闭合的时间更长。另一方面,两种技术之间的术后疼痛强度差异是明显的,皮瓣技术是中等到强烈的,而VAC®技术在很大程度上是轻微的。结论:VAC®吸引系统对胫骨前中部三分之一创伤性缺损的骨覆盖是有效的。它是一种不改变解剖结构的潜在恢复方法,因为它提供了更好的功能结果和更少的并发症。这是一种有效和安全的选择,可以刺激伤口愈合,最大限度地减少手术治疗的需要。
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Funcionalidad del miembro inferior con exposición ósea con el uso de terapia con presión negativa VAC® vs. colgajo de gemelo medial
Objective: To compare two reconstructive surgery techniques for lower limb injury with exposed bone and demonstrate that the VAC® (vacuum-assisted closure) negative pressure wound therapy is an alternative for potential recovery showing no significant changes that could lead to functional compromise. Materials and methods: An analytical, prospective, quantitative and longitudinal study conducted with all the patients of Clínica Stella Maris with traumatic injuries of the lower limb and exposure of the middle third of the tibia treated with the VAC® system and the medial calf flap in 2019. Results: The measurement obtained with the functional ambulation categories (FAC) scale showed better results among the patients treated with the VAC® technique (since 50 % got grade V) than those who underwent the flap technique (50 % got grade IV), being the differences statistically significant (p < 0.05). It was observed that the time to closure was longer with the VAC® technique due to the progressive regeneration process consisting of the complete filling or coverage of the lesion area. On the other hand, the difference in the postoperative pain intensity between the two techniques was evident, being moderate to intense with the flap technique and mild, for the most part, with the VAC® technique. Conclusions: The VAC® suction system is effective for bone coverage in traumatic defects of the anterior middle third of the tibia. It is an alternative for potential recovery that does not change the anatomical structures because it provides better functional results and fewer complications. It is a useful and safe option that stimulates wound closure and minimizes the need for surgical treatment.
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