Surgical Treatment of Carbuncles-A Single Center Study with 10 Year Experience

癰的手術治療－一家醫學中心的十年經驗

張惇皓(Dun-Hao Chang) ； 謝綺瀅(Chi-Ying Hsieh) ； 陳右昇(Chen Yo-Shen) ； 張克中(Ke-Chung Chang)

《臺灣整形外科醫學會雜誌》 28卷2期 (2019/06) Pp. 107-118

摘要

Background: Carbuncle is a common skin and soft tissue infection that is usually caused by Staphylococcus aureus. The principles of treatment of carbuncles involve early aggressive surgical debridement and appropriate antibiotic cover. However, only a few studies have discussed the techniques of surgical debridement, and there is no relevant publication in Taiwan. In general, opinions on the surgical treatment are divided between simple incision and drainage and saucerization. Aim and Objectives: To describe the surgical method called ＂skin-preserving radical excision＂ to treat carbuncles with the aim to control the infection in a single operation, with minimal skin defect and decreased necessity of skin grafting. Materials and Methods: Patients with carbuncles who underwent skin-preserving radical excision at our hospital between January 2007 and December 2016 were included. Data on the patient characteristics, affected sites, lesion diameter and area, laboratory examinations, results of microbiological tests, methods of wound closure, number of surgical interventions, and outcomes were obtained from their medical records. Results: A total of 46 carbuncles from 36 patients and 37 hospitalizations were recorded. All patients were treated successfully without mortality, and no patients showed recurrence in the follow-up. The average length of hospital stay was 12.8 ± 6.3 days. The patients underwent an average of 1.3 ± 0.6-times debridement and 2.0 ± 1.0-times total surgery. Most patients achieved wound closure by primary closure (41.3%) and secondary healing (37.0%), and 17.4% and 4.3% patients needed skin grafts and local flaps, respectively. Conclusions: Skin-preserving radical excision can adequately control infection within a debridement surgery procedure without causing large skin defects. Combined with an appropriate antibiotic coverage, this technique is a reliable, feasible surgical method to treat carbuncles.

關鍵字

carbuncle ； surgical treatment ； debridement

並列摘要

背景：癰是一種常見的皮膚軟組織感染，致病菌通常為金黃色葡萄球菌。治療的原則包含早期且積極的清創和適當的抗生素使用。然而，過去很少研究討論到相關的手術技巧或是方法，在台灣也沒有相關的文獻報告。一般來說，有兩種方法最常被採用：簡單的切開引流或是廣泛的碟形切除術。目的及目標：我們提出過去所採用的一種手術方法來治療癰：皮膚保留廣泛性切除術。我們的目標是在一次清創手術中就能控制感染，而且盡量減少皮膚缺損的面積，來避免後續的皮膚移植。材料及方法：從2007年1月至2016年12月，我們蒐集了經“皮膚保留廣泛性切除術”治療的癰的病患。病患的基本資料，病灶部位、大小及面積，血液及微生物檢驗的結果，傷口關閉的方法，總手術的次數及結果都列入統計分析。結果：總計我們蒐集了36位病患合計37次住院及46處癰。所有的病患都治療成功，沒有病患死亡或是復發。平均住院天數為12.8±6.3天。病患平均接受1.3±0.6次清創和總計2.0±1.0次手術（包含重建）。大部分的病患達到傷口癒合的方法為：直接縫合（41.3%）及次級癒合（37.0%）。而17.4%的病患需要皮膚移植，4.3%的病患採用局部皮瓣。結論：皮膚保留廣泛性切除術可以順利的於一次手術中控制感染，而且不會造成過大的皮膚缺損。合併使用適當的抗生素之下，這是個可信賴且有效的手術方式於癰的治療。