傷口大師

    今天上台北參加外科醫學會年會，發表了三篇海報，這是第一篇，為一個案報告，今年的海報受限於場地，變得好小。看官往下看時要小心，會有限制級的照片。

   STSG的植皮區一旦受到感染，便容易導致植皮失敗。含銀敷料據研究可以降低感染，可在傷口上發揮抗菌的能力。 在這個研究中，作者評估一種含銀敷料（ KoCarbonAg®含銀活性碳纖維，BCT，科云生醫科技，此為台灣製造）在已受到感染的STSG植皮區的功效。

個案報告：
   一個76歲的女性，過去病史有糖尿病，高血壓，心臟病及周邊動脈阻塞疾病， 在2011/11/26因右腿紅腫痛一天，來院求診，隔天因產生水泡，診斷為壞死性筋膜炎，經過四次的筋膜切開及清創手術，患者接受第一次的植皮手術，但因韌帶露出，只有一半的皮膚缺損被治療。患者於2012/1/11出院，此時，仍有12*8平方公分的開放傷口。在過完農曆新年後，患者於1/27再次住院，並於2/9接受第二次的STSG植皮手術。然而，傷口感染卻在手術後第三天發生，有膿樣的滲液產生，並且大部分的種上去的皮膚都被吃掉。直到術後第6天，我們才開始使用KoCarbonAg®抗菌敷料（一種銀敷料）。
結果
   使用銀敷料3天後，感染改善，傷口變乾及沒有膿瘍，種上去的皮膚也逐漸開始生長，患者於2/24拆線（釘子）後出院，於3/5門診第一次追蹤時，傷口已完全癒合。
討論：
   也許STSG植皮區在遭受感染時 ，使用KoCarbonAg® 抗菌敷料或其他銀敷料可以增加STSG植皮區的存活。

2011/11/28 necrotizing fasciitis

2012/12/16 接受NPWT中

12/28 植皮後，仍有12*8cm因筋膜無法植皮

2/15剛補完皮第6天

2/16 使用銀敷料，膿瘍仍很多

2/18 膿瘍明顯變少，傷口變乾

2/20 沒有滲液

2/24 出院

3/5 OPD回診
附上Abstract原文如下:
Purpose:
Some Split-thickness skin grafts (STSGs) can form infections in the area of the wound leading to the failure of the graft. Silver-coated dressing is reported to reduce infection and exhibit antimicrobial activity in wounds. In this study, the author evaluated the efficacy of silver-coated dressing on infected split thickness skin graft using KoCarbonAg® antimicrobial dressing which is a silver-coated active carbon fiber made in Taiwan.
Materials and Methods:
We report a case of necrotizing fasciitis with massive skin defect. The 76 year-old female with past history of DM, PAOD, HTN, CHF is well until 2011/11/26 when she suffered from right thigh erythema and pain for 1day followed by buttock abscess. Necrotizing fasciitis was diagnosed. After 4 times of fasciotomies and debridements, STSG was performed on half of her skin defect of right lower limb. Then she was discharge on 2012/1/11 with open wound about 12*8cm² left. After Chinese New Year, she was admitted again on 1/27 and received another STSG on 2/9. However, this time, wound infection developed 3 days post OP. Purulent drainage developed and most of the skin graft breakdown. Not until day 6 post OP did we start to use the KoCarbonAg® antimicrobial dressing (a kind of silver dressing).
Results:
3 days after the use of the silver dressing, the infection improved and the wound became dry without pus. The skin graft began to grow gradually thereafter. She was discharge on 2/24 after removal of all staple. The wound healed on the following OPD day (3/5).
Conclusion:
KoCarbonAg® antimicrobial dressing or other kind of silver dressing may be effective in promoting STSG survival when infection develops.