Preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid of foot and ankle wounds improves outcome of reconstructive skin flap surgery

Abstract

Objectives: By observing the infection and soft tissue defect on the wound surface of the foot and ankle, this paper attempts to explore the effect of preoperative irrigation and vacuum sealing drainage with antibiotic-containing drainage fluid (abPI-VSD) on the bacterial quantity and the local inflammatory response at the flap, and further to provide a basis for applying this technique before a reconstructive skin flap surgery of foot and ankle wounds.

Methods: Seventy-five patients were randomly divided into two groups, and all surgeries were done by one physician. The flap reconstructions were done to 31 cases with the abPI-VSD being used (group A); the flap reconstructions were done to the rest 44 cases after wound cleaning using antibiotic irrigation solution without the use of the abPI-VSD (group B). Quantitative bacteriology was made to group A before and after the use of abPI-VSD; quantitative bacteriology was made to group B before and after wound cleaning. Then, the reconstructive skin flap surgery was done. After the surgeries, the time of local inflammatory response at the flap in both groups were recorded. The measured bacterial quantity was evaluated in logarithm and by t test.

Results: The bacterial quantity was 3.2 ± 1.9 × 10⁷ cfu/g in group A before the use of abPI-VSD and 2.3 ± 2.0 × 10⁷ in group B (P > 0.05) before debridement. The bacterial quantity was 1.2 ± 2.0 × 10⁴ cfu/g in group A after abPI-VSD and was 2.9 ± 4.0 × 10⁶ in group B after wound cleaning (P < 0.05). The time of postoperative inflammatory response in the flap was 8 ± 2.5 days in group A and 13 ± 3.4 days in group B (P < 0.05).

Conclusions: abPI-VSD can distinctly reduce the bacterial quantity on the surface of the wound, provide a good condition of tissue bed for the flap reconstruction, and effectively control the local inflammatory response at the flap and hence improve the survival quality of the flap.

Keywords: Bacterial infection; Flap reconstruction; Inflammatory response.

Fig. 1

a Summary of the abPI-VSD procedure. b Image of abPI-VSD implemented on a patient with traffic accident. The shown components of the abPI-VSD system include (1) main tube connected to the medical suction unit and a drainage container, (2) two-way connector, (3) main drainage pipe, (4) gentamycin-containing irrigation solution supply, (5) multi-hole foam cushion that is placed over the wound through which the drainage fluid is passed (arrows indicate direction), (6) tube that drains the fluid, and (7) breathable film for adhesion and sealing

Fig. 2

a Wound changes before and after PI-VSD application. Squeezing the soft tissue defect, the wound is red and swelling and has a smell (left side). After radical debridement through PI-VSD for 1 week, the wound is clean, the granulation tissue is fresh, and the infection is controlled (right side). b Quantitative bacterial before and after PI-VSD application. The quantitative bacterial before and after PI-VSD application is 0.9 × 10⁷ cfu/g (10,000×) (left side) and 6.5 × 10⁴ cfu/g (100×) (right side). The bacterial quantity is obviously reduced

Fig. 3

After flap surgery, the flap is good, red and moist, not swelling, without exudation and with normal temperature. The granulation on the foot dorsal front side is fresh. Medium thickness flap is used to do the skin graft; the skin graft survives and is in good condition