儿童严重创伤性软组织损伤的负压封闭治疗

Treatment of serious traumatic soft tissue injuries in children by vacuum sealing

目的探讨负压封闭引流技术（vacuum sealing drainage，VSD）治疗儿童严重创伤性软组织损伤的效果。方法16例严重创伤性软组织损伤的患儿，共20个创面，创面范围约为10cm×15cm×30cm×50cm，严格清创后采用负压封闭引流（VSD）技术，持续40-60kPa负压引流，5～7d后再行Ⅱ期缝合、植皮、组织瓣转移闭合创面。同期13例采用传统换药或引流的患儿为对照组。结果VSD治疗组中，15例经负压封闭引流治疗后均可见创面肉芽组织新鲜，Ⅱ期缝合、植皮或组织瓣转移全部成活，无局部和全身并发症，1例反取皮原位移植的患儿发生创面感染，多次引流后行游离植皮成功。VSD治疗组与对照组比较，在Ⅱ期缝合时间、换药次数、平均住院时间及植皮愈合率等方面均有统计学意义（P〈0．05）结论负压封闭引流技术能充分引流、控制感染和刺激创面肉芽组织生长，为及早覆盖创面提供了良好的条件，而且可以免除换药和缩短治愈时间，是治疗儿童严重创伤性软组织损伤的一种简便、有效方法。

Objective To investigate the therapeutic effect of vacuum sealing drainage （VSD） in treatment for serious traumatic soft tissue injuries in children. Methods Sixteen patients with 20 traumatic soft tissue injuries were treated by vacuum sealing after debridement. The wound area varied from 10 cm× 15 cm to 30 cm× 50 cm. The wound surfaces or cavities were filled with polyvinyl alcohol foams with embedded drainage tubes connected to the vacuum bottle （with negative pressure at 40 to 60 kPa）. Secondary suturing of wound closure was performed and patients underwent skin transplantation or local flap grafting after 5 -7 days. Thirteen patients were treated by traditional dressing which served as the control group. Results In the VSD group, wounds of 15 cases achieved fresh granulation tissue after VSD, and skins survived after secondary suturing, skin transplantation or local flap grafting, without any local or systemic complications. One case got wound infection and was treated with free skin graft after VSD for several times. There were significant differences in the interval between two operations, the times of dressing, the length of stay and the rate of successful skin grafting between two groups （P〈0. 05）. Conclusions VSD can protect the wounds against contamination, evacuate the wound exudates completely, stimulate the growth of granulation tissue, promote early healing of wounds, and reduce the working load of medical staff. VSD is a simple and effective method in treatment for serious traumatic soft tissue injuries in children.