负压封闭引流技术联合皮片移植修复四肢深度烧伤

Using vacuum sealing drainage combining with skin graft to repair deep burn wound in the limbs

目的观察负压封闭引流(VSD)技术联合皮片移植治疗四肢深度烧伤的临床效果。方法根据治疗方法的不同对32例患者分组,VSD治疗组17例手术清创后应用VSD技术;常规治疗组15例采用传统换药方法,去除坏死组织并控制感染,促进肉芽组织生长。两组患者创面新鲜后,分别移植断层皮片修复创面。结果 VSD治疗组经持续负压吸引7～10d后,去除VSD敷料,13例肉芽组织新鲜,移植刃厚或中厚皮片,4例仍有肌腱、骨组织外露,更换VSD敷料,再次行持续负压吸引7～10d,至肉芽组织新鲜,移植刃厚或中厚皮片,术后皮片成活;常规治疗组中10例传统换药后经1次手术,5例患者经2次手术移植刃厚皮片封闭创面。VSD治疗组与常规治疗组创面细菌培养阳性率比较,P<0.05,创面疼痛,肉芽组织生长和愈合时间比较,P<0.01。结论 VSD技术方法简便,易于掌握,能有效减轻患者痛苦,降低创面细菌检出率,促进肉芽组织生长,缩短创面愈合时间,因此,值得在深度创面治疗上进行推广。

Objective To observe the clinical therapeutic effect of the vacuum-sealing drainage （VSD） combining with transplanting skins on deep bum wound in the limbs. Methods Thirty-two patients were divided into 2 groups according to treatment method. Seventeen patients treated by VSD were choosed as VSD treatment group, 15 patients treated by routine dressing change were selected as routine treatment group. VSD treatment group was treated by VSD after debridement. Routine treatment group was treated by means of traditional regular dressing change to remove necrotic tissue, control the infection and promote granulation tissue, both wounds were transplanted split thickness skins when they were fitted. Results Thirteen cases of VSD treatment group were treated by VSD for 7-10 days, other 4 cases were treated by VSD for another 7-10 days because of tendons or osseous tissues exposed after VSD dressing was removed, till their granulation was fresh, epidermal skin or thin intermediate thickness skin was transplanted to the wound, and the skin survived well. Ten cases of routine treatment group after traditional regular dressing change were transplanted epidermal skin once, other 5 cases operated twice, and all patients＇ wounds were cured. Comparing VSD treatment group with routine treatment group, the wound germiculture positive rate （ P 〈 0.05 ）, in the wound pain（P 〈0.01 ） ,the period of granulation tissue growth and wound healing were significantly differont （P 〈 0.01 ）. Conclusions VSD is a simple method, which is easy to grasp, can relieve patients＇ pain, reduce the wound germiculture positive rate, promote granulation tissue growth and shorten the wound healing period, worth spreading in the deep wound therapy.