封闭负压引流对猪皮肤软组织爆炸伤感染创面肉芽组织生成的影响

The effect of vacuum-assisted drainage on granulation tissue formation of infected soft tissue explosive injury in pig

目的 观察封闭负压引流技术 (VAC)对猪皮肤软组织爆炸伤感染创面肉芽组织生成的影响。方法 用电雷管在 4只 15～2 0kg的小白家猪双侧肩胛及双侧臀部造成 16个爆炸伤创面 ,随机分为对照组和治疗组。各组创面伤后 72h内不做任何处理 ,以造成创面感染。伤后第 3天起 ,对照组油纱布换药 ,治疗组用 - 15kPa的VAC治疗。于治疗前和治疗后 1、3、6、9、14、19、2 4天测量创面深度 ,并取创面中心的活组织进行HE染色和免疫组化染色 ,观察血管内皮细胞和增殖细胞的数目 ,计算增殖指数。结果 治疗后 1～ 19天 ,治疗组创面深度较对照组浅 (P <0 0 1) ;治疗后 1～ 6天 ,治疗组创面中血管内皮细胞数较对照组显著增高 (P <0 0 1) ;治疗后 1～ 3天 ,治疗组创面的增殖指数较对照组高 (P <0 0 1)。结论 与常规治疗相比 ,VAC能快速启动猪皮肤软组织爆炸伤感染创面肉芽组织生成 ,缩短肉芽组织填平伤口的时间。

Objective To observe the effect of vacuum-assisted drainage (VAC) technique on the granulation tissue formation of infected soft tissue explosive injury in pig. Methods 16 wounds produced by explosion with electric detonators,which were fixed on the skin of the shoulders and hips of 4 small white pigs. The wounds were divided into 2 groups randomly: in group A the wounds were treated with conventional method,and in group B the wounds were treated with VAC set with a pressure of -15kPa. All wounds were infected on the third day after explosion. The depth of wounds was measured,and specimens were talcen from wound bed,immediately before treatment,and 1,3,6,9,14,19,and 24 days after treatment. The specimens were bistopathologieally studied with HE staining to assess the wound healing process of the two groups. Furthermore,immunohistochemistry for Factor Ⅷ related antigen and Ki67 was done to estimate the number of vascular endothelial cells and proliferating cells. Results From 1 to 19 days after the treatment,the depth of the wounds in group B were shallower than those of group A ( P <0.01). From 1 to 6 days after treatment,the number of vascular endothelial cells in group B was larger than that of group A ( P <0.01). From 1 to 3 days,the number of proliferating cells in wounds of group B was larger than that of group A ( P <0.01). Conclusion Compared with conventional treatment,VAC could initiate the granulation tissue formation more promptly and could shorten the period for granulation tissne to fill the wound cavity completely.