Effect of Double Layer Lamination Method in Vacuum Sealing Drainage for Treating Poor Incision Healing after Posterior Spinal Surgery

Effect of Double Layer Lamination Method in Vacuum Sealing Drainage for Treating Poor Incision Healing after Posterior Spinal Surgery | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effect of Double Layer Lamination Method in Vacuum Sealing Drainage for Treating Poor Incision Healing after Posterior Spinal Surgery Lishan Huang, Lin Wang, Yanxin Xu, Qihui Luo, Fang Liu, Hui Wu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4173419/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective : To explore the efficacy of the double layer lamination method in VSD for the treatment of poor incision healing after posterior spinal surgery. Methods: Out of the 915 patients hospitalized in our department for posterior spine surgery between January 2021 and December 2022, 41 cases with postoperative poor incision healing treated with VSD were included in the study. The enrolled cases underwent treatment with vacuum sealing drainage and were subsequently divided into study and control groups according to their admission order. Among the cases, 20 in the study group received treatment utilizing the double layer lamination method, whereas the conventional laminating method was employed for 21 cases in the control group. This study compares the incidence of localized skin adverse reactions (skin redness, itching, skin breakdown, blistering), patch leakage, patch replenishment, dressing change, duration of tube placement, and comfort ( pipe pulling pain) at the exit end of the VSD drain in the two groups of patients. Results: The incidence of localized skin redness and blistering at the outlet end of the VSD drain in the test group was lower than that in the control group, and the leakage of the film, the frequency of replenishment of the film and the time of placement of the tube were less than that in the control group, and the comfort was better than that in the control group, and the difference was statistically significant ( P < 0.05). Conclusion: The implementation of the double layer lamination method is beneficial in minimizing the occurrence of localized skin adverse reactions at the outlet end of the VSD drainage tube, reducing film leakage and the need for replenishment, reducing duration of tube placement, enhancing the comfort of VSD drainage, and positively impacting the prognosis of patients. This method exhibits promising potential for extensive application in clinical practice. Double Layer Lamination Method Vacuum Sealing Drainage posterior spine poor incision healing Figures Figure 1 Figure 2 1 Introduction Posterior spine surgery is a highly invasive and complex surgical procedure classified as level IV. It is commonly performed in clinical settings to treat various conditions, including degenerative spine disease, spinal fractures, scoliosis, osteoporosis with pathologic fractures, and other disorders[ 1 ]. Insufficient wound healing at the incision site is a common postoperative complication of spine surgery. Contributing factors to poor incision healing include surgical site wound infections, dural abnormalities, and preexisting comorbidities related to underlying disorders[ 2 ]. The occurrence of insufficient wound healing after spinal surgery ranges from 1.6–12% [ 3 ], and it represents the leading cause of unforeseen secondary procedures, accounting for over 50% of cases[ 4 ]. Insufficient healing of postoperative incisions hinders patients' recovery and unexpected hospital stays prolonging overall hospitalization costs and reducing patient satisfaction with the surgical procedure[ 5 ]. Vacuum sealing drainage technology establishes a sterile negative pressure environment within the wound, facilitating the prompt evacuation of wound secretions, accelerating tissue swelling reduction[ 6 , 7 ], enhancing local blood circulation, stimulating new tissue generation, and ultimately fostering wound healing. The conventional VSD patch employs a single layer that directly covers the outlet end of the drainage tube and adheres to the skin, causing skin irritation and resulting in adverse reactions like pressure-induced redness and blisters, ultimately diminishing patient comfort. However, this approach is prone to air leakage at the VSD drain tube and film loosening, limiting the flexibility of the VSD drain tube. As a result, it increases the risk of skin pressure damage in the tube fixation area and inflates the cost of clinical treatment. This study focused on patients who had undergone posterior internal spinal fixation and experienced inadequate healing of their incisions. The objective of this study was to evaluate the effectiveness and clinical impact of the Double Layer Lamination Method in treating vacuum sealing drainage in patients with inadequately healed incisions following posterior internal spinal fixation. The findings are presented as follows. 2 Methods 2.1 General information During the period from January 2021 to December 2022, a total of 915 patients underwent posterior spine surgery and among them, 41 cases with postoperative poor incision healing and treated with VSD were included in the study. Subsequently, these cases were divided into two groups: the control group and the study group, based on the sequence of their admission. The treatment approach differed between the two groups, with 20 patients in the control group receiving the double layer lamination method , while the remaining 21 patients received the standard lamination method. Table 1 demonstrates that there were no statistically significant differences between the two groups in terms of age, gender, duration of surgery, length of postoperative incision, and comorbidity of diabetes mellitus ( P >0.05). The hospital's Ethics Committee approved this study (Project No. 2021-KZ-236), and all patients provided their informed consent by signing a consent form. 2.2 Criteria for determining poor postoperative incision healing Surgical Nursing (7th edition)[ 8 ] classifies the assessment criteria for the healing status of an incision into three grades. Grade A indicates excellent healing without any adverse reactions during the initial healing process. Grade B is characterized by the possibility of an inflammatory reaction during the incision healing process, presenting symptoms such as redness, swelling, hardness, hematoma, effusion, etc., without the presence of pus. Grade C indicates incision healing involving the formation of pus, requiring the implementation of suitable treatment measures such as a second suture, incision, drainage, etc. Grades B and C are indicative of suboptimal incision healing. 2.3 Inclusion criteria Participants must meet the following criteria: (1) Age over 18 years; (2) First posterior spine surgery; (3) Poor incision healing after posterior spine surgery; (4) Willingness to provide informed consent for voluntary participation in the study. 2.4 Exclusion criteria Patients who met any of the following criteria were excluded from this study: (1) Posterior spinal surgery-related infection caused by anaerobic bacteria; (2) Severe heart, liver, or kidney impairment, or the coexistence of immune diseases and malignant tumors; (3) Pregnancy or breastfeeding status; (4) Diagnosed psychological or psychiatric disorders, or cognitive impairments; (5) Worsening wound conditions or patient withdrawal from the study. Table 1 Comparison of baseline data between the two groups of patients Variable Intervention group (n = 20) Control group (n = 21) χ 2 /t p-value Gender 0.266 0.751 Male 13(65.0) 12(57.1) Female 7(35.0) 9(42.9) Age in years 60.65 ± 13.41 58.57 ± 12.40 -0.516 0.609 Duration of surgery 293.80 ± 164.11 327.57 ± 170.30 0.646 0.522 Incision length 12.80 ± 4.60 13.33 ± 5.10 0.351 0.728 Combined diabetes 0.196 0.751 Yes 8(40.0) 7(33.3) No 12(60.0) 14(66.7) 2.5 Intervention The drainage tube was routinely removed 48 hours after the surgery, and poor healing wound was observed during alternate-day dressing changes. Promptly evaluate the patient's overall nutritional status, incision length, presence of hidden sinus tracts and granulation tissue, and optimize hemoglobin levels (≥ 90g/L), and albumin levels (≥ 30g/L). Adequate regulation of the patient's water-electrolyte and acid-base balance was performed, and imaging confirmed the absence of involvement of deep structures such as nerves, blood vessels, catheters, joints, tendons, or bones in the incision. Following that, VSD was promptly conducted in the hospital ward [ 9 ]. The VSD materials used in this study were specifically disposable wound-protection materials with negative-pressure drainage, supplied by Shandong Chuangkang Biotechnology Co. 2.5.1 Control group (1) Disinfection and debridement:After the ward was sterilized by ultraviolet light for 40 min, the patient was instructed to take a comfortable position to fully expose the location of the wound. Conventional disinfection methods are employed to thoroughly eliminate necrotic or non-functional tissues from the wound and its surrounding skin. For patients sensitive to pain, 5-10mL of lidocaine is administered for surface infiltration anesthesia, then remove inactivated or necrotic tissue from the wound for thorough debridement. (2) Prepare drainage materials: lay out sterile therapeutic towels, put on sterile gloves, sterilize the incision again and leave it to dry. Trim the appropriate medical foam dressing according to the size and shape of the wound. According to the actual size and shape of the patient's incision, cut the head end of the disposable silicone gastric catheter (Terumo disposable gastric catheter SF-GL) into several similarly sized, symmetrically distributed lateral holes. The disposable intravenous infusion needle hose (needle end) with the needle removed is buried into the trimmed gastric tube, and the connecting seat and protective cap are left on the outside of the gastric tube to facilitate postoperative flushing. (3) Placement of drainage materials: Trimmed gastric tubes and scalp syringes are inserted into the middle layer of the foam dressing. Depending on the patient's specific condition, either surface VSD treatment or implantation of the foam dressing into the sinus tract of the incision is selected. (4) Closure of the wound: After placing the drains, clean the skin around the wound and leave it to dry. Choose a piece of bio-transparent film of appropriate size and shape, cover the wound with foam dressing, gastric tube, disposable IV needle hose, the coverage of the translucent film should include at least 2cm of healthy skin around the wound. gently shape the outlet of the VSD drainage tube (gastric tube), and seal the edges of the surrounding edges with a wide breathable adhesive tape or transparent film for sealing and fixation, to ensure that the sealing is not air leakage (Refer to Fig. 1 ). (5) Connect the negative pressure: connect the gastric tube interface to the special negative pressure suction device, follow the doctor's instructions to adjust the negative pressure value, test the foam dressing tightness. 2.5.2 Study group Steps (1) to (3) were the same as those in the control group. (4) Closure of the incision: Cleanse the skin surrounding the incision and position the first translucent membrane accurately over the wound. The upper portion of the membrane should directly contact the foam dressing, gastric tube, disposable intravenous infusion hose, and skin, serving as a protective barrier. The lower part of the transparent membrane should hang without direct attachment to the skin. Fold the second translucent membrane into a symmetrical "U" shape with the adhesive side facing downward. Next, position half of the translucent membrane on the skin at the lower end of the wound with gentle handling to form the foundational membrane. Attach the remaining half of the translucent membrane to the lower section of the initial membrane, encapsulating the VSD drain tube (also referred to as the gastric tube) in a sandwich-like configuration. This arrangement also subtly shapes the VSD drain tube's (gastric tube's) outflow, as illustrated in Fig. 2 . Remove the misaligned opaque membrane using sterile scissors. To ensure airtightness, seal the edges of the tube with wide, breathable adhesive tape or translucent film along its outer perimeter. Step (5) exhibited identical characteristics to the control group. 2.6 Outcome measures The following parameters were compared between the two groups to evaluate the efficacy of the treatment: (1) Assess the occurrence of localized skin adverse reactions, such as redness, itching, skin breakage, and blistering, near the outlet end of the VSD drainage tube. Compare the incidence of these reactions between two groups of patients. (2) Compare the occurrence rate of VSD patch leaking, patch, and dressing change between the two groups. (3) The pain visual analog scale (VAS) was utilized to assess the level of tugging pain experienced during VSD treatment in both patient groups[ 10 ]. (4) Duration of tube placement: the duration of tube placement is defined as the duration from the time the VSD is administered until it is removed. 2.7 Statistical method SPSS 20.0 software (IBM) was used for statistical processing. The distributional normality of the data was tested using the Shapiro–Wilks test and histograms. Using an unpaired Student t-test, quantitative data reported as mean and standard deviation were analyzed. Using the Mann-Whitney test, the median and interquartile range of nonparametric quantitative data were analyzed. When applicable, qualitative variables were expressed as frequency and percentage (percent) and analyzed with the Chi-square or Fisher exact test. A 2-tailed P value of 0.05 or less was considered statistically significant. 3 Result 3.1 Comparison of localized skin adverse reactions and comfort at the outlet end of the VSD drain tube between the two groups of patients The occurrence of local skin erythema, vesiculation, and tractional discomfort at the exit site of the drainage tube in the study group was much reduced compared to the control group (P < 0.05). Refer to Table 2 for detailed information. Table 2 Comparison of localized skin adverse reactions and comfort at the outlet end of the drainage tube between the two groups of patients Variable Intervention group (n = 20) Control group (n = 21) χ 2 /t p-value Adverse skin reactions redness of the skin 2(10.0) 9(42.9) 5.634 0.018 Itchy skin 3(15.0) 6(28.6) 1.101 0.452 Skin breakage 1(5.0) 4(19.0) 1.888 0.169 skin blisters 3(15.0) 10(47.6) 5.034 0.025 catheterization pain 1.81 ± 0.87 2.85 ± 0.88 -3.810 <0.01 3.2 Comparison of VSD patch leakage, patch, number of dressing changes and Duration of VSD tube placement in two groups of patients The patients in the experimental group had significantly lower film leakage, film replenishment frequency and VSD placement time than those in the control group, ( P < 0.05). Refer to Table 3 for detailed information. Table 3 Comparison of the frequency of patch leakage, patch, and dressing change between the two groups of patients Variable Intervention group (n = 20) Control group (n = 21) χ 2 /t p-value Film Leakage 5(25.0) 15(71.4) 8.838 0.003 patch 4(20.0) 12(57.1) 5.939 0.015 change medicine 4(20.0) 9(42.9) 2.472 0.116 Duration of tube placement 10.80 ± 4.53 8.19 ± 2.96 2.195 0.037 4 Discussion Incision healing is a complex and intricate process involving cellular and biochemical activities. It can be categorized into three distinct phases: the inflammatory phase, the proliferation of fibrous tissue phase, and the phase of scar formation and repair[ 11 ]. Age, obesity, smoking, malnutrition, and diabetes mellitus are systemic factors that contribute to poor incision healing[ 12 ]. Additionally, local factors like excessive stretching of the incision, infection, and edema also contribute to poor healing[ 13 ]. Inadequate wound healing can result in traumatic loss of soft tissue and exposure of internal fixation, leading to further surgical complications, prolonged scar tissue formation, extended hospitalization, increased medical expenses, and other related outcomes. Severe cases may give rise to complications such as sepsis, cardiac failure, renal failure, and other associated conditions[ 14 ]. The VSD device utilizes a bio-semi-permeable membrane to isolate the external environment and avoid stimulation of the wound by external factors, and the drainage tube with multiple side holes is wrapped with a layer of sponge porous material to be applied to the wound. The use of a bio-permeable membrane to close the wound and apply continuous negative pressure attraction can effectively promote local vasodilatation, accelerate the microcirculation of the wound, increase the local blood supply, and promote protein synthesis and granulation tissue growth. This helps to promote wound healing, reduce the risk of infection, shorten hospitalization time, and improve patients' quality of life[ 15 , 16 ]. This technique is commonly employed in the treatment of various acute and chronic wounds, such as slow-healing surgical incisions in orthopedics, severe postoperative pancreatitis, burns, and other acute and chronic wounds [ 17 – 20 ]. The study findings revealed a significant decrease in the occurrence of skin redness and blistering in the test group compared to the control group( P < 0.05). Clinical cases of failure of VSD negative pressure suction still exist, in which unfavorable reactions to the skin around the edge of the trauma are one of the reasons[ 21 ]. Skin dryness resulting from the use of potent cleansers, high ambient humidity, or low temperature, as well as prolonged use of antibiotics, anticoagulants, chemotherapeutic agents, or hormones, can cause harm to the skin barrier. This damage increases the skin's susceptibility to further damage[ 22 ]. Following posterior spinal surgery, patients engage in essential activities such as sitting up, lying down, or turning over, which can create slight friction on the patch film placed over the tube's exit end. The conventional method of securing the patch in a fixed position can lead to continuous pressure of the tube against the skin. Prolonged closure of the film may result in localized redness, itching, skin breakage, or blister formation[ 23 ]. This study aims to address the local adverse skin reactions caused by the film covering the exit end of the VSD drain tube. The traditional method involves directly covering the drain tube exit with a single-layer film, which can lead to skin irritation due to the compression of the drain tube exit. This irritation may result in adverse reactions in the surrounding skin. However, the improved double layer lamination method can alleviate this issue by reducing skin pressure and minimizing the occurrence of redness and blisters resulting from pressure on the drainage tube outlet[ 24 ]. The results of the study showed that VSD patch leakage, patch frequency, and tube placement duration were less in the experimental group than in the control group, and the difference was statistically significant( P < 0.05). Another cause of VSD failure is the presence of air leakage in the patch film. The incidence of patch film leakage in the process of negative pressure closure and drainage of limb wounds was 25%, and the reasons for this were mainly the inability of the patch film to be tightly bonded to the tissue, and the movement of the patient's limb led to the breakage of the patch film, and so on[ 25 ]. Clinical research indicates that air leakage during negative pressure closed drainage primarily occurs due to inadequate sealing of the patch film. Insufficient tightness of the patch film when wrapped around the drainage tube, inadequate fixation of the drainage tube, and the possibility of inadvertent pulling on the drainage tube due to the patient's limb movements can account for patch film leakage. [ 26 – 28 ]. (2) The patient's skin becomes moist with sweat, causing a decrease in skin thickness. As a result, the patch film does not adhere tightly and can easily roll up at the edges due to friction with clothing and bed sheets[ 29 ]. Anatomical features such as bone protrusions, joints, armpits, neck, and irregular wounds pose challenges for securely maintaining the airtightness of the translucent film due to its mobility, unevenness, and unstable fixation.[ 25 ]. The conventional technique involves placing a translucent film directly over the foam dressing, VSD drain tube, and skin surface. However, this method tends to cause the drain tube to break and the film to become loose, resulting in leakage. In this study, the pancake laminating method was employed, suspending the outlet end of the VSD drain tube. This method effectively minimizes direct friction with the skin during movement, ensuring a secure fixation of the drain tube. Consequently, This method can maintain good fixation of the drainage tube, reduce the occurrence of folded tube dislodgement, reduce the occurrence of patch loosening and rolled edge, thus prolonging the maintenance time of VSD patch, reducing the number of patch replacement and medication change, avoiding frequent leakage and replacement of patch affecting the healing of the incision, and thus shortening the duration of tube placement. The level of tugging pain was significantly lower in the test group compared to the control group( P < 0.05). In this study, after the filming method was improved, the translucent film was tightly covered on the surface of the VSD drainage tube to avoid air bubbles or gaps. The device can be easily adjusted and positioned in alignment with the tube outlet based on the patient's activity requirements, preventing twisting, folding, and excessive pressure on the drainage tube. This feature reduces the limitations imposed by the tube on the patient's movements, effectively preventing pain caused by tube tugging[ 30 ]. Furthermore, it enhances the safety of the drainage tube and enhances the patient's comfort. 5 Conclusion The pancake laminating method offers greater flexibility and reliability in securing the drainage tube compared to the traditional film method. This reduces the incidence of localized adverse skin reactions at the outlet end of VSD drainage tubes, reduce the incidence of film leakage and film replenishment, shorten the duration of tube placement, and improve the comfort of patients in tube placement. Additionally, it enhances the patient's comfort level during tube placement. Overall, this method is scientifically proven, safe, and effective, and has a positive clinical impact on the patient's prognosis. Nevertheless, it is important to recognize specific constraints. The study's restriction to a single center hinders its applicability to a broader population, and a bigger sample size would increase the accuracy and reliability of the statistical analysis. The limited duration of the subsequent time impedes the evaluation of extended-term results and complexities. To overcome these constraints, future research might conduct multicenter trials with bigger sample sizes. Declarations Authors Contribution: Study design: HZ, LSH; experiment implementation: LW, YXX, QHL; data analysis: FL, HW; manuscript writing: LSH, LW; study supervision: HZ. All authors read and approved the final manuscript. Funding: Not applicable. Acknowledgements: Not applicable. Conflict of Interest: Not applicable. Ethics approval and consent to participate Ethical approval was awarded by theirector of the Ethics Committee of the Guangdong Second Provincial General Hospital(Approval number: 2021-KZ-236-03). Informed consent was obtained from each participant through written consent forms, which clearly outlined the purpose of the study and the rights of the participants. References Huang Q, et al. Comparison of Vacuum Sealing Drainage and Traditional Therapy for Treatment of Diabetic Foot Ulcers: A Meta-Analysis. J Foot Ankle Surg. 2019;58(5):954–8. Hu X, et al. Vacuum sealing drainage system combined with an antibacterial jackfruit aerogel wound dressing and 3D printed fixation device for infections of skin soft tissue injuries. J Mater Sci Mater Med. 2022;34(1):1. Jian B, Yan X. Analysis of factors associated with postoperative infection in spinal surgery. Chin J Pathogen Biology. 2020;15(12):1469–72. Kang A, et al. 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Yixia Y, Hui L, Yao J. Application of fuming waterproof dressing in the emergency treatment of orthopedic negative pressure closed drainage leakage. Chin J Mod Nurs. 2012;18(05):593. Lijun W, et al. Analysis of the causes and countermeasures of poor closure of chronic ulcers treated with negative pressure closed drainage. J Continuing Nurs Educ. 2012;27(11):1035–6. Fengjuan L. Analyzing the factors associated with postoperative ductal occlusion after VSD and nursing care measures. J Electrocardiography (electronic version). 2020;9(01):190–1. Xiaoyun D, et al. Observation on the effect of medical and patient collaboration in preventing film leakage after negative pressure closed drainage surgery. J Anhui Inst Health Professions Technol. 2018;17(05):139–40. Shuang Z, Chunying G. Thoracic and abdominal drain protection tape in drain immobilization after drainage of thoracic and abdominal effusions. Clin Res. 2022;30(12):60–3. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4173419","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":284765709,"identity":"a05cd90c-e16c-435c-b1d1-5241bfa34b25","order_by":0,"name":"Lishan Huang","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Lishan","middleName":"","lastName":"Huang","suffix":""},{"id":284765710,"identity":"86745b61-1341-4198-a20e-49156b55ae16","order_by":1,"name":"Lin Wang","email":"","orcid":"","institution":"Guangdong pharmaceutical university","correspondingAuthor":false,"prefix":"","firstName":"Lin","middleName":"","lastName":"Wang","suffix":""},{"id":284765711,"identity":"b6c473f6-342c-4142-9009-1ef06a9b1a77","order_by":2,"name":"Yanxin Xu","email":"","orcid":"","institution":"Guangdong pharmaceutical university","correspondingAuthor":false,"prefix":"","firstName":"Yanxin","middleName":"","lastName":"Xu","suffix":""},{"id":284765712,"identity":"98d3b2b4-ae43-4340-b069-15baee220452","order_by":3,"name":"Qihui Luo","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Qihui","middleName":"","lastName":"Luo","suffix":""},{"id":284765713,"identity":"c4907685-1073-4505-bbbb-433a8cd1c090","order_by":4,"name":"Fang Liu","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Fang","middleName":"","lastName":"Liu","suffix":""},{"id":284765714,"identity":"3854a1bc-b76d-4279-b5ab-14eab2a7e588","order_by":5,"name":"Hui Wu","email":"","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Hui","middleName":"","lastName":"Wu","suffix":""},{"id":284765715,"identity":"19c2064b-3bed-4f5a-8081-57bb036b3bf8","order_by":6,"name":"Hui Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1UlEQVRIiWNgGAWjYDACCSBmbGDgYWA+fODAhx8kaWFLSzw4s4cELQwMbDnGhznYiNAhP7v52cOvOw7LGBzj+XAYaJk8v9gB/FoY5xwzN5Y9c5hHso13w+ECCwbDmbMT8Gthlkgwk5ZsO8zDL9+74fAMHoYEg9sEtLBJpH8Da2Fj43kAJInQwiORYyb5EWQLGw8DcVokJHLKpBnb0oF+YTMABrIEYb/Iz0jfJvmzzdre4Bjz4w8fftjI80sT0AICzDxIthJWDgKMRCWTUTAKRsEoGLkAAKcAQFji/bXRAAAAAElFTkSuQmCC","orcid":"","institution":"Guangdong Second Provincial General Hospital","correspondingAuthor":true,"prefix":"","firstName":"Hui","middleName":"","lastName":"Zhang","suffix":""}],"badges":[],"createdAt":"2024-03-27 04:44:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4173419/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4173419/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":53878468,"identity":"23ec9506-9645-4a25-971f-da4908eea731","added_by":"auto","created_at":"2024-04-01 16:59:59","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":156274,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTraditional Laminating Method.\u003c/strong\u003e (\u003cstrong\u003eA, B\u003c/strong\u003e Schematic diagram of the traditional film covering method; \u003cstrong\u003eC\u003c/strong\u003e negative pressure is applied.)\u003c/p\u003e","description":"","filename":"Figure1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4173419/v1/0b9bfdcda0a394a6b1b4f2fb.jpg"},{"id":53878517,"identity":"0de96744-ed01-4f2d-912e-399202f2b345","added_by":"auto","created_at":"2024-04-01 17:00:02","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":208141,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDouble Layer Lamination Method. \u003c/strong\u003e(\u003cstrong\u003eA\u003c/strong\u003e Left translucent membrane in a 'U' shape; \u003cstrong\u003eB\u003c/strong\u003e two halves of the translucent membrane are glued to each other; \u003cstrong\u003eC,D\u003c/strong\u003e negative pressure is applied.)\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4173419/v1/0a098f1add23365862fe5e89.jpg"},{"id":54659310,"identity":"845a9b27-4ef4-4fb2-87b5-3fa422dc4ed3","added_by":"auto","created_at":"2024-04-14 23:59:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":621118,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4173419/v1/910ebeaf-1feb-499c-a83b-809df78eeb2f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effect of Double Layer Lamination Method in Vacuum Sealing Drainage for Treating Poor Incision Healing after Posterior Spinal Surgery","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003ePosterior spine surgery is a highly invasive and complex surgical procedure classified as level IV. It is commonly performed in clinical settings to treat various conditions, including degenerative spine disease, spinal fractures, scoliosis, osteoporosis with pathologic fractures, and other disorders[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Insufficient wound healing at the incision site is a common postoperative complication of spine surgery. Contributing factors to poor incision healing include surgical site wound infections, dural abnormalities, and preexisting comorbidities related to underlying disorders[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The occurrence of insufficient wound healing after spinal surgery ranges from 1.6\u0026ndash;12% [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and it represents the leading cause of unforeseen secondary procedures, accounting for over 50% of cases[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Insufficient healing of postoperative incisions hinders patients' recovery and unexpected hospital stays prolonging overall hospitalization costs and reducing patient satisfaction with the surgical procedure[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVacuum sealing drainage technology establishes a sterile negative pressure environment within the wound, facilitating the prompt evacuation of wound secretions, accelerating tissue swelling reduction[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], enhancing local blood circulation, stimulating new tissue generation, and ultimately fostering wound healing. The conventional VSD patch employs a single layer that directly covers the outlet end of the drainage tube and adheres to the skin, causing skin irritation and resulting in adverse reactions like pressure-induced redness and blisters, ultimately diminishing patient comfort. However, this approach is prone to air leakage at the VSD drain tube and film loosening, limiting the flexibility of the VSD drain tube. As a result, it increases the risk of skin pressure damage in the tube fixation area and inflates the cost of clinical treatment.\u003c/p\u003e \u003cp\u003eThis study focused on patients who had undergone posterior internal spinal fixation and experienced inadequate healing of their incisions. The objective of this study was to evaluate the effectiveness and clinical impact of the Double Layer Lamination Method in treating vacuum sealing drainage in patients with inadequately healed incisions following posterior internal spinal fixation. The findings are presented as follows.\u003c/p\u003e"},{"header":"2 Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 General information\u003c/h2\u003e \u003cp\u003eDuring the period from January 2021 to December 2022, a total of 915 patients underwent posterior spine surgery and among them, 41 cases with postoperative poor incision healing and treated with VSD were included in the study. Subsequently, these cases were divided into two groups: the control group and the study group, based on the sequence of their admission. The treatment approach differed between the two groups, with 20 patients in the control group receiving the \u003cb\u003edouble layer lamination method\u003c/b\u003e, while the remaining 21 patients received the standard lamination method. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates that there were no statistically significant differences between the two groups in terms of age, gender, duration of surgery, length of postoperative incision, and comorbidity of diabetes mellitus (\u003cem\u003eP\u003c/em\u003e\u0026gt;0.05). The hospital's Ethics Committee approved this study (Project No. 2021-KZ-236), and all patients provided their informed consent by signing a consent form.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Criteria for determining poor postoperative incision healing\u003c/h2\u003e \u003cp\u003eSurgical Nursing (7th edition)[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] classifies the assessment criteria for the healing status of an incision into three grades. Grade A indicates excellent healing without any adverse reactions during the initial healing process. Grade B is characterized by the possibility of an inflammatory reaction during the incision healing process, presenting symptoms such as redness, swelling, hardness, hematoma, effusion, etc., without the presence of pus. Grade C indicates incision healing involving the formation of pus, requiring the implementation of suitable treatment measures such as a second suture, incision, drainage, etc. Grades B and C are indicative of suboptimal incision healing.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Inclusion criteria\u003c/h2\u003e \u003cp\u003eParticipants must meet the following criteria: (1) Age over 18 years; (2) First posterior spine surgery; (3) Poor incision healing after posterior spine surgery; (4) Willingness to provide informed consent for voluntary participation in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Exclusion criteria\u003c/h2\u003e \u003cp\u003ePatients who met any of the following criteria were excluded from this study: (1) Posterior spinal surgery-related infection caused by anaerobic bacteria; (2) Severe heart, liver, or kidney impairment, or the coexistence of immune diseases and malignant tumors; (3) Pregnancy or breastfeeding status; (4) Diagnosed psychological or psychiatric disorders, or cognitive impairments; (5) Worsening wound conditions or patient withdrawal from the study.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of baseline data between the two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.266\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13(65.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7(35.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(42.9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge in years\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60.65\u0026thinsp;\u0026plusmn;\u0026thinsp;13.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.57\u0026thinsp;\u0026plusmn;\u0026thinsp;12.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.609\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of surgery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e293.80\u0026thinsp;\u0026plusmn;\u0026thinsp;164.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327.57\u0026thinsp;\u0026plusmn;\u0026thinsp;170.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.646\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIncision length\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.33\u0026thinsp;\u0026plusmn;\u0026thinsp;5.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.728\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCombined diabetes\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.751\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8(40.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7(33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12(60.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14(66.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Intervention\u003c/h2\u003e \u003cp\u003eThe drainage tube was routinely removed 48 hours after the surgery, and poor healing wound was observed during alternate-day dressing changes. Promptly evaluate the patient's overall nutritional status, incision length, presence of hidden sinus tracts and granulation tissue, and optimize hemoglobin levels (\u0026ge;\u0026thinsp;90g/L), and albumin levels (\u0026ge;\u0026thinsp;30g/L). Adequate regulation of the patient's water-electrolyte and acid-base balance was performed, and imaging confirmed the absence of involvement of deep structures such as nerves, blood vessels, catheters, joints, tendons, or bones in the incision. Following that, VSD was promptly conducted in the hospital ward [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The VSD materials used in this study were specifically disposable wound-protection materials with negative-pressure drainage, supplied by Shandong Chuangkang Biotechnology Co.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.5.1 Control group\u003c/h2\u003e \u003cp\u003e(1) Disinfection and debridement:After the ward was sterilized by ultraviolet light for 40 min, the patient was instructed to take a comfortable position to fully expose the location of the wound. Conventional disinfection methods are employed to thoroughly eliminate necrotic or non-functional tissues from the wound and its surrounding skin. For patients sensitive to pain, 5-10mL of lidocaine is administered for surface infiltration anesthesia, then remove inactivated or necrotic tissue from the wound for thorough debridement.\u003c/p\u003e \u003cp\u003e(2) Prepare drainage materials: lay out sterile therapeutic towels, put on sterile gloves, sterilize the incision again and leave it to dry. Trim the appropriate medical foam dressing according to the size and shape of the wound. According to the actual size and shape of the patient's incision, cut the head end of the disposable silicone gastric catheter (Terumo disposable gastric catheter SF-GL) into several similarly sized, symmetrically distributed lateral holes. The disposable intravenous infusion needle hose (needle end) with the needle removed is buried into the trimmed gastric tube, and the connecting seat and protective cap are left on the outside of the gastric tube to facilitate postoperative flushing.\u003c/p\u003e \u003cp\u003e(3) Placement of drainage materials: Trimmed gastric tubes and scalp syringes are inserted into the middle layer of the foam dressing. Depending on the patient's specific condition, either surface VSD treatment or implantation of the foam dressing into the sinus tract of the incision is selected.\u003c/p\u003e \u003cp\u003e(4) Closure of the wound: After placing the drains, clean the skin around the wound and leave it to dry. Choose a piece of bio-transparent film of appropriate size and shape, cover the wound with foam dressing, gastric tube, disposable IV needle hose, the coverage of the translucent film should include at least 2cm of healthy skin around the wound. gently shape the outlet of the VSD drainage tube (gastric tube), and seal the edges of the surrounding edges with a wide breathable adhesive tape or transparent film for sealing and fixation, to ensure that the sealing is not air leakage (Refer to Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e(5) Connect the negative pressure: connect the gastric tube interface to the special negative pressure suction device, follow the doctor's instructions to adjust the negative pressure value, test the foam dressing tightness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.5.2 Study group\u003c/h2\u003e \u003cp\u003eSteps (1) to (3) were the same as those in the control group.\u003c/p\u003e \u003cp\u003e(4) Closure of the incision: Cleanse the skin surrounding the incision and position the first translucent membrane accurately over the wound. The upper portion of the membrane should directly contact the foam dressing, gastric tube, disposable intravenous infusion hose, and skin, serving as a protective barrier. The lower part of the transparent membrane should hang without direct attachment to the skin. Fold the second translucent membrane into a symmetrical \"U\" shape with the adhesive side facing downward. Next, position half of the translucent membrane on the skin at the lower end of the wound with gentle handling to form the foundational membrane. Attach the remaining half of the translucent membrane to the lower section of the initial membrane, encapsulating the VSD drain tube (also referred to as the gastric tube) in a sandwich-like configuration. This arrangement also subtly shapes the VSD drain tube's (gastric tube's) outflow, as illustrated in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Remove the misaligned opaque membrane using sterile scissors. To ensure airtightness, seal the edges of the tube with wide, breathable adhesive tape or translucent film along its outer perimeter.\u003c/p\u003e \u003cp\u003eStep (5) exhibited identical characteristics to the control group.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Outcome measures\u003c/h2\u003e \u003cp\u003eThe following parameters were compared between the two groups to evaluate the efficacy of the treatment:\u003c/p\u003e \u003cp\u003e(1) Assess the occurrence of localized skin adverse reactions, such as redness, itching, skin breakage, and blistering, near the outlet end of the VSD drainage tube. Compare the incidence of these reactions between two groups of patients.\u003c/p\u003e \u003cp\u003e(2) Compare the occurrence rate of VSD patch leaking, patch, and dressing change between the two groups.\u003c/p\u003e \u003cp\u003e(3) The pain visual analog scale (VAS) was utilized to assess the level of tugging pain experienced during VSD treatment in both patient groups[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e(4) Duration of tube placement: the duration of tube placement is defined as the duration from the time the VSD is administered until it is removed.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Statistical method\u003c/h2\u003e \u003cp\u003eSPSS 20.0 software (IBM) was used for statistical processing. The distributional normality of the data was tested using the Shapiro\u0026ndash;Wilks test and histograms. Using an unpaired Student t-test, quantitative data reported as mean and standard deviation were analyzed. Using the Mann-Whitney test, the median and interquartile range of nonparametric quantitative data were analyzed. When applicable, qualitative variables were expressed as frequency and percentage (percent) and analyzed with the Chi-square or Fisher exact test. A 2-tailed P value of 0.05 or less was considered statistically significant.\u003c/p\u003e \u003c/div\u003e"},{"header":"3 Result","content":"\u003cp\u003e \u003cb\u003e3.1 Comparison of localized skin adverse reactions and comfort at the outlet end of the VSD drain tube between the two groups of patients\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe occurrence of local skin erythema, vesiculation, and tractional discomfort at the exit site of the drainage tube in the study group was much reduced compared to the control group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Refer to Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e for detailed information.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of localized skin adverse reactions and comfort at the outlet end of the drainage tube between the two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAdverse skin reactions\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eredness of the skin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2(10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.634\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eItchy skin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.452\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSkin breakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1(5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4(19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.888\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eskin blisters\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3(15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ecatheterization pain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.81\u0026thinsp;\u0026plusmn;\u0026thinsp;0.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-3.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u0026lt;0.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003e3.2 Comparison of VSD patch leakage, patch, number of dressing changes and Duration of VSD tube placement in two groups of patients\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe patients in the experimental group had significantly lower film leakage, film replenishment frequency and VSD placement time than those in the control group, (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Refer to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e for detailed information.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of the frequency of patch leakage, patch, and dressing change between the two groups of patients\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIntervention group (n\u0026thinsp;=\u0026thinsp;20)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eControl group\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;21)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eχ\u003csup\u003e2\u003c/sup\u003e/t\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFilm Leakage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5(25.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15(71.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.838\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003epatch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12(57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.939\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003echange medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4(20.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.472\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of tube placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.80\u0026thinsp;\u0026plusmn;\u0026thinsp;4.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8.19\u0026thinsp;\u0026plusmn;\u0026thinsp;2.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eIncision healing is a complex and intricate process involving cellular and biochemical activities. It can be categorized into three distinct phases: the inflammatory phase, the proliferation of fibrous tissue phase, and the phase of scar formation and repair[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Age, obesity, smoking, malnutrition, and diabetes mellitus are systemic factors that contribute to poor incision healing[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, local factors like excessive stretching of the incision, infection, and edema also contribute to poor healing[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Inadequate wound healing can result in traumatic loss of soft tissue and exposure of internal fixation, leading to further surgical complications, prolonged scar tissue formation, extended hospitalization, increased medical expenses, and other related outcomes. Severe cases may give rise to complications such as sepsis, cardiac failure, renal failure, and other associated conditions[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe VSD device utilizes a bio-semi-permeable membrane to isolate the external environment and avoid stimulation of the wound by external factors, and the drainage tube with multiple side holes is wrapped with a layer of sponge porous material to be applied to the wound. The use of a bio-permeable membrane to close the wound and apply continuous negative pressure attraction can effectively promote local vasodilatation, accelerate the microcirculation of the wound, increase the local blood supply, and promote protein synthesis and granulation tissue growth. This helps to promote wound healing, reduce the risk of infection, shorten hospitalization time, and improve patients' quality of life[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. This technique is commonly employed in the treatment of various acute and chronic wounds, such as slow-healing surgical incisions in orthopedics, severe postoperative pancreatitis, burns, and other acute and chronic wounds [\u003cspan additionalcitationids=\"CR18 CR19\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study findings revealed a significant decrease in the occurrence of skin redness and blistering in the test group compared to the control group(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Clinical cases of failure of VSD negative pressure suction still exist, in which unfavorable reactions to the skin around the edge of the trauma are one of the reasons[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Skin dryness resulting from the use of potent cleansers, high ambient humidity, or low temperature, as well as prolonged use of antibiotics, anticoagulants, chemotherapeutic agents, or hormones, can cause harm to the skin barrier. This damage increases the skin's susceptibility to further damage[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Following posterior spinal surgery, patients engage in essential activities such as sitting up, lying down, or turning over, which can create slight friction on the patch film placed over the tube's exit end. The conventional method of securing the patch in a fixed position can lead to continuous pressure of the tube against the skin. Prolonged closure of the film may result in localized redness, itching, skin breakage, or blister formation[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. This study aims to address the local adverse skin reactions caused by the film covering the exit end of the VSD drain tube. The traditional method involves directly covering the drain tube exit with a single-layer film, which can lead to skin irritation due to the compression of the drain tube exit. This irritation may result in adverse reactions in the surrounding skin. However, the improved double layer lamination method can alleviate this issue by reducing skin pressure and minimizing the occurrence of redness and blisters resulting from pressure on the drainage tube outlet[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results of the study showed that VSD patch leakage, patch frequency, and tube placement duration were less in the experimental group than in the control group, and the difference was statistically significant(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Another cause of VSD failure is the presence of air leakage in the patch film. The incidence of patch film leakage in the process of negative pressure closure and drainage of limb wounds was 25%, and the reasons for this were mainly the inability of the patch film to be tightly bonded to the tissue, and the movement of the patient's limb led to the breakage of the patch film, and so on[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Clinical research indicates that air leakage during negative pressure closed drainage primarily occurs due to inadequate sealing of the patch film. Insufficient tightness of the patch film when wrapped around the drainage tube, inadequate fixation of the drainage tube, and the possibility of inadvertent pulling on the drainage tube due to the patient's limb movements can account for patch film leakage. [\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. (2) The patient's skin becomes moist with sweat, causing a decrease in skin thickness. As a result, the patch film does not adhere tightly and can easily roll up at the edges due to friction with clothing and bed sheets[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Anatomical features such as bone protrusions, joints, armpits, neck, and irregular wounds pose challenges for securely maintaining the airtightness of the translucent film due to its mobility, unevenness, and unstable fixation.[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The conventional technique involves placing a translucent film directly over the foam dressing, VSD drain tube, and skin surface. However, this method tends to cause the drain tube to break and the film to become loose, resulting in leakage. In this study, the pancake laminating method was employed, suspending the outlet end of the VSD drain tube. This method effectively minimizes direct friction with the skin during movement, ensuring a secure fixation of the drain tube. Consequently, This method can maintain good fixation of the drainage tube, reduce the occurrence of folded tube dislodgement, reduce the occurrence of patch loosening and rolled edge, thus prolonging the maintenance time of VSD patch, reducing the number of patch replacement and medication change, avoiding frequent leakage and replacement of patch affecting the healing of the incision, and thus shortening the duration of tube placement.\u003c/p\u003e \u003cp\u003eThe level of tugging pain was significantly lower in the test group compared to the control group(\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). In this study, after the filming method was improved, the translucent film was tightly covered on the surface of the VSD drainage tube to avoid air bubbles or gaps. The device can be easily adjusted and positioned in alignment with the tube outlet based on the patient's activity requirements, preventing twisting, folding, and excessive pressure on the drainage tube. This feature reduces the limitations imposed by the tube on the patient's movements, effectively preventing pain caused by tube tugging[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Furthermore, it enhances the safety of the drainage tube and enhances the patient's comfort.\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eThe pancake laminating method offers greater flexibility and reliability in securing the drainage tube compared to the traditional film method. This reduces the incidence of localized adverse skin reactions at the outlet end of VSD drainage tubes, reduce the incidence of film leakage and film replenishment, shorten the duration of tube placement, and improve the comfort of patients in tube placement. Additionally, it enhances the patient's comfort level during tube placement. Overall, this method is scientifically proven, safe, and effective, and has a positive clinical impact on the patient's prognosis. Nevertheless, it is important to recognize specific constraints. The study's restriction to a single center hinders its applicability to a broader population, and a bigger sample size would increase the accuracy and reliability of the statistical analysis. The limited duration of the subsequent time impedes the evaluation of extended-term results and complexities. To overcome these constraints, future research might conduct multicenter trials with bigger sample sizes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthors Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy design: HZ, LSH; experiment implementation: LW, YXX, QHL;\u0026nbsp;data analysis: FL, HW; manuscript writing: LSH, LW;\u0026nbsp;study supervision: HZ.\u0026nbsp;All authors\u0026nbsp;read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was awarded by theirector of the Ethics Committee of the Guangdong Second Provincial General Hospital(Approval number: 2021-KZ-236-03). Informed consent was obtained from each participant through written consent forms, which clearly outlined the purpose of the study and the rights of the participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHuang Q, et al. Comparison of Vacuum Sealing Drainage and Traditional Therapy for Treatment of Diabetic Foot Ulcers: A Meta-Analysis. J Foot Ankle Surg. 2019;58(5):954\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu X, et al. Vacuum sealing drainage system combined with an antibacterial jackfruit aerogel wound dressing and 3D printed fixation device for infections of skin soft tissue injuries. J Mater Sci Mater Med. 2022;34(1):1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJian B, Yan X. Analysis of factors associated with postoperative infection in spinal surgery. 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Chin Conval Med. 2022;31(08):858\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLezhi L, Qian L. \u003cem\u003eSurgical Nursing (7th Edition)\u003c/em\u003e. People's Health Publishing House.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatthew J, Streitz. and MD. \u003cem\u003eHow to clean, irrigate, debride and dress a wound\u003c/em\u003e. 2021 2021-03; \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.msdmanuals.cn/professional/injuries-poisoning/how-to-care-for-wounds-and-lacerations/how-to-cleanse-irrigate-debride-and-dress-wounds\u003c/span\u003e\u003cspan address=\"https://www.msdmanuals.cn/professional/injuries-poisoning/how-to-care-for-wounds-and-lacerations/how-to-cleanse-irrigate-debride-and-dress-wounds\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrice DD, et al. 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Mod Clin Nurs. 2022;21(12):70\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWanru M, Tianyan M, Qingli G. Analysis of the reasons for the failure of closed negative pressure suction efficiency and nursing countermeasures. PLA Nurs J. 2016;33(18):68\u0026ndash;70.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYixia Y, Hui L, Yao J. Application of fuming waterproof dressing in the emergency treatment of orthopedic negative pressure closed drainage leakage. Chin J Mod Nurs. 2012;18(05):593.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLijun W, et al. Analysis of the causes and countermeasures of poor closure of chronic ulcers treated with negative pressure closed drainage. J Continuing Nurs Educ. 2012;27(11):1035\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFengjuan L. Analyzing the factors associated with postoperative ductal occlusion after VSD and nursing care measures. J Electrocardiography (electronic version). 2020;9(01):190\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXiaoyun D, et al. Observation on the effect of medical and patient collaboration in preventing film leakage after negative pressure closed drainage surgery. J Anhui Inst Health Professions Technol. 2018;17(05):139\u0026ndash;40.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShuang Z, Chunying G. Thoracic and abdominal drain protection tape in drain immobilization after drainage of thoracic and abdominal effusions. Clin Res. 2022;30(12):60\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Double Layer Lamination Method, Vacuum Sealing Drainage, posterior spine, poor incision healing","lastPublishedDoi":"10.21203/rs.3.rs-4173419/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4173419/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To explore the efficacy of the double layer lamination method in VSD for the treatment of poor incision healing after posterior spinal surgery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e Out of the 915 patients hospitalized in our department for posterior spine surgery between January 2021 and December 2022, 41 cases with postoperative poor incision healing treated with VSD were included in the study. The enrolled cases underwent treatment with vacuum sealing drainage and were subsequently divided into study and control groups according to their admission order. Among the cases, 20 in the study group received treatment utilizing the \u003cstrong\u003edouble layer lamination method,\u003c/strong\u003ewhereas the conventional laminating method was employed for 21 cases in the control group. This study compares the incidence of localized skin adverse reactions (skin redness, itching, skin breakdown, blistering), patch leakage, patch replenishment, dressing change, duration of tube placement, and comfort ( pipe pulling pain) at the exit end of the VSD drain in the two groups of patients.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The incidence of localized skin redness and blistering at the outlet end of the VSD drain in the test group was lower than that in the control group, and the leakage of the film, the frequency of replenishment of the film and the time of placement of the tube were less than that in the control group, and the comfort was better than that in the control group, and the difference was statistically significant (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The implementation of the \u003cstrong\u003edouble layer lamination method\u003c/strong\u003e is beneficial in minimizing the occurrence of localized skin adverse reactions at the outlet end of the VSD drainage tube, reducing film leakage and the need for replenishment, reducing duration of tube placement, enhancing the comfort of VSD drainage, and positively impacting the prognosis of patients. This method exhibits promising potential for extensive application in clinical practice.\u003c/p\u003e","manuscriptTitle":"Effect of Double Layer Lamination Method in Vacuum Sealing Drainage for Treating Poor Incision Healing after Posterior Spinal Surgery","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-01 16:59:28","doi":"10.21203/rs.3.rs-4173419/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9cb20cfe-00b9-4741-88d5-86c4c5336044","owner":[],"postedDate":"April 1st, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-04-14T23:59:26+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-01 16:59:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4173419","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4173419","identity":"rs-4173419","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}