Continuous High-Pressure Negative Suction Drain: New Powerful Tool for Closed Wound Management: Clinical Experience

Continuous High-Pressure Negative Suction

Drain: New Powerful Tool for Closed Wound

Management: Clinical Experience

by

Seung Jun Shin

Major in Medicine

Department of Medical Sciences

The Graduate School, Ajou University

Continuous High-Pressure Negative Suction

Drain: New Powerful Tool for Closed Wound

Management: Clinical Experience

by

Seung Jun Shin

A Dissertation Submitted to The Graduate School of

Ajou University in Partial Fulfillment of the Requirements for

The Degree of Ph.D. in Medicine

Supervised by

Myong Chul Park, M.D., Ph.D.

Major in Medicine

Department of Medical Sciences

The Graduate School, Ajou University

This certifies that the dissertation

of Seung Jun Shin is approved.

SUPERVISORY COMMITTEE

The Graduate School, Ajou University

December, 19th, 2014

i

ABSTRACT

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Background & Aims:Although various reconstructive flap surgeries have beensuccessfullyperformed,therestillaredifficultwoundcomplications,such

as seroma formation,wound margin necrosis,delayed wound healing,and

even flap failures.The negative-pressure wound therapy hasbeen described in detailin the literature to assistopen chronic/complex wound closure in reconstructive surgery.However,the negative-pressure wound therapy was difficulttobeappliedundertheincisionalclosedwounds.

Methods:A totalof23 patients underwentthe various reconstructive flap surgeries with continuous high-pressure negative suction drain.Instead of

using regular suction units,BarovacⓇ (50 - 90 mmHg,Sewoon Medical,

Seoul,RepublicofKorea)drainagetubeswereconnectedtothe　wallsuction

unit, providing continuous high-powered negative pressure.　 In addition,

continuoussubatmosphericsuction pressure(100－300　mmHg)wasapplied.

Outcome of the measures was obtained from the　 incidence of seroma,

volume of postoperative drainage,hospitalization　 period,and incidence of

other typical　 wound complications. Dead space　 was evaluated

postoperativelywithultrasonography.

Results:Using continuous high-pressure negative suction drain,　 successful

managementofseroma was obtained withoutany major　 complication such

aswoundinfection,flaploss,andwoundmargin　necrosis,exceptforonly 1

drain in the latissimus dorsi donor　 site was significantly reduced in

comparison with the authors’previous　 data (P = 0.047).The volume of

drainage and hospitalization　 period were also reduced;however,these were notstatistically significant.　 The dead space with continuous high-pressure negative　 suction drain was more reduced than in the controlgroup in the　 immediatepostoperativeperiodandconfirmedwithultrasonography.　

Conclusions:Continuous high-pressure negative suction drain mightbe the

simple and powerful solution in the management of challenging closed

wounds.

Key Words:Seroma,Wallsuction,Continuoushigh-pressurenegativesuction

iii

TABLE OF CONTENTS

ABSTRACT ···ⅰ TABLE OF CONTENTS ···ⅲ LIST OF FIGURES ···ⅳ LIST OF TABLES ···v

Ⅰ.INTRODUCTION···1

Ⅱ.PATIENTS AND METHODS···3

Ⅲ.RESULTS ···8

IV.CASE REVIEWS ···12

V.DISCUSSION ···15

REFERENCES ···20

LI

ST OF FI

GURES

Fig.1.Barovac® (Sewoonmedical,Seoul,Korea)draintubesareperforated

polyvinylchloridesuctiondrainsproviding50-90mm Hgofnegative

pressure···5

Fig.2.Wallsuctionunitprovideshighpressurenegativepowerranging

from 0-300mmHg···6

Fig.3.Volumeofdrainoutputuntildrainsincontrolandwallsuction

groupswereremoved ···10

Fig.4.Ultrasonographywasexaminedimmediatepostoperatively.Compared withregularsuctionunit(leftpanel),bothdeadspaceandthegap betweenlayersweredefinitelyreduced(rightpanel).Redarrows indicatedeadspace,andbluearrowsindicatedrainagetube ···11

Fig.5.Onapplyinghighpressurenegativesuctiontherapyundertheskin

flapat150–160mmHg,theflapsweremorestabilizedtofixthe

underlyingtissues(bluearrows)thanothermethodssuchas

v

LI

ST OF TABLES

Table1.Diagnosisandoperationdataoftotalpatients···3

Table2.Comparisonofoutcomemeasurementsinextendedlatissimus

I

.I

NTRODUCTI

ON

Nowadays, various reconstructive flap surgeries have been

successfully performed to cover the challenging wounds thatrequire extra care.There are some complications - donor site seroma in the latissimus

dorsiflap,seroma in the abdominoplasty area,hematoma under the flaps,

wound margin necrosis,partialflap loss,repetitive seroma,and even flap necrosis.Among severaldifferenttechniques,whichhavebeendocumentedin the managementofthese complications,some preventive maneuvers are not uniformlysuccessful.

Negative-pressure wound therapy (NPWT) is an adjunct therapy

using negativepressureto removefluid from open woundsthrough asealed

dressing(reticulatedopen-cellpolyurethaneetherfoam)andaspecializedtube thatis connected to a suction unit.The technique is designed to remove chronicedema fluid,thereby decreasing theafterload to blood flow,resulting in increased localized tissue perfusion (Timmeretal.,2005;Scherer etal., 2008;Schintler,2012;Argenta etal.,2006).With applied negative-pressure forces,theformation ofgranulation tissueisenhanced (Timmeretal.,2005; Schintler,2012;Leeetal.,2011;Saxenaetal.,2004). Thenegative-pressure technique has been demonstrated to be an extremely efficacious method to stimulatehealingbysecondaryintention(Argentaetal.,2006;.Leeetal.,2011; Mendonca etal.,2006).Thiseffectivetechniquehas been mostly applied on

challengingwoundssuchasexposedcomplex andchronicwounds,oronskin

graftarea,orclosed surgicalincision sites(Leeetal.,2011;Mendoncaetal.,

2006;Kilpadiand Cunningham,2011;Schmedes etal,2012;Ubbink etal,

2008;ArgentaandMorykwas,1997).

2

-wounds oroverthe closed surgicalincision sites.This reportreviews such articles that state that using negative-pressure technique successfully preventedthecomplicationsinvariousflapsurgeries.

No.Sex/Age Diagnosis Op.name 1 F/42 Invasiveductalcarcinoma,breast,Lt. Totalmastectomyandimmediate

reconstructionusingextendedlatissimus dorsimyocutaneousflap

2 F/49 Invasiveductalcarcinoma,breast,Lt. Totalmastectomyandimmediate reconstructionusingextendedlatissimus dorsimyocutaneousflapandcohesive-gel filledbreastimplant

3 M/68 Madelung'sdisease,posteriorneck Massexcision,excessskinremovaland coverageusinglocalflapadvancement 4 F/48 Tubularcarcinoma,breast,Lt. Totalmastectomyandimmediate

reconstructionusingextendedlatissimus dorsimyocutaneousflapandcohesive-gel filledbreastimplant

5 F/19 Avulsionflapinjury,

temporoparietooccipitalarea,scalp,Lt.

Arteriorrhaphy,debridementandrepair 6 M/27 Gynecomastia,bilateral Subcutaneousmastectomy

7 M/18 Gynecomastia,Lt. Subcutaneousmastectomy 8 M/57 Pressuresore,coccygealarea,greater

trochantericarea,Rt.andbuttockarea, Lt.

Debridement,bursectomyandcoverageusing localflaprotationandadvancement

9 F/19 Hugefibrolipoma,upperback,Rt. Massexcisionandrepair 10 F/48 Invasiveductalcarcinoma,breast,Lt. Totalmastectomyandimmediate

reconstructionusingextendedlatissimus dorsimyocutaneousflapandcohesive-gel filledbreastimplant

11 F/39 Postmastectomystatus,breast,Rt. Delayedreconstructionimmediate

reconstructionusingextendedlatissimusdorsi myocutaneousflapandcohesive-gelfilled breastimplant

12 F/38 Intraductalcarcinoma,breast,Lt. Totalmastectomy,sentinellymphnode biopsy,andimmediatereconstructionusing ipsilateralpedicledTRAM flap

I

I

.PATI

ENTS AND METHODS

Thisstudyincluded23patientswhounderwentthereconstructive

surgery from September 2011 to January 2013 (Table 1). Breast

reconstruction,abdominoplasty,giantmass excision,gynecomastia correction, traumatic avulsed flap reconstruction,and reconstruction for pressure sore wereperformedasthereconstructivesurgery.

4

-13 F/54 Pendulousabdomen Fullabdominoplastyandliposuction 14 F/51 Recurredductalcarcinomainsitu,

breast,Lt. rSkieconstnsparructingmasionusingetectomyandixtendedlatmmeissidimusate dorsimyocutaneousflapandcohesive-gel filledbreastimplant

15 F/51 Infiltratingductalcarcinoma,breast,

Rt. iNimmepplesdiatpareriengtconsottralmasuctionustectiomyandngextended latissimusdorsimyocutaneousflapand cohesive-gelfilledbreastimplant 16 F/44 Pendulousabdomen Fullabdominoplasty

17 F/44 Recurredseroma,back

S/P Nipplesparingmastectomyand immediatereconstructionwithextended latissimusdorsiflaptranspositionwith cohesivegelbreastimplant

d/tDuctalcarcinomainsitu,breast,Lt.

Drain tube insertion and connect with wall suction

18 F/57 Giantlipoma,anteriorneck Massexcision,excessskinremovaland coverageusinglocalflapadvancement 19 F/46 Ductalcarcinomainsitu,breast,Lt. Nipplesparingmastectomyandimmediate

reconstructionusingextendedlatissimusdorsi flaptranspositionwithcohesivegelbreast implant

20 F/44 Avulsionflapinjury,lowerlegand

dorsum offoot,Lt. Defatting,debridementandrepair 21 F/37 Pressuresore,greatertrochanteric

area,Lt. Delocbralfidelaprmentot,burationandadvancsectomyandcemeoventrageusing 23 M/54 Recurredpressuresore,coccygealarea Debridement,bursectomyandcoverage

usinggluteusmaximusmusculocutaneousflap rotation

F,female;M,male;S/P,statuspost;d/t,dueto.

When the operative fields were closed after the main operative procedures,BarovacⓇ (SewoonMedical,Seoul,RepublicofKorea)draintubes, which areperforated polyvinylchloridesuction drains(Fig.1),wereinserted into the cavity.In place ofthe regularsuction unitproviding 50 to 90 of

mmHg negative pressure, the drains were connected to the continuous

high-pressure suction wallsuction unit(Fig.2).Negative pressure ranged

from 120 to 300 mmHg,minimalpressure,to maintain the stable flap base

and to reduce dead space.In the largeroperative area,the higherpressure

quilting sutures orfibrin glue injection.To evaluate the dead space in the operative sites,ultrasonography was performed.Patients were treated with the standard conventionalpostoperative care (Stebbins etal.,2011).Amount

of the volumes and duration of　 wound drainage were recorded

postoperatively.When drainage was less than 20 mL fora 24-hourperiod,

thedrainagetubeswereremoved(Chaetal.,2012;Shinetal.,2012).

Fig. 1. Barovac® (Sewoon medical, Seoul, Korea) drain tubes are

perforated polyvinylchloridesuction drainsproviding 50- 90mmHg of

6

-Fig. 2. Wall suction unit provides high pressure negative power

Outcome ofthe measures was the volume ofdrainage output,the length oftimethatthedrain remained in thesite,hospitalization period,and evaluationofdeadspaceusingultrasonography.Inaddition,anycomplications, including recurred seroma,wound dehiscence,infections,and delayed wound healing, were studied. In the group of the breast reconstruction with latissimus dorsiflap,each patientwas compared with thepatients who had undergone the same surgical procedures without high-pressure negative suctiondrain.

Statisticalanalysis was performed using the StatisticalPackage for theSocialSciencesversion13.0(Windowsversion,StatisticalPackageforthe

SocialSciences Inc,Chicago,IL).The Mann-Whitney test was used to

8

-I

I

I

.RESULTS

Continuous high-pressure negative suction drain was applied to 23 patientswhounderwentreconstructiveflapsurgery.Among them,therewere 8 breast reconstructions with extended latissimus dorsiflap and cohesive gel-filled implant,1 breast reconstruction with pedicled transverse rectus

abdominus myocutaneous flap, 2 abdominoplasties, 3 giant benign mass

removals,2 traumatic avulsed flap reconstructions,and 8 other cases.The authors used the continuous high-pressure negative suction drain as an

adjuvantmethod.There was no typicalwound complication,such as wound

infection,flaploss,andwoundmargin necrosis,exceptfor1recurredseroma case,which waseasily solved with theone-timeaspiration and compressive

dressing.However,inthecontrolgroup,8in 10caseshadseromaformation,

and serialaspiration with compression dressing was performed to treatthe seroma.In extended latissimus dorsiflap donor site,drainage volume was significantly reduced in comparison with recentdataof10patientsfrom the authors’previous study.These patients underwenta conventionaldonorsite closurewithoutquiltingsuturesorfibringlueinjection.

Thetotaldrainagevolumesweredecreasedwiththismethod,from

a median of680.00 (269.5 - 3127.9)mL to 438.85 (163.0 - 1243.0)mL in

extendedlatissimusdorsiflapdonorsite.Themedianindwelling periodofthe

drainswas6.0 (3 - 10)dayswith thewallsuction group and 9.0 (8 - 19)

dayswith thecontrolgroup(Table2andFig.3).Themedian hospitalization

periodofthewallsuctiongroup(8days)wasshorterthanthatofthecontrol

group (12 days);however,this was notstatistically different(P = 0.183). Ultrasonography was examined immediately after the operation.Compared with the regular suction unit,dead space was definitely reduced (Fig.4).

Outcome Group1: W allsuction (n=8)

Control2:

Control(n=10) p-value Cumulative drainagefluid

volumein donorsite(mL)

435.85 (163–1243.0)

680.00 (269.5– 3127.9)

0.441

Day ofdrain removal(day) 6.0 (3– 10)

9.0 (7– 19)

0.047

No. ofseromaformation (n) 1 8

Valuesarepresentedinthemedianvalue(range).

Finally,woundslastedfor6monthsto18months.

Table 2.Comparison ofoutcome measurements in extended latissimus

10

-Fig.3.Volumeofdrain outputuntildrains in controland wallsuction

Fig. 4. Ultrasonography was examined immediate postoperatively.

Comparedwith regularsuctionunit(leftpanel),bothdeadspaceandthegap

between layers were definitely reduced (right panel).Red arrows indicate

12

-I

V.CASE REVI

EWS

Patient1

A 43-year-oldwomanwasexaminedintheclinicforreconstruction

of her right breast.She had undergone modified radical mastectomy for

intraductal carcinoma 5 years ago. Breast reconstruction using extended latissimus dorsifasciocutaneous flap and cohesive gel-type breast implant

(Mentor,Santa Barbara,CA;175mL)was performed.When the donor site

was closed,simple suture method withoutquilting suture was applied,and

thedrainagetubewasplaced into thedonorsitewith theconnection tothe

high-pressurenegativesuction unitat300mmHg.Thedrainagevolumewas

134mL onthefirstpostoperativeday anddecreasedrapidly sincethesecond

postoperativeday.Onthefifthpostoperativeday,thedrainagewas22mL

duringa24-hourperiod,sothedrainwasremovedonthesixthpostoperative

day.Therewerenowound-relatedproblemsandnoseromaformation.

Patient2

A 19-year-oldwoman had atrafficaccidentand washospitalized for

multiple rib fractures,livercontusion,and leftparietotemporalfasciocutaneous avulsion flap injury. The superficial temporal artery was transected. In emergentoperation,arteriorrhaphy wasdonesuccessfully.Afterdirty margin debridement,theavulsedflapwasrepairedwithsimplesilasticdrains.Despite a successfuloperation,a largeamountofserous drain was noted along the silasticdrains.

On thefourth postoperativeday,thedrainagetubewasplaced under

suction unit at 120 mmHg.On the fifth postoperative day,the drainage

volumewas25mL.Drainagevolumewasdecreaseddaily andwas5mL on

the ninth postoperative day, so the drain was removed on the 10th

postoperativeday.

Patient3

A 42-year-old woman had undergone breast reconstruction using

extended latissimusdorsifasciocutaneousflap andcohesivegel-filled implant. Shehadbeenvisiting theoutpatientclinicforrepetitiveaspirationtherapyfor

chronic seroma on the donor site for 2 weeks after discharge.The mean

aspiration volumewas26.5mL.Shewasadmitted,and 1drainagetubewas

inserted and connected tothecontinuoushigh-pressurenegativesuction unit

at 200 mmHg.On the third day after application,drainage volume was

decreased to nearly 0 mL. After 2 more days,the drainage tube was

removed, and compressive dressing was applied. Chronic seroma was

successfullyresolved,andtherewasnorecurrence.

Patient4

A 54-year-old man had a chronic recurred pressure sore on the

coccygealarea.Hehad paraplegiafor20years.GradeIV pressuresorewas

noted.DebridementandconventionalNPWT withintravenousantibioticswere applied for 2 weeks.Despite repetitive adjuvant therapy,there was not enoughfreshgranulation tissue.Afterdirty margindebridement,V-Y gluteus

maximus musculocutaneous flap rotation was performed using 2 drainage

tubesinserted and connected toahigh-pressurenegativesuction unitat300

mmHg.Flapsizewasapproximately20x10cm2.Theflapseemedstableand

14

-by day and was 15 mL on the 10th postoperative day;therefore,the drain

was removed on the 14th postoperative day. There were no wound

V.DI

SCUSSI

ON

Treatmentsofwounds,especially hard-to-healwounds,havebeenthe

working basisofplasticsurgerysincethestartofthisspecializeddiscipline( Schintler,2012).However,reconstructive flap surgery is one of the main methods for these complicated wounds and many related complications –

seroma/ hematoma,wound margin dehiscence,delayed wound healing,and

evenflapfailures.

Among these complications, seroma is one of the common

postoperative complications in reconstructive surgeries.The etiology behind seromaformation remainsunclear.Severaltheorieshavebeen suggested that include disruption of vascular and lymphatic channels, shearing effects between subcutaneous surfaces and underlying musculates, creation of a surgical dead space, and an effect of inflammatory mediators generated

subsequent to tissue damage (Shin et al, 2012; Arrawal et al., 2006;,

Taghizadeh etal.2008).Themain conceptsoftheprevention and controlof

theseromaarethereduction ofmechanicalshearing effectsandpromotion of

woundhealing(Chaetal.2012;Taghizadehetal.2008;Alietal,2010;Nahas

etal.,2007).

In the various methods of preventing seroma formation, quilting suture and fibrin sealanthave been tried in many groups (Cha etal.2012;

Shin etal,2012;Alietal,2010;Nahas etal.,2007;Andrades etal.,2007).

Quiltingsuturebetweenskinflapsandunderlyinglayersiscommonlyusedto

reduceseromaformation,andstudieshaveshownthismethodtobeeffective

in a clinicalsetting (Nahas etal.,2007;Andrades et al.,2007).It might eliminate the mechanical shearing force and dead space. However, this

16

-especially when large skin paddles are harvested (Cha etal.2012).Fibrin sealant,a componentadhesive tissue composed offibrinogen and thrombin,

has been used in a number of surgical settings primarily to achieve

hemostasisand sealtissues.Themodeofaction ofthefibrin sealantistwo

pronged:itreduces the dead space between 2 planes by means oftissue

adhesion,whichcoaptstheelevatedskinflaptotheunderlyingtissues,andit

reduces hematoma and serous oozing from the involved surfaces by

enhancing hemostasis and blocking the lymph channels responsible for

drainageinto theoperativesite(Cha etal.2012;Shin etal,2012;Alietal,

2010). Some studies have reported that fibrin sealant was found to be

effective in reducing wound drainageorseroma formation (Shin etal,2012; Alietal,2010).Incontrast,itwasnotfoundtobeeffectiveinotherstudies. In conclusion,fibrin sealantdoesnotproduceuniform resultsyet(Chaetal.

2012).

Authorspaidattentiontothemethodthatreducesmechanicalshearing effectsand promoteswound healing.Theuseofnegativepressuretherapies

inwoundhealingwasfirstdescribedintheearly1990sandhassubsequently

beenadoptedinthetreatmentofcomplexsurgicalandtraumaticwounds(Lee

etal.2011).During the pastdecade,NPWT has gained favor in a wide

variety of fields. Negative-pressure wound therapy is thought to yield wound-healing benefits by increasing blood flow,promoting angiogenesis, modulating inhibitory contents in wound fluid,and inducing cellproliferation

(Timmersetal.,2005;Schitler,2012;Argentaetal.,2006;Saxenaetal.,2004;

ArgentaandMorykwas,1997).OtherreportedeffectsofNPWT includetissue

deformation with stretching of individualcells,thereby promoting cellular proliferationinthewoundmicroenvironment(Saxenaetal.,2004).

hematomaand promotion ofwound healing wasrefined toapply through the

drainage tubes withoutthe polyurethane foam.The usualnegative drainage

system providesonly 50to 90ofmmHg negativepressure.Authorstried to apply highernegative pressure continuously using wallsuction units,which

provideamaximum of300mmHg.Thelargertheareaoftheflap was,the

higherthe pressure was applied.Largerareas such as abdominoplasty area, latissimus dorsiflap donor site,and giantlipoma excision site were very effective.In contrast,the effectiveness in relatively smallareas was not different between low pressure and high pressure. In our experiences, effectivenegativepressureperareamightbethekeystoneofthistrial.

On applying high-pressurenegativesuction drain undertheflaps,the flaps seemed to be more stabilized to fix the underlying tissues than were othermethodssuchasquilting sutures(Fig.5).Ultrasonography showedthat dead space and the gap between tissues of each layer were decreased

dramatically (Fig.4).Pressurelevelwaschangedcaseby case.Thedaysof

indwelling ofthewallsuction group weresignificantly shorterthan thoseof

thecontrolgroup (P = 0.047).However,themedian oftotaldrainagevolume

and hospitalization period seemed to decrease,which was not statistically significant(P =0.441and0.183,respectively).Thismightbetheresultofthe

smallnumbers ofpatients in both groups.No serious wound complications

such as wound dehiscence,flap margin necrosis,orflap losswerefound.It means thatour refined technique mightreduce mechanicalshearing effects

and promote wound healing effectively. The advantages of continuous

negative suction over conventionalsuction drains are (1) keeping vacuum state ofclosed space;(2) keeping zero dead space;(3) rapid decrease of serum products;(4)helpfulto theflap successfordifficultwounds;(5)and, consequently,rapidreductionofthehospitalizationtime.

18

-In the resultofour study,a large flap wound or donor site that

needscontinuouscompression toreducedead spacecan beagood indication

ofhigh-pressurenegativesuction drain.Latissimusdorsiflap and transverse abdominis flap donor site,flap area after the pressure sore reconstruction,

abdominoplasty area, and defect after huge mass excision were good

examples. As the disadvantage of this method, it is presumed that

high-pressure negative suction can induce ischemia of fat tissue and fat

necrosis.However,wethink thatoursuction drain istoo smallto inducea

large area offatnecrosis,so dead space willnotbe formed by a small

amountoffatnecrosis.

Fig.5.On applying high pressurenegativesuction therapy underthe

skin flapat150~160mmHg,theflapsweremorestabilizedtofix the

underlying tissues(bluearrows)than othermethodssuchasquilting

Before using high-pressure negative suction drain,there are a few

things to be aware of. If there is a bleeding vessel in the wound,

high-pressure negative suction can cause massive bleeding.Thus,before applying high-pressure negative suction drain,meticulous hemostasis ofthe flap and recipientwound is mandatory.In addition,negative suction drain with the highestpressure (300 mmHg)can induce painfulsensation forthe patient.Therefore,ifthe patientcomplains ofpain,gradually increasing the negativepressurewillbehelpful.Becauselocalhigh pressure(>200 mmHg) can inducedrain tubecollapsenearthewallsuction bottle,regularchecking

ofthetubeisneeded,andithastobechangedtoathickertubewhenthere

isrepetitivecollapse.Inaddition,forthefreeflaporthepedicledflapwound, negativesuctiondrainneartheanastomosissiteortheflappediclecancause vascularcollapsebecauseofhighpressure.Therefore,suctiondrainshouldbe keptawayfrom theanastomosissiteortheflappedicle.

In ourexperience,the application ofnegative-pressure therapy under the clean closed wound is a new powerfultechnique in the postoperative

management of various flap surgeries, which may decrease wound

complications.Thisisthefirststudy toreportsuch anoveluseofnegative suction drain therapy.A largergroup ofpatientsand prospectiverandomized studiesforappropriatepressurelevelareneededforourrefinedtechnique.

20

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-고압력 연속 음압 흡입기를 이용한,

패쇄 창상의 치료의 새로운 해결방법

아주대학교 대학원의학과 신 승 준 (지도교수 :박 명 철) 배경 및 목적:현재까지 다양한 재건 피판 수술이 소개되고 그 성공례가 보 고되고 있지만 장액종의 형성,창상의 변연부의 괴사,지연성 회복,또는 피판의 괴사와 같은 어려운 합병증들이 꾸준히 있어오고 있다.음압치료는 이제까지 재 건수술에 있어서 개방성 창상의 회복을 도와주는 것은 여러 문헌에 소개되어왔 다.하지만,음압치료가 패쇄적인 창상에 직접적인 적용을 하는 것은 어려움이 있어왔다.이에 본 연구에서는 이러한 창상의 회복에 대한 새로운 방법을 고안하 여 성공적인 결과를 보고하고자 한다. 방법:다양한 재건수술을 받은 환자 중 고압력 연속 음압 흡입술을 받은 23 명의 환자를 대상으로 하였다.일반적은 흡입기 대신 고압력 음압을 지속적으로 재공해 줄 수 있는 음압기를 사용하였다.또한 음압은 100– 300mmHg의 범 위로 적용하였다.결과의 측정은 장액종의 빈도,수술 후 배액량,병원 재원 기 간,그 외의 다른 창상과 연관된 합병증을 수집하여 평가하였다.또한 수술 후 발생하는 사강은 초음파를 통하여 평가하였다. 결과:고압력 연속 음압 흡입술을 통하여 치료한 환자들은 창상 감염,피판 괴사와 같은 주요 합병증은 발생하지 않았지만,단 1례의 경우 퇴원 후 지연성으 로 장액종이 발생하였다.광배근의 공여부에서 삽입한 배액관의 유지기간의 경우

24 -저자들의 과거 자료와 비교 시 의미 있게 감소함을 알 수 있었다 (P = 0.047). 배액량과 재원기간 역시 감소함을 나타내었으나 통계적인 유의함은 없었다.초음 파를 통해 평가한 술후 발생한 사강의 경우 대조군과 비교 시 크게 감소하였다. 결론:고압력 연속 음압 흡입치료는 간단하지만 패쇄적 창상의 치료에 있어 서 강력한 치료 방법이다.