负压封闭引流术在大面积皮肤缺损感染坏死中的应用及疗效

Vacuum sealing drainage therapy for large skin defect with infection and necrosis following trauma

目的探讨负压封闭引流技术(VSD)在大面积皮肤缺损及感染坏死中的应用及疗效。方法 2008年9月～2010年2月为15例髂腰部及下肢大面积皮肤缺损感染患者进行了持续负压封闭吸引治疗,负压封闭引流技术的应用包括创面肉芽准备及游离植皮封闭创面两个阶段,在每个阶段手术前均对创面进行细菌培养。结果 15例患者均获得创面完全愈合后1个月随访,无感染复发及皮肤再坏死或缺损等并发症发生,其中2例1次使用负压封闭引流技术,10例2次使用负压封闭引流技术,3例3次使用负压封闭引流技术。自使用负压封闭引流技术至创面皮肤愈合时间平均为24天(13～40天)。首次使用负压封闭引流术前创口细菌培养阳性率87%(13例),最后一次术前均为阴性。结论负压封闭引流术在大面积皮肤缺损及感染创面处理上有尽快覆盖创面、促进创面肉芽形成、协助控制创面感染、减轻患者痛苦、提高患者全身抵抗力等优点,是目前治疗大面积皮肤缺损感染较安全有效的方法。

Objective To explore the clinical effect of vacuum sealing drainage（VSD） on large skin defect with infection and necrosis following trauma.Methods From Sep 2008 to Feb 2010,15 patients of large skin defect with infection and necrosis of iliac-lumber and lower limb were treated.The VSD was used in two stages operation,preparative fresh granulation tissues and followed by closure trauma defect surgery.Preoperative bacterial cultures were conducted at each stage.Results The following-up persisted till one month after each defect healed completely and none had evidence of infection recurrence and skin necrosis.2 of 15 cases underwent one time VSD therapy,10 cases underwent two times,3 cases underwent three times.The mean operative duration was 24 days（range 13～40 days） from the preparative VSD therapy to the closure surgery.13 of the 15 bacterial cultures were positive before first surgical debridement and all were negative before the closure surgery.Two and three times surgery cases were closed by free-skin grafting and one time case by direct suture and skin graft reconstructions.Conclusions VSD can stimulate the growth of fresh granulation tissues,help eradicate infection,promote the wound healing and release the patient pain.It is a safe and effective for the management of illa-lumber and lower limbs large skin defect with infection and necrosis.