改良负压封闭引流技术治疗难愈性创面的体会

Improved Vacuum Sealing Drainage for Refractory Wounds

目的探讨VSD和改良后的VSD在治疗深度和难愈创面的优劣及注意事项。方法选择8例四肢术后不愈、骨及钢板外露、反复感染的深度创面,应用VSD治疗,其中3例再采用改良后VSD治疗,观察创面肉芽生长、创面培养、创面愈合情况。结果 8例患者均经VSD治疗,其中:5例患者14～21d揭除敷料,肉芽生长旺盛,适宜皮片或皮瓣移植,创面愈合;另3例患者,使用VSD 14～21d揭除敷料后清创缝合、皮片或(和)皮瓣移植,术后创面再次感染,行改良的VSD治疗14d后,再行清创缝合、皮片或皮瓣移植,创面愈合。结论使用VSD治疗有利于创面肉芽生长,促进了创面愈合;对反复感染及反复形成窦道的深度、难愈性创面使用改良的VSD治疗可进一步减少创面感染,加快创面的缩小、愈合。

Objective To investigate the characteristics and cautions of conventional vacuum sealing drainage（VSD） and improved VSD for full-thickness wounds and refractory wounds.Methods Eight cases of postoperative unhealed limb wounds with bone and plate exposure and recurrent infections received conventional VSD and 3 of them were further treated with improved VSD.Granulation tissue formation,bacterial infection and wound healing were observed.Results The dressing was removed on day 14-21 in all patients.In 5 of the 8 patients,granulation tissue grew at a fast rate which was suitable for skin or flap transplantation and wound healing.Improved VSD was further performed in other 3 patients who had wound infection after debridement,suturing and skin flap transplantation.After improved VSD treatment for 14 days,the debridement,suturing,and skin or flap transplantation were performed again,and then the wounds healed.Conclusion The VSD can promote granulation tissue formation and wound healing.The improved VSD can further reduce wound infection and accelerate wound healing for full-thickness wounds and refractory wounds with recurrent infection and recurrent sinuses.