• Journal of Chest Surgery
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• 제27권7호
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• pp.634-638
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• 1994

Infection of a median sternotomy incision may result in a large, unsightly,unstable,and potentially fatal wound. During the past 8 years, 5 consecutive patients [ 4 male and 1 female ] had repair of infected sternotomy wound. We describe our current preferred techniques and the results we have achieved with them. As soon as the sternal infection was shown, operative wound was opened and irrigated more than 4 times a day with 0.5% Betadine iodine solution until the exudate became clean with no growth of bacteria. Operation was performed in one-stage, which consisted of aggressive debridement of the infected bone and muscle transposition. Reconstruction was with one-side or both pectoralis flaps in all patients and rectus abdominis in 2 patients. There was no mortality or morbidity within 30 days postoperatively. We conclude that early aggressive debridement and muscle transposition remain the treatment of choice for most patients with infected median sternotomy wounds.

• Archives of Plastic Surgery
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• 제34권5호
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• pp.551-556
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• 2007

Purpose: Pseudomonas aeruginosa is an etiologic agent in serious wound infection. Pseudomonas aeruginosa infection is problematic because this organism is resistant to many antimicrobial drugs. The purpose of this study was to compare the bactericidal effect of commonly used topical agents and their effect on wound healing. Methods: Pseudomonas aeruginosa-infected full-thickness skin defect was developed on the mouse to compare 3 commonly used topical agents-Betadine, 2% Gentamicin solution and 0.3% Acetic acid with the control group. Wound size change, bacterial colony counts and histologic findings of each groups were analyzed. Results: The wound size decreased in all treated groups as compared with the control group. However, there was no statistical difference. Gentamicin solution group was showed the lowest bacterial colony count and statistically significant difference compared with the control group(p=0.032). Other treated groups were also effective against Pseudomonas aeruginosa, but not different statistically. Histologic findings revealed that epithelialization, granulation tissue formation and microvessel proliferation were increased and necrosis and inflammation were decreased in all treated groups compared to the control group, but not different statistically. Betadine group significantly increased granulation tissue formation compared to the control group (p= 0.041). Conclusion: There is no universal topical agent that enhances most aspects of wound healing while simultaneously decreasing the bacterial concentration. However, Gentamicin solution may be an optimal topical agent for Pseudomonas aeruginosa infected wound. Further study should experiment on human with Gentamicin solution to confirm a effect on Pseudomonas aeruginosa infected wound for clinical applications.

• Archives of Plastic Surgery
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• 제34권3호
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• pp.305-313
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• 2007

Purpose: Wound healing is a result of complex processes whose components, such as cells, extracellular matrix, proteolytic enzymes, and their inhibitors receive effects from immune compartments, cytokines, chemokines, and growth factors. Impairment of normal physiologic response to wounding makes nonhealing chronic wounds. Wound infection and exacerbated proteolytic process may induce uncontrolled tissue degradation or exudates formation, which may result in the development of a nonhealing chronic wound. Thus proper management of wound infection and exudates is critical to prevent and treat nonhealing wound. The aim of this study is to evaluate effects of Aquacel AG, silver-containing carboxymethylcellulose dressing on treatment for exudative infected wound. Methods: The study included 31 patients with nonhealing wound. Wound was dressed with Aquacel AG. The effect of dressing was investigated by serial bacterial culture and wound exudates assessment. Each infection and exudates control time was determined and statistically analyzed. Results: Wound infection and exudates were effectively managed using Aquacel AG dressing. Mean infection and exudates control time were $3.4{\pm}1.2$ and $5.7{\pm}1.4$ weeks, respectively. Statistical analysis of the data indicated that infection control time correlated positively to age and exudates control time (p<0.05). Conclusion: There is as yet no ideal dressing for the topical treatment of chronic nonhealing wound. But silver-containing carboxymethylcellulose dressing can be used effectively for exudative, infected nonhealing wound.

• Archives of Plastic Surgery
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• 제37권3호
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• pp.227-232
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• 2010

Purpose: Continuous irrigation method is an important step in managing wound infection. V.A.C. devices have been used in intractable wounds for reducing discharge, improving local blood flow, and promoting healthy granulation tissue. We expect synergistic effects of reduced infection and more satisfactory, accelerated wound healing when using both methods simultaneously. This study evaluated continuous irrigation combined with V.A.C. appliance for treatment of infected chronic wounds. Methods: We reviewed data from 17 patients with infected intractable chronic wounds. V.A.C. device (Group A) was used in 9 patients, and V.A.C. with antibiotics irrigation (Group B) was used in 8 patients. We placed Mepitel$^{(R)}$ on the surface of wound and placed an irrigation and aspiration tube on each side. A sponge was placed on the Mepitel$^{(R)}$ and covered with film dressing. The wound was irrigated continuously with mixed antibiotics solution at the speed of 200 cc/hr and aspirated through the wall suction at the pressure of -125 mmHg. V.A.C. applied time, wound culture and wound size were compared between the two groups. Results: No complication were seen in two groups. Compared with Group A, in the Group B, V.A.C. applied time was shortened from 32.7 days to 25.6 days and showed efficacy in the reduction rate of wound size. No statistical differences were shown in bacterial reversion. Conclusion: V.A.C. appliance with continuous irrigation is an effective new method of managing infected chronic wounds and useful to reduce treatment duration and decrease wound size. Moreover it could be applied more widely to infected wound.

• Archives of Plastic Surgery
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• 제35권4호
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• pp.393-399
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• 2008

Purpose: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. Methods: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. Results: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. Conclusion: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.

• Archives of Plastic Surgery
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• 제33권5호
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• pp.632-636
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• 2006

Purpose: Methicillin-Resistant-Staphylococcus aureus(MRSA) has been increasingly recognized as a cause of nosocomial infection. MRSA is hardly-controllable organism among the pathogen of nosocomial infection, because it is resistant to most antibiotics except vancomycin, and local treatment with most antiseptics are not effective to eradicate MRSA from the infection. The effectiveness of Vacuum-Assisted-Closure(VAC) was reported widely. we tried to modify original VAC. We tried VAC dressing on MRSA infected wound to evaluate whether or not the VAC is effective to eradicate MRSA which existed in the open wound. Methods: From September 2003 to December 2003, 24 patients admitted to the plastic and reconstructive surgery and orthopedic surgery, were studied. All patients were found to be positive in previous wound. Using clinical randomized study, 24 patients were divided into two groups: VAC dressing group and the $Betadine^{(R)}$ dressing group(control). During treatment, wound culture was done twice a week for evaluation of MRSA infection elimination. Results: The mean period that MRSA become not detected in all case was 17.1 days in VAC dressing group, and 25.8 days in control group, respectively. The p value was 0.013. The result reveals that the VAC dressing group is more effective to MRSA infection control. As a result, the VAC dressing was more effective in MRSA infected wound than conventional dressing. Conclusion: Through this study, we found objective result of VAC dressing. We hope that VAC dressing is more widely applied to fresh and infected wound.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.359-368
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• 2011

Purpose: Aquacel Ag$^{(R)}$ is a hydrofiber wound dressing integrated with ionic silver. Sorbact$^{(R)}$ is a hydrophobiccoated dressing that uses the hydrophobic interaction with microbes. In this study, we compared the wound healing effects and the antibacterial effects of Medifoam$^{(R)}$, Betadine soaked, Aquacel Ag$^{(R)}$ and Sorbact$^{(R)}$ dressings against MRSA-infected wounds. Methods: Eighty rats were divided into four groups: Medifoam$^{(R)}$; Betadine soaked; Aquacel Ag$^{(R)}$; and Sorbact$^{(R)}$. A $1.5{\times}1.5cm$ square full-thickness wound was made on the dorsum of each rat and infected with MRSA. Twenty-four hours thereafter, each dressing was applied to the wound and changed every other day. One, 3, 7, 11 and 15 days after the wound infection, swab culture grade, wound bed appearance score, and wound defect size change were evaluated, and 7 and 15 days after, histologic evaluation was compared between the groups. Results: The bacteria load of wounds in the Sorbact$^{(R)}$ group decreased earlier than in the other groups. The wound bed appearance score of the Sorbact$^{(R)}$ group also increased quicker, compared with the other groups. However, the size of wounds of the Aquacel Ag$^{(R)}$ group decreased more rapidly, compared with other groups. From the histologic point of view, there was no significant difference between Betadine soaked, Aquacel Ag$^{(R)}$ and Sorbact groups. Conclusion: The hydrophobic dressing using Sorbact$^{(R)}$ showed a more rapid reduction in the MRSA load and an elevation in the wound bed appearance score, but a slower decrease in wound size change due to detachment of wound bed tissue when the dressing was eliminated in the low exudate wound. The silver-containing hydrofiber dressing using Aquacel Ag$^{(R)}$ was more effective in ultimate wound size reduction, but some debris was trapped in the wound tissue and induced foreign body reaction in the high exudate wound. Thus, ongoing selection process of treatment based on the evaluation of the infectious wound state will be very important.

• Archives of Plastic Surgery
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• 제37권3호
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• pp.213-219
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• 2010

Purpose: Iodine has been used for the prevention or management of wound infection as a topical agent. Although iodine was widely used mainly by Betadine$^{(R)}$ and cadexomer iodine, there was no comparative study on the efficacies of dressing methods of iodine. And also it's wound healing effect was not yet clear. The purpose of this study is to compare antibacterial effects and wound healing effects associated with various dressing methods of iodine on infected full thickness skin defect in the mouse. Methods: One full thickness skin defects in the mice (n=60) were developed on the back and left open for twenty-four hours. Sixty mice were divided into four groups : group S (dressing with Betadine$^{(R)}$ soaking, n=15), group T (dressing with Betadine$^{(R)}$ topping, n=15), group I (dressing with Iodosorb$^{(R)}$, n=15), group G (control group, dressing with dry gauze, n=15). The size of the wound defects and the grades of wound healing were evaluated in 4, 7, 10 days, and antibacterial effect was evaluated with restricted zone in Mueller Hinton agar by disk diffusion method. Results: After the wound was left open for twenty-four hours, many Staphylococcus aureus were cultured. The wound defect size was decreased in order of Betadine$^{(R)}$ soaking, Iodosorb$^{(R)}$, Betadine$^{(R)}$ topping and gauze dressing group in all days, but difference among experimental groups was not statistically significant. The grade score of wound healing was increased in order of Betadine$^{(R)}$ soaking, Iodosorb$^{(R)}$, Betadine$^{(R)}$ topping and gauze dressing group, and the difference was statistically significant. Antibacterial effect for S. aureus was increased in order of Iodosorb$^{(R)}$, Betadine$^{(R)}$ soaking, Betadine$^{(R)}$ topping and gauze dressing group, and the difference was statistically significant. Conclusion: Selection of the effective dressing method of iodine for infected wounds remains a controversial decision. According to this study, Iodosorb$^{(R)}$ may be most effective method for antibacterial effect and Betadine$^{(R)}$ soaking may be most effective method for infected wound healing. However, further study is necessary to evaluate the clinical efficacy of dressing methods of iodine and to search for the mechanisms that explain their effects.

• 대한족부족관절학회지
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• 제8권1호
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• pp.26-30
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• 2004

감염된 당뇨병성 족부궤양의 병실내 벽매립형 중앙 흡인 장치를 이용한 창상 밀봉관리로 빠른 창상의 호전을 얻을 수 있었다. 이 창상관리 방법은 빠른 창상의 호전 외에도 비용을 획기적으로 줄일 수 있으며 환자의 동통을 줄이고 병실내 세균 전파의 위험이 적으며 필요 인력 축소 등의 장점이 있으나 말기신장부전 환자에서의 적용은 추가의 연구가 필요할 것으로 사료된다.

• 한국임상수의학회지
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• 제29권6호
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• pp.464-469
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• 2012

Nude mouse의 세균 감염 피부에서 Aureobasidium 유래 ${\beta}$-glucan이 창상 치유에 미치는 영향을 평가하기 위해 본 실험을 실시하였다. 실험 결과, ${\beta}$-glucan은 S. aureus, S. pyogenes 및 P. aeruginosa 에 대해 살균 작용을 나타내지는 않았으나 대조군에 비해 감염 창상 크기를 현저히 감소시켰다. 따라서 ${\beta}$-glucan을 새로운 창상 치유 촉진제로서 고려해볼 수 있을 것이다.