封闭负压引流技术修复猪皮肤软组织爆炸伤创面的促愈合作用

Vacuum-assisted closure for the wound healing after blast injury to pig soft tissue

目的:封闭负压引流技术是一种创面治疗新技术,观察不同负压封闭负压引流技术对猪皮肤软组织爆炸伤后创面愈合的修复作用。方法:实验于2003-04/05在唐都医院组织工程实验室完成。用电雷管在10只15～20kg的小白家猪双侧肩胛及双侧臀部造成40个爆炸伤创面,按随机数分为5组:对照组、-10kPa治疗组、-15kPa治疗组、-20Pa治疗组和-25kPa治疗组。各组创面伤后前3d不做任何治疗,以造成创面感染。伤后第3天,对照组常规换药,各治疗组分别用相应负压的封闭负压引流技术治疗。于治疗前和治疗后不同时间点测量创面面积、创面深度,并取创面中心的活组织进行细菌计数。结果:对照组,-10,-15,-20,-25kPa治疗组创面平均愈合时间分别为(32.8±1.6),(27.1±1.5),(25.8±1.0),(26.4±1.1),(27.8±1.4)d,各组间差异有显著性意义(P<0.01)。对照组在治疗前创面面积为(10.76±0.42)cm2,治疗3d后扩大至(13.30±0.43)cm2,随后面积逐渐缩小;各治疗组从治疗后第1天(伤后第4天)起创面面积维持不变或略缩小,其后创面面积逐渐缩小。对照组创面在伤后3～6d,创面深度由(1.65±0.25)cm加深至(2.43±0.25)cm,治疗后19d,肉芽组织长满伤口。各治疗组封闭负压引流技术治疗后深度就开始变浅;-15kPa治疗组伤后第9天肉芽组织已长平伤口。

AIM:Vacuum assisted closure(V.A.C.) is a new technique for wound healing.This experiment aims to observe the effect of V.A.C.at different pressure on wound h ealing after blast injury to pig soft tissue. METHODS:The experiment was accomplished in Laboratory for Tissue Engineering i n Tangdu Hospital from April 2003 to May 2004.Forty blast wounds,established by explosion of a specific type of electric detonators which were fixed at 1 cm ove r the skin of the shoulders and hips of 10 small white domestic pigs with body m ass of 15 to 20 kg,were divided into five groups randomly:control group which wa s treated with conventional gauze changing,treatment groups were treated with V. A.C.set at the pressure of -10 kPa, -15 kPa,-20 kPa,and -25 kPa respectively (-10 kPa,-15 kPa, -20 kPa,and -25 kPa groups respectively).All wounds were l eft untreated until the third day after explosion and subsequently were infected .On the 3rd day,the administration of control group was changed.The data of woun d area and wound depth were collected before treatment and at different time poi nts after treatment,and the number of bacterial colony was counted. RESULTS:Wounds in control -10,-15,-20 and -25 kPa groups healed on the(32. 8±1.6),(27.1±1.5),(25.8±1.0),(26.4±1.1),and (27.8±1.4) days after injury re spectively and there were significant difference among the 5 groups(P< 0.01).The wound area of control group increased from(10.76±0.42) cm2 before treatment to (13.30+0.43) cm2 3 days after treatment,and then decreased gradually;that of o ther groups remained unchanged or a little decreased from the 1st day after trea tment(i.e.,the 4th day after injury),and then decreased gradually.The wound dept h of control group increased from (1.65±0.25) cm to (2.43±0.25) cm from 3 to 6 days after injury.Wound cavity was filled in granulation tissue on the 19th day after treatment in control group,on the 9th day in -15 kPa group,on the 14th d ay on the other 3 groups.Before treatment,the bacteria load of the 5 groups was up to 3×107 CFU/g,but after V.A.C treatment it decreased to 1×105 CFU/g at 3 d ays,and to about 1×104 CFU/g at 6 days in treatment groups;it decreased more sl owly in control group to(19.54±3.67)×105 CFU/g on the 9th day after treatment and to(3.26±0.83)×105 CFU/g on the 19th day after treatment.The wound area,wou nd depth and the number of bacterial colony was significantly different among th e four treatment groups at different time points after treatment(P< 0.01). CONCLUSION:At the pressure from -25 kPa to -10 kPa,V.A.C.can accelerate the wound healing of pig infected soft tissue blast injury,decrease the number of ba cterial colony,and -15 kPa is optimal for V.A.C.to repair the infected soft tis sue blast injury.