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Questions and Answers

What are the common complications of open fracture?

Answer: 

1. Infection

2. Thrombosis

3. Muscular and soft tissue necrosis

4. Blood injury and nerve damage

5. Osteofascial compartment syndrome

6. Delayed fracture healing or un-healing (bone un-union)

What is the infective rate of open fracture?

Type I 2 %

Type II 7 %

Type IIIA 7 %

Type IIIB 10-50 %

Type IIIC 20-50 %

Infective rate is varied in accordance with Gustilo types. The results come from literatures in JBJS (Journal of Bone and Joint Surgery--American), which is the most praised information source by orthopedists and researchers in the past 100 years, and also the golden standard for peer reviewed scientific information in the filed of orthopedics.  

What are Gustilo types?

Answer: Gustilo types of open fracture

Type I: Wound size is less than 1 cm, and mostly are clear puncture wounds. Bone tip got through skin, soft tissue injury was slight, and there was without contused injury. The bone fracture was simple, mostly in transverse type or short oblique type, and without crushing.

Type II: Wound size is more than 1 cm, soft tissue injuries are wide, and there was without formation of tissue flap. Soft tissues were with slight or moderate crushing injury, wound was with moderate infection and crushing fracture.

Type III: Soft tissue injury was wide, including serious infection of muscle, skin, blood vessel and nerve. 

Type IIIA: There were wide avulsion injury and formation of tissue flap, or high energy injury. No matter how big is the size of wound, bone fracture area should be covered with soft tissues.

Type IIIB: There were wide soft tissue injury and defect, periosteal stripping, bone exposure and severe infection.

Type IIIC: Concomitant with artery injury requiring recovery. 

What are the most common skin grafting methods? After what kinds of skin grafting can VSD be used?

Answer: The most common skin grafting methods include autologous skin graft, allogeneic skin graft and xenogeneic skin graft. Autologous skin graft includes free skin grafting and skin flap transplantation. Free skin grafting includes epidermal skin graft, split-thickness skin graft and full-thickness skin graft. Skin flap transplantation includes free skin flap and pedicle skin flap. VSD can be used after free skin grafting, allogeneic skin graft and xenogeneic skin graft

What are the most common causes of skin-grafting failure?

Answer: Infection, poor body condition, poor wound condition, bleeding, graft movement and improper pressure, poor quality of skin graft

What are the advantages of VSD after skin grafting?

Answer: Anti-infection, increase blood circulation at skin grafting area, extract exudates and hematocele, closely adhere skin graft to receiver field, avoid graft floating, be easy to solve problems for difficult fixation on complex skin grafting area, so VSD can improve survival quality of skin graft. Moreover, it can relieve patient’s pain during dressing change, and reduce work load of medical staffs. 

What should be noticed for VSD after skin grafting?

Answer: Negative pressure should be maintained at -0.017to -0.06MPa. Collapse of VSD materials indicates presence of negative pressure. Do not compress or fold drainage tube. Make sure drain is not block drainage tube. The materials can be rinsed or changed. Pay attention to the property and amount of drain. 

Can drainage tube be rinsed after skin grafting?

Answer: It is suggested to use washing pipe slowly rinsing drainage tube, in order to prevent blockage (saline infusion bag). 

What is the conventional treatment method after wound infection?

Answer: Remove foreign matter, change dressing in open environment, and take complete drainage, systematic antibiotic treatment and nutritional support. 

Does it need to wash infected wound after VSD treatment? How to wash?

Answer: If there are more exudates at infected wound, it is suggested to use type B product. It needs to slowly and continuously rinse drainage tube by washing pipe, in order to prevent blockage (saline infusion bag is used). Drainage tube cannot be used for type A product. 

How to manage infected wound after being treated with VSD?

Answer: Wound can be immediately cured at stag I. At stage II, suture can be made, and skin grafting, skin flap operation and muscular flap operation can be taken, if necessary.

What are the reasons for common wound infection?

Answer: Serious infection, untimely and incomplete debridement, incomplete drainage, improper treatment, hospital cross infection, etc. 

What are the advantages of taking VSD for treating infective wound?

Answer: Effectively cover wound, avoid cross infection, complete drainage, remove bacterial medium, and effectively control infection. It can inhibit bacterial growth under negative pressure. 

How is VSD used for treating soft tissue defect?
Answer: 1. It can be immediately used after stage I debridement until proliferation of fresh granulation and reduce of wound area. Skin grafting and flap transplantation can be used to recovery wound surface. 
2. If VSD is not used at stage I and wound surface is infected, VSD can be used for two or three times after debridement, and stage II operation can be taken after infection control and proliferation of granulation. 

Answer:1. It can be immediately used after stage I debridement until proliferation of fresh granulation and reduce of wound area. Skin grafting and flap transplantation can be used to recovery wound surface.

2. If VSD is not used at stage I and wound surface is infected, VSD can be used for two or three times after debridement, and stage II operation can be taken after infection control and proliferation of granulation.

3. It can replace traditional oil gauze during skin grafting. 

2. If VSD is not used at stage I and wound surface is infected, VSD can be used for two or three times after debridement, and stage II operation can be taken after infection control and proliferation of granulation. 
3. It can replace traditional oil gauze during skin grafting. 
What are the principles of treating soft tissue defect?

Answer: Take timely and correct debridement, prevent infection, and try to close opened wound surface in order to decrease defect areas. 

What is the biggest problem during the treatment of soft tissue defect?

Answer: Wound infection can lead to further expansion of defected area. The bigger the defect area, the slower the wound recovery is, and the more difficult is to take operative recovery. The longer the recovery time, the poor the postoperative functional recovery is. 

What is the biggest problem for VSD treating soft tissue defect?
Answer: Pay attention to make complete debridement and blood supply at wound surface. The poor blood supply can directly affect wound recovery.
 
Answer: Pay attention to make complete debridement and blood supply at wound surface. The poor blood supply can directly affect wound recovery.
 
Answer: Pay attention to make complete debridement and blood supply at wound surface. The poor blood supply can directly affect wound recovery.
How is VSD used to treat soft tissue defect at stage II?

Answer: Stage II recovery should use skin flap. It may only need skin grafting after taking VSD at early stage. After skin grafting, VSD can replace conventional pressing package. 

What advantages of VSD are in use of soft tissue damaged or wound surface?

Enhance the wound bet quality, prevent and control infection and accelerate the union of wound surface. 

Can VSD cause compression and necrosis of tissues surround wound?

Answer: No. the high negative pressure of VSD can be conducted on medical foam materials through drainage tube, and equally distributed on the surface of medical foam that avoid suction of organs and tissues induced by traditional vacuum drainage, or ischemia, necrosis, perforate or other complications induced by compression. 

What are the contraindications of VSD treatment?

Answer: The drained area is with active bleeding, cancerous ulcer, and coagulation disorders (be caution with anaerobic infections). 

Why is granulation growth promoted under negative pressure?

Answer: Clinical and experimental studies shows that blood flow peak of granulation is 3 times higher than basic blood flow peak under -16 kPa, and is difficult to decrease. After taking negative pressure for 15 minutes, blood flow volume is 3 times of basic blood flow. The acceleration of blood flow can promote granulation growth. 

How about the clinical application of VSD technology?

Answer: VSD technology (called VAC technology in American) is widely used in clinical treatment of wounds. Professor Qiu Fazu gives a high appraise on VSD technology, which is widely used in China, and also used for surgical drainage. The technology is with high practicability, easy to operate, and obvious efficacy, and gets high reputation from clinical staffs. Further studies should be taken about its application in other areas. 

Why is VSD materials not fixed with suture? Is the fixation firm?

Answer: Materials can be sutured or fixed on skin surface with common suture; the fixation is firm and rarely fall off. 

What are the reasons for semi-permeable membrane cannot being pasted on the skin firmly or cannot pa

Answer: It may be caused by improper treatment on wound surrounding. Treatment on wound surrounding should meet the requirement that the area surrounding wound should be dry as pasting semi-permeable membrane; after wiping with 0.9% sodium chloride injection and medical alcohol, the wound should be wiped with dry gauze; VSD materials should not be squeezed as pasting, in order to avoid moisture wetting wound surroundings. If there is lots of abrasion and exudation on wound surrounding, the wound should be covered with gauze and then pasted with semi-permeable membrane. 

What to do about air leakage, if negative pressure is incomplete after pasting semi-permeable membra

Answer: It should be careful and with patience for pasting and carefully examines the folding part of semi-permeable membrane and pasting area of drainage tube. The recommended sealing methods for drainage tube include mesentery method, opposite pasting method and suture method. It is suggested to take “dumpling” method for treating wound at four extremities. Take close observation on wound surface, in order to find the leakage area, and then take pasting treatment. Note: It cannot ensure complete sealing for large wound due to more materials and large area. There is local negative pressure and it can achieve vacuum drainage efficacy. And attention should be paid to daily nursing round. 

Can VSD drainage tube be cut?

Answer: VSD drainage tube can be cut. But the drainage hole should note be too large, otherwise the ability will decrease for tube wall resisting negative pressure, and drainage tube will be blocked. As design VSD materials, port of drainage tube and lateral hole should be within VSD dressings, in order to avoid blockage after exposure. 

Can VSD materials be reused?

Answer: VSD materials cannot be reused, but drainage tube and T-junction device can be reused after strict disinfection. Supplier can provide sufficient drainage tubes and T-junction devices in common condition. 

Where can we buy VSD materials? Does anyone give guidance?

Answer: There are many distribution outlets or agents of Wuhan VSD Medical Technology Co., Ltd, and professionals will guide you to be familiar with or comprehend the characteristics and operation of the technology. If you have any question, please visit our website WWW.VSD-VAC.COM, or contact us (Phone: 4008-820-210), and we will make comprehensive introduction. 

Can VSD be directly used before debridement?

Answer: VSD materials cannot be used before debridement, and drainage cannot replace debridement. 

Can VSD be used after vascular repair surgery?

Answer: For patients with complex injury, VSD can be used to avoid wound infection and necrosis and increase operative success rate after vascular anastomosis. Negative pressure can be adjusted according to circumstances, and is suggested to be less than -120 mmHg for special areas.

How about is without central vacuum suction?

Answer: If there is without central vacuum suction, you can choose ordinary vacuum aspirator. The negative pressure should be maintained at -120 mmHg to -450 mmHg, in order to prevent element wear induced by long-term use of aspirator, and the element should be changed every 3 to4 hours. It is suggested to take designated vacuum aspirator, but not spring vacuum aspiration devices.

Can drainage tube in VSD materials be replaced by ordinary medical drainage tube?

Answer: No, drainage tube in VSD is made of special materials, which are hard and difficult to deform as resisting to higher negative pressure. Ordinary medical drainage tube cannot resist higher negative pressure, becomes deformity and blockage, and finally induce obstruction and operation failure.

Can VSD materials be replaced by gauze and ordinary sponge?

Answer: VSD indicates to vacuum sealing drainage. Clinical test is carried out for replacing VSD materials by gauze or ordinary sponge, but the efficacy is poor, and cannot achieve better curative efficacy. Wound excretion will be remained or obstruct drainage, so it is suggested not change VSD materials by gauze or other materials.

How about VSD materials are remained in human body?

Answer: VSD materials are made of special polyvinyl alcohol, and have good biocompatibility. They are seldom with obscission. Little VSD materials in human body cannot induce common complications of foreign matter residue. It should wash wound surface during operation, in order to prevent retention of foreign body.

How to preserve residual VSD materials?

Answer: VSD materials are disposable materials. It is not suggested to preserve VSD materials, in order to prevent infection.

 

What needs to notice for designing VSD materials?

Answer: Firstly, VSD materials should cover wound surface, in order to prevent wound exposure or insufficient drainage. The foam width between drainage tubes should be not more than 2-3 cm, in order to maintain sufficient negative pressure on foam. Multi-port drainage tube and lateral holes should be within foam, in order to avoid exposure and drainage tube blockage. Thin film should cover the healthy skin at 3 to 4 cm around the wound.

How about is VSD materials being placed for a long time and becoming dry?

Answer: Try to avoid materials being exposed in air for a long time. If the materials become dry and hard, please soak them in 0.9% sodium chloride solution for several minutes (note: do not soak in alcohol, and the materials will be dissolved with alcohol).

How long a VSD material can be used?

Answer: Disposable VSD can maintain effective drainage for 3 to 10 days, and is always removed or changed 5 to 7 days later (do not more than 10 days). It should determine specific use and change time according to wound condition.

What are the reasons for wound pain or discomfort during treatment?

Answer: These symptoms may be induced by higher negative pressure, and can be relieved by decreasing negative pressure. Please notice peripheral circulation. But the conditions of wound infection aggravation and vascular nervous system damage should be excluded. If necessary, please complete relevant examination by physician.

If the VSD material broken and wound exposed, how can we fix that?

Answer: Drainage tube can be fixed with bandage after operation, in order to avoid drainage tube twist and semi-permeable membrane torn induced by patient movement. Patients can be fixed with plaster during internal and external fixation. If there is injury, wound surface should be immediately covered, in order to avoid infection. If necessary, please change VSD material under sterile condition, and take vacuum aspiration again. 

Is negative pressure maintained at good condition?

Answer: If the collapsed VSD materials are recovered, there is effusion under film, indicating failure negative pressure. If some VSD materials become harden, vacuum drainage tube is closed temporarily. If VSD materials are recovered, it indicates existence of negative pressure. If VSD material still collapses, it indicates existence of effusion, indicating failure negative pressure or blockage of drainage tube for VSD materials. It needs to change dressing or wash tubes, etc. 

Can drainage tube be washed after VSD treatment?

Answer: Under normal condition, if negative pressure maintained at good condition, and drainage is smooth, please take specific treatment. If drainage tube is blocked, please take 

Can vacuum suction be temporarily closed?

Answer: If there is specific condition, clipper or relevant instrument can be sued to close drainage tube for a certain time. Please connect, if necessary, to avoid untimely drainage caused by wound secretion. 

Does it need to change VSD materials, if there is foul smell?

Answer: Because of little necrotic tissues and exudates residues, VSD care materials is smelly through the semipermeable membrane, and VSD care materials looks yellow-green, green pus, dark or other dirty color, but it is not caused by necrotic tissues at wound surface, and it cannot affect clinical efficacy of VSD. After carefully observing condition of VSD negative pressure, it does not need to take specific treatment under good vacuum sealing. It needs to differentiate with wound necrosis or sever infection. 

What should be observed and recorded during VSD treatment?

Answer: During VSD treatment, medical staffs should pay attention to following conditions besides of observing patient’s vital signs. 

1. Is pressure of negative pressure source in specific range (-125mmHg to -450mmHg; -0.017 to -0.08 MPa).

2. Is VSD material collapsed, or is negative pressure effective?

3. Is lots of fresh blood aspirated? Please take transparent suction bottle and suction tube to observe characteristics and volumes of drain.

4. Is drain smooth, in order to avoid blockage?

How to examine air leakage area, if there is air leakage on VSD surface?

Answer: Common air leakage areas were at mesentery sealing part of drainage tube or buckle fastening nail, T-junction part, the area with lots of exudates but not having negative pressure, skin fold, or the area without past due to irregular pasting. Press ear close to semi-permeable membrane and find the air leakage point, or pinch susceptible points to observe whether there is air leakage points. You should find the reasons of air leakage, and corresponding treatment should be taken. 

Is there complication for longer pasting time of semi-permeable membrane?

Answer: In general, there is without skin injury for pasting thin membrane on normal skin within 10 days. But some patients are with tension blisters on skin areas pasted with thin membrane, and seldom are with folliculitis. As pasting thin membrane, tension blisters can be avoided without stretching local skin excessively. Folliculitis are mainly found in the part with effusion for a long time or repeatedly pasted with thin membrane. Effusion under thin membrane should be avoided and treated immediately. The same place should not be pasted with thin membrane repeatedly, and the skin should be cleared as changing drainage tube. It is an effective method to prevent from folliculitis. Even if there is folliculitis, it can be cured after removing thin membrane. 

Is it normal with drain in drainage tube?

Answer: There is without drainage of drain, which is commonly found at about 4 days after operation (be determined according to wound condition). As drainage tube is smooth, and negative pressure source is normal, if there is without drain, it may be the normal condition that there is less secretion after wound healing. 

Is it necessary to take bacterial culture of wound excretion during VSD treatment? How to do?

Answer: Bacterial culture is the routine method for surgical treatment. It can effectively observe the condition of infection. Proper antibiotics can be selected according to results of drug allergy, and it is good for anti-infection treatment of server wound injury. It is not necessary to open VSD materials as extracting wound excretion, which can be extracted through drainage tube. After extracting, conventional iodine disinfection was taken for drainage pipe interface. And if necessary, the extraction can be carried out when replacing the VSD materials.

How about VSD is used for treating open fracture?

Answer: We mainly introduced the treatment of serious open fracture. Main procedures of treating open fracture (Gustilo III): 1. Debridement; 2. External fixation of bone fracture; 3. Examination of blood vessel, and corresponding examination should be taken for vascular injury. Examination and treatment on nerves should be also taken. 4. Incision of fascia compartment to reduce pressure. 5. Wound surface was treated with VSD. Notes: Take debridement according to specific condition of injury. After corresponding fixation on bone fracture, measures were taken to prevent osteofascial compartment syndrome; VSD materials were placed on wound surface, or at the place with bone exposure according to condition of injury, and VSD was taken. We should pay attention to: during design and placing VSD materials, it should avoid improper place of materials, which can compress blood vessel, nerves and skin, and induce tissue necrosis. It is better to place materials along vascular direction and skin texture.

What are the principles for treating open fracture?

Answer: Take timely and proper wound treatment to prevent from infection, change open fracture to close fracture (Surgery in General Practice, the 7th Edition)

What is the biggest risk for open fracture?

Answer: Wound is infected and invaded by lots of bacterium, which can reproduced quickly and induce bone infection (Surgery in General Practice, the 7th Edition)

What should be paid attention to for treating open fracture with VSD?

Answer: External fixation is pasted and sealed, in order to prevent air leakage; preventive rinse can prevent blockage; it needs to observe wound and prevent active bleeding. 

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