猪后肢软组织爆炸伤后封闭负压引流组织修复效果与常规法的比较

Repair of explosive wound in pig thigh soft tissue:Vacuum assisted closure versus conventional method

背景:以往封闭式负压引流在外伤、切割伤等感染创面治疗上效果较为满意,但其对爆炸伤的治疗效果却少见报道。目的:以猪后肢软组织爆炸伤为治疗模型,观察封闭式负压引流对爆炸伤的治疗效果。方法:用雷管先后于4只活体健康白猪双后肢肌肉组织发达处行模拟爆炸,建立爆炸伤动物模型,并造成伤口污染后,一侧行封闭式负压引流治疗,对侧行常规治疗即每日用双氧水、新洁尔灭、生理盐水冲洗,油纱覆盖。实验动物于爆炸伤后第3,5,7天分别进行细菌学检查,羟辅氨酸含量测定,苏木精-伊红染色,观察对比双侧各项指标的差异。结果与结论:封闭式负压引流治疗3d后,治疗侧细菌数量少于对照侧(P<0.05)。封闭式负压引流治疗侧在治疗后第3,5,7天羟辅氨酸含量明显高于对照侧(P<0.05),相比对照侧,封闭式负压引流侧无明显炎症细胞渗出,碎裂区外侧可见大量肉芽组织形成。由此可见,封闭式负压引流能够加快爆炸伤创面愈合,可减少感染和各种并发症发生概率,治疗效果明显优于常规治疗。

BACKGROUND：Vacuum assisted closure（VAC） or vacuum sealing drainage has received satisfactory results in the treatment of infective wound caused by surgical trauma or incised injury,however,whether it can treat explosive wound remains poorly understood.OBJECTIVE：Based on the therapy model of the explosive wound on the pig thigh soft tissue,this experiment aims to study the treating effect of the VAC on the explosive wound.METHODS：The explosive wound model was established by blasting the well developed muscle tissue of an alive and healthy pig＇s double thighs.The wound was polluted by leaving alone for one day without any intervention.One thigh was treated with VAC,and the other,by regular methods,was cleaned by H2O2,bromo-geramine,normal saline and then covered with oil gauze.The bacteriological test,hydroxyproline（HYP） content determination and hematoxylin-eosin staining were performed at 3,5 and 7 days after operation.The differences between the parameters of the two sides were compared.RESULTS AND CONCLUSION：The density of bacteria at the VAC side was smaller than that of the control side at 3 days after treatment（P 0.05）.The content of HYP at the VAC side was obviously higher than the other side at 3,5 and 7 days after treatment（P 0.05）.There was no obviously seepage,but large of granuloma tissues around the broken area at VAC side.VAC is capable of accelerating the healing of the explosive wound,decreasing the rate of infection and complications.The effect of VAC is obviously better than the regular treatment.