One patient with poor healing of sinus after implant of vascular prosthesis due to infected abdominal aortic aneurysms treated with negative pressure wound therapy combined with local flap
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摘要:
2018年2月,青岛大学医学院附属烟台毓璜顶医院血管外科收治1例67岁男性感染性腹主动脉瘤患者。入院后血管外科给予腹主动脉腔内隔绝术、右腋动脉-双股动脉人工血管旁路+感染性腹主动脉瘤切除+支架取出术,同时积极抗感染。人工血管旁路术后7 d,患者人工血管表面皮肤红肿破溃,有脓性分泌物溢出,诊断为人工血管窦道愈合不良。笔者科室医师联合血管外科医师早期在局部麻醉下行人工血管窦道切开清创+负压封闭引流(VSD)术,待局部感染控制、创面血运改善后,Ⅱ期在全身麻醉下行人工血管窦道切除+人工血管部分改道+局部皮瓣推进术。手术后切口愈合良好,患者顺利出院。随访6个月,患者皮瓣外形良好,创面愈合可。本病例提示确诊感染性腹主动脉瘤人工血管窦道愈合不良后,积极开放感染窦道,采用VSD技术处理肉芽创面,随后对植入的人工血管进行改道,制备新鲜的局部皮瓣覆盖人工血管,创面覆盖新型银离子敷料,可取得较佳疗效。
Abstract:In February 2018, a 67-year-old male patient with infected abdominal aortic aneurysm was admitted to the Department of Vascular Surgery of Yantai Yuhuangding Hospital Affiliated to Qingdao University Medical College. After admission, abdominal aortic endovascular exclusion surgery, right iliac artery-double femoral artery vascular bypass+ infected abdominal aortic aneurysmectomy+ stent removal surgery, and active anti-infective treatment were performed in the department of vascular surgery. Seven days after the vascular prosthesis bypass surgery, the surface skin of the vascular prosthesis of the patient was red and swollen, and there was a purulent discharge, which was diagnosed as poor healing of sinus of vascular prosthesis. Surgeons of our department and the department of vascular surgery performed incision and debridement of sinus of vascular prosthesis+ vacuum sealing drainage (VSD) in the early stage under local anesthesia. After the local infection was controlled and wound blood supply was improved, stage Ⅱ surgery of resection of sinus of vascular prosthesis+ vascular prosthesis partial diversion+ local flap propulsion under general anesthesia was performed. The incision healed well after surgery, and the patient was discharged smoothly. During the follow-up of 6 months, the patient′s flap was in good shape, and the wound was healed. This case prompts that after the diagnosis of infected abdominal aortic aneurysm vascular sinus poor healing, we can actively open the infected sinus, use VSD technology to treat granulation wounds, then divert the implanted vascular prosthesis to prepare fresh local flap which covers the vascular prosthesis, and use new silver ion dressing to cover the wounds, thus achieving satisfactory results.
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