负压引流对全厚皮片移植成活的影响

Experiment Study on Influence of Negative Pressure Drainage on Survival Rate of Full-thickness Skin Grafting

目的:探讨负压引流对全厚皮片移植成活的影响。方法:新西兰大白兔9只,在脊柱两侧3个术区建立全厚皮片移植模型。术区应用简易负压引流管,引流管分别在术后第2天、引流液无明显增加时和第7天拔除(即A1,A2,A3组)。拔管时、术后第7天和第14天取材,取材位置在引流管的上方和远离引流管的周围。组织染色处理后,应用光学显微镜和透射电镜,观察组织形态学特征。实验结果表明,当引流液不再增加时拔管,皮片成活最好。新西兰大白兔8只,在大白兔脊柱两侧3个术区做全厚皮片移植,随机分别采用传统缝合加压包扎、简易负压引流和普通负压引流(即A,B,C组)。观察皮片成活情况,于术后第2、3周计算皮片成活率,并在移植皮片上取材。对于负压引流组,拔管时间选择在当引流液不再增加时。结果:负压引流可明显提高全厚皮片的成活率。皮片移植应用负压引流组(A组)的皮片成活率显著高于传统缝合加压包扎组(B组)(P<0.05),传统缝合加压包扎组(B组)的皮片成活率显著高于普通负压引流组(C组)(P<0.05)。组织形态学结果显示,引流管上方皮片在早期出现缺血改变。当引流液不再增加时拔除引流管,可以充分引流术区且不影响管上方皮片成活,如果拔除过早或过晚会阻碍皮片成活。结论:负压引流可以提高皮片成活率。

Objective： To study the influence of negative pressure drainage on survival rate of full -thickness skin grafting. Method： A model of full - thickness skin grafting in 3 operation zones was established in the two sides of spinal col- umn of 9 New Zealand white rabbits. Simple negative pressure drainage was used. Drainage tube was pull out on the 2nd day after operation （A1 group）, at the day of no significant increased drainage liquid （A2 group） and on the 7th day after operation （ A3 group）. The samples were taken on the day of extubation, the 7th day and the 14th day after operation respectively. The positions of the sampling were in the top of drainage tube and away from the surrounding of drainage tube. After the tissues staning, the histomorphological characteristics of the samples were observed by optical microscopy and transmission elec- tron microscope. The results of experiment showed that survival rate of skin flap were highest when drainage tube was removed at the time point of no increased drainage liquid. The modal of full - thickness skin graft in 3 operation zones was established in two sides of spinal column of 8 New Zealand white rabbits. The wounds were deal with by conventional suture and compres- sion bandage, simple negative pressure drainage and normal negative pressure drainage randomly, i. e. A group, B group and C group. The survival of skin graft was observed. The survival rate was calculated on the day of 2 weeks and 3 weeks after operation. The sample was taken from the grafted flap. The suitable time point of drainage tube removed was the day of no increased drainage liquid in the negative pressure group. Result： Negative pressure drainage can significantly improve the survival rate of full - thickness skin flap. The survival rate of skin flap in negative pressure drainage group （ A group） was significant higher than that in conventional suture and compression bandage （ B group, P 〈 0. 05）, while the survival rate of skin flap in conventional suture and compression bandage （B group） was significant higher than that in normal negative pres- sure drainage （ C group, P 〈 0. 05）. The result of histomorphological check showed that the skin flap taken from the part of the top of skin flap appeared ischemia at the early stage. When drainage tube removed at the time point of no increased drain- age liquid, drainage in operation zone was thorough smoothly and no influence was observed for the survival of skin flap from the part above the drainage tube. But, it would affect the survival of skin flap if the removal of drainage tube too early or too late. Conclusion： Negative pressure drainage can improve the survival rate of skin flap.