静脈うっ滞性潰瘍に対するｖａｃｕｕｍ‐ａｓｓｉｓｔｅｄ ｃｌｏｓｕｒｅの１例 [in Japanese] Vacuum-assisted Closure for a Venous Stasis Ulcer [in Japanese]
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静脈うっ滞性潰瘍の治療は外科的手術，圧迫療法による下肢静脈高血圧の是正が重要である．今回われわれは感染を伴う一次性静脈不全症による難治性静脈うっ滞性潰瘍に対し，不全穿通枝を結紮し下肢うっ滞を改善した後，vacuum-assisted closure（以下VAC）を併用し良好な創治癒を得ることのできた症例を経験した．症例は78歳女性，以前より左下肢静脈瘤を自覚していた．1 年前より左下腿潰瘍が出現し外来通院処置を受けていたが改善せず静脈瘤加療目的にて入院となった．潰瘍部のデブリードメントを行った後，局所麻酔下に左大伏在静脈高位結紮術および大腿中央部，下腿 2 箇所に対し小切開下不全穿通枝結紮術を施行した．術後 1 日目よりVACを装着した．術後10日目には潰瘍部の良好な肉芽増生を認め，さらに術後20日目には上皮化も認めた．術後22日目VAC終了とし，術後27日目退院となった．術後 2 カ月目には創部の完全治癒が得られ，以後再発は認めていない．
Venous stasis ulcer is a disease which is often encountered on medical examinations. It is difficult to treat and has a high rate of recurrence. We experienced a case which good wound healing was able to be obtained by using vacuum-assisted closure (VAC) for an intractable infected venous stasis ulcer. A 78-year-old obese female who had a history of primary varicose veins in her left lower limb complicated by a venous stasis ulcer. The ulcer was not covered by bandage and conventional gauze dressing for 1 year or more and it was accompanied with gangrene. <i>Staphylococcus aureus and Morganella morganii ssp</i> were detected from incubation of specimens of the wound.<br>After having done surgical debridement of the sphacelus, we performed ligation to the sapheno-femoral junction and 2 lower perforating veins under local anesthesia. We started VAC for the ulcer from the past postoperative day (POD 1). Good granulation of the ulcer was accelerated on POD 10, and the reduction of the ulcer was recognized. Furthermore, the epithelization of the wound progressed on POD 20. She was discharged on POD 27 and the complete healing of the ulcer was at 2 months postoperatively.<br>We were able to obtain the comparatively early healing of a venous stasis ulcer by using VAC. It was considered to be a useful method for venous stasis ulcer.
- Japanese Journal of Vascular Surgery
Japanese Journal of Vascular Surgery 16(7), 803-807, 2007
JAPANESE SOCIETY FOR VASCULAR SURGERY