Closed lavage, negative pressure drainage

Spine and suppurative infections are effective in the treatment of adequate antibiotics throughout the body. Complete removal of lesions and adequate drainage are important surgical principles. Closed lavage, negative pressure drainage is to remove the double tube into the wound after the lesion is cleared, the incision is completely closed, and an effective antibiotic solution containing a certain concentration of antibiotic solution is used for continuous lavage drainage. This method has the following advantages: 1 continuous lavage can effectively dilute the pus, so that the necrotic tissue is detached, can be smoothly discharged through negative pressure drainage, keep the wound clean, inhibit bacterial sensitization, form a sterile environment, and use granulation to grow. And wound healing; 2 reduce intra-articular adhesions; 3 wounds completely closed, to prevent secondary infection, can achieve first-stage healing; 4 is conducive to postoperative functional recovery. The clinical application is extensive, not only can be used as adjuvant therapy, but also can be used as the main treatment method, so it is described in a single section. Treatment of diseases: osteomyelitis Indication 1. The residual cavity of the acute, chronic osteomyelitis, the residual cavity and the dead cavity can not be treated by filling, but the wound must be tightly sutured. 2. Acute septic arthritis has pus exudation, and the early effect is better. 3. Bone and joint tuberculosis combined with sinus and secondary infection. 4. After the bone and joint surgery, early fixation and late infection after internal fixation and prosthetic replacement. 5. Open bone and joint damage with serious pollution. Preoperative preparation 1. Apply antibiotics for 1 to 2 weeks before surgery to control infection. It is best to do a pus bacterial culture and antibiotic susceptibility test first. The general condition should be improved. Local acute inflammation should cause it to completely resolve. 2. If the scope of surgery is large, a certain amount of blood should be prepared for intraoperative application. 3. Conventional preoperative examination of the bone and lateral x-ray films to examine the condition of dead bone, dead space and new bone to correctly determine the timing and exposure of the operation. If necessary, the secondary layer should be taken or the sinus angiography should be used as a reference. 4. Preoperative skin preparation must be prepared to reduce the chance of secondary infection and cannot be ignored because it is infected with the wound. 5. If a pathological fracture is combined, it must be treated until the fracture is basically healed. It is estimated that it can be operated when there is enough osteophyte support after removing the dead bone. Surgical procedure Take chronic osteomyelitis as an example. 1. Position, incision, exposure of the lesion, removal of the lesion: the same as the removal of the bone. 2. Trimming the dead space: Use the osteotome to cut the hardened bone into small pieces around the dead space until the color of the bone is almost normal and there is good blood supply. Although it does not need to be cut into a dish, it should be repaired into an open bone cavity. Be careful not to remove too much normal bone, and do not cut it in large pieces to avoid fracture. Then release the tourniquet and use the compression and heat to seep the bone to stop bleeding. 3. Place the double tube: generally use the 18th catheter or 2 to 5mm diameter, 30~40cm long silicone tube, cut 4~5 side holes according to the length of the bottom of the wound, and lay it flat on the wound. On both sides; the other end is taken out of the skin through a small puncture of adjacent muscles and skin, and wrapped with sterile gauze. The tube is sewn and fixed to the skin of the puncture. 4. Stitching: The wound was again washed, the muscle layer was sutured with a chrome gut, and then sutured by layer. The suture is required to be tightly sealed so that the wound does not leak when the lavage is continued. It should be lavaged with physiological saline after the suture is completed, and the suction test can be performed.

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