全厚皮移植中简易负压引流的应用

Application of vacuum sealing drainage in full-thickness skin grafts

背景:全厚皮移植是烧伤整形基本操作之一,植皮后均匀加压和局部制动是保证皮片成活、避免皮片坏死的关键。传统的手术方法是植皮后打包加压固定,但往往会出现残留死腔和皮片固定不确实的情况,且打包固定的缝线处易出现缝线瘢痕。目的:观察简易负压引流在全厚皮片移植中的应用效果。方法:选用新西兰大白兔8只,分别在大白兔脊柱两侧3个术区建立全厚皮片移植模型。3个术区分别采用简易负压引流、传统缝合打包加压和普通包扎,观察皮片成活情况,第14,21天计算皮片成活率。第3,7,14天在移植皮片上取材,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。对于负压引流组,拔管时间选择在引流液不再增加或引流液变清亮时。结果与结论:植皮后各时相点简易负压引流组皮片成活率明显高于其他两组(P<0.05),传统缝合打包加压组的皮片成活率显著高于普通包扎组(P<0.05)。组织形态学结果显示:植皮后早期,简易负压引流组皮片表皮层部分坏死,炎细胞浸润,成纤维细胞变性,线粒体肿胀;后期成纤维细胞和基底细胞增生,线粒体、质粒等细胞器功能活跃。提示负压引流可以提高皮片成活率。

BACKGROUND：Full-thickness skin graft was a base for burn and plastic surgery,while uniform pressure and regional brake were key factors to ensure skin graft survival and avoid from necrosis.Traditionally,package and pressurized fixation were performed after skin transplantation;however,it induced residual dead space and unclear skin graft fixation,as well as suturing scar.OBJECTIVE：To study the effect of vacuum sealing drainage applied to full-thickness skin graft.METHODS：A total of 8 New Zealand rabbits were used to establish full-thickness skin graft models in three regions of bilateral spine.Vacuum sealing drainage,traditional pressurized suture and common wrapping were performed in the three regions,respectively.The skin graft survival was observed,and survival rate was calculated at 14 and 21 days.On the 3rd,7th,and 14th days,samples were selected from skin graft and stained.The morphology was observed under light microscope and transmission electron microscope.The time to remove the drain vessel was that when the fluid was not increased or the fluid was clear.RESULTS AND CONCLUSION：The survival rate of vacuum sealing drainage group was significantly higher than that in other two group（P 0.05）,while the survival rate of traditional pressurized suture group was significantly higher than that in the common wrapping group（P 0.05）.Morphology examination demonstrated that regional cuticular layer was necrotic in the vacuum sealing drainage group after early skin transplantation,while inflammatory cell infiltration,fibroblast degeneration,and mitochondrial swelling were also observed.At later skin transplantation,fibroblast and basal cell were proliferated,and function of mitochondria and plasmid was active.This suggested that vacuum sealing drainage promoted survival rate of skin graft.