负压封闭治疗特殊部位创面42例疗效分析

Treatment of the special wound with Vacuum assisted closure(VAC)

目的探讨应用负压封闭技术（vacuum assisted closure，VAC）辅助修复身体特殊部位创面的效果。方法1998年8月～2004年12月，42例患者（其中骶尾部褥疮创面11例，臀部及会阴部27例，足跟部3例，头顶部1例）接受VAC治疗，清创后将Vacuseal材料覆盖在相应大小的创面表面或创腔内，接50～60kPa的中心负压，7～9d后Ⅱ期缝合、植皮或皮瓣转移，其中植皮后创面继续接中心负压5～7d。治疗后观察创面形态学变化和治疗效果。结果42例患者经Ⅱ期处理后全部治愈：采用Ⅱ期缝合5例，中厚皮植皮关闭18例，Ⅱ期缝合加植皮关闭9例，局部转移皮瓣关闭8例，交腿皮瓣关闭2例。与传统换药方法比较，在Ⅱ期缝合、植皮或皮瓣转移的时间、换药次数、住院时间和总体治疗费用等方面差异均有统计学意义（P〈O．01）。结论应用负压封闭辅助治疗技术能防止创面污染，充分引流和刺激创面肉芽组织快速良好生长，缩短治疗时间。对于创伤后的急、慢性软组织缺损的患者具有简单安全、经济有效，并易于接受的特点。

Objective To investigate the clinical effect of vacuum assisted closure in treating the special wound. Methods From August 1999 to December 2004, 42 patients with special wounds including 11 in sacrococcyx,27 in hip and perineum, 3 in heel,and 1 in calvaria were treated by vacuum sealing after debridement. The wound area varied from 4cm× 5cm to 30cm× 40cm. In the experimental group, the wound surfaces or cavities were filled with polyvinyl alcohol foams with embedded drainage tubes connected with vacuum bottle （negative pressure of 50--60kPa）. Definite wound closure was performed with secondary suture, skin grafting , or local flap grafting after 7--9 days. And the wound after skin grafting was continuously treated by VAC for 7 days. Besides, 20 patients were managed by traditional dressing as the control groupfrom January 1996 to July 1998. Results Of 42 patients, the wound closure was performed with sequential secondary suture in 5, split thickness skin grafts （STSG） in 18, secondary suture ＋ STSG in 9, loco-regional free flaps in 8 and cross-leg flaps in 2. All patients recovered and no complications （systemic and located） occurred. There were significant differences in time of secondary closure, times of dressing and total cost of treatment between two groups （P〈0.01）. Conclusion VAC therapy can protect the wound from contamination, evacuate the wound exudates completely, stimulate the growth of granulation tissue, and facilitate the wound healing; so VAC therapy is a simple and effective method for posttraumatic acute and chronic soft tissue defect.