《骨伤科-KCI》-课件.pptVIP

* Attention: focus on orthopedic wounds! * Think of external fixators like any circumferential wound. Do not cut the drape into strips and try to go round and round the pin. Take some stoma paste strips. If you do not have them, use any extra thin hydrocolloid cut into strips. Go up from the skin about 1 inch. Wrap the strips around the fixator pins and pinch to get a good fit. Fill the wound with the appropriate foam and then begin to cover the wound with the drape. When you get close to the pins, start the drape on the foam and then walk the drape up one side of the pin. Do the same from the other side of the pin. Pince the two pieces of drape together to get a seal. Repeat the same process to the other pins until you get a seal. * Consider shaving/clipping the hair to assist in obtaining a seal and ease of removal for patient. * Yes you can get a seal on this type of wound. * If the pins are too low to the skin, the previous technique will not work. In this case, cover the pins and entire structure with some sort of nonadherent that the surgeon ok’s. Once the structure is protected, and the appropriate foam is in the wound, encase the entire area in the drape to get a seal. This is a real time saver to encase everthing. The nonadherent layer makes removal of the drape faster than trying to pick drape off of a titanium structure. If the pin site ends are sharp, a sterile foam cap, or pin cap, or if all else fails, a sterile 2x2 gauze can be used to keep the sharp point from poking through the drape. In some cases, you may need to bridge the Trac Pad outside of the “tent”. * Review the points Photo courtesy of Andrew N. Pollak, MD * 病例2 伊拉克战争爆炸伤 清创后应用V.A.C.? 负压治疗 Photo courtesy of Andrew N. Pollak, MD * 从回顾性分析2004年9月到2005年5月的数据 88例高能量性爆炸伤，立即行广泛根治性清创，冲洗并用VAC 连续手术冲洗和清创直到伤口清洁和一期闭合 伤口感染率：0% 并发症发生率：0% 病例 3 应用V.A.C.? 负压治疗用于筋膜切开术 * Improper placement of TRAC pad. Slide * B1_M2_S12_EN 如何为安装外固定器的病人应用敷料 TIP: Sealing around hardware 针眼部位周围的毛发需要剔除 三文