负压辅助愈合治疗系统在胸腹背部断层皮片游离移植术后的应用

Application of the Vacuum-assisted Closure Therapy on Pressure Dressing in Free Transplant Operation for Free Split-Thickness Skin Graft on Anterior Thoracic Wall,Abdominal Wall and Back

目的探讨应用负压辅助愈合治疗系统(V.A.C.Therapy)在胸、腹、背部断层皮片游离移植术后加压固定的有效性。方法 2010年10月-2011年10月,应用V.A.C.Therapy加压固定游离断层皮片修复21例胸、腹、背部皮肤软组织缺损患者。男15例,女6例;年龄21～63岁,平均43岁。其中瘢痕切除后创面13例,皮瓣切取后供瓣区形成的创面8例。创面位于胸部7例,腹部9例,背部5例。皮肤及软组织缺损范围12 cm×10 cm～18 cm×15 cm。游离移植的断层皮片厚度为0.6 mm,在缺损部位移植断层皮片后,使用V.A.C.Therapy固定皮片,压力范围100～125 mm Hg(1 mm Hg=0.133 kPa)。结果住院时间19～32 d,平均24 d。21例植皮均成活,受区创面Ⅰ期愈合;供皮区创面Ⅰ期愈合。随访时间6～12个月,平均8个月。游离移植皮肤色泽与周围皮肤色泽相似,无破溃,无明显凹陷。结论应用V.A.C.Therapy加压固定的游离断层皮片,成活率高,效果可靠,是一种安全实用的固定方法。

Objective To explore the effect of the vacuum-assisted closure（VAC） therapy on the pressure dressing in free transplant operation for free split-thickness skin graft on anterior thoracic wall,abdominal wall and back.Methods Between October 2010 and October 2011,the VAC therapy was applied to the pressure dressing in free transplant operation in 21 patients for free split-thickness skin graft on anterior thoracic wall,abdominal wall and back.The ages of the patients ranged from 21 to 63 years old with an average of 43（15 males and 6 females）.Among these patients,13 had wound from cicatrectomy and 8 had from removal of the skin flaps that were used in the operations;7 had wound on the anterior thoracic wall,9 on abdominal wall,and 5 on the back.The lesion areas ranged from 10 cm×12 cm to 15 cm×18 cm and the average thickness for the free transplant split-thickness skin grafts was 0.6 mm.After transplanting split-thickness skin to the lesion areas,the VAC therapy was applied with a pressure range of 100-125 mm Hg（1 mm Hg=0.133 kPa）.The hospital stays for these subjects lasted from 19 to 32 days with an average stay of 24 days.Results The transplanted skin survived in all 21 patients and lesion area recovered to stage Ⅰ in the follow-up periods ranging from 6 to 12 months,with an average of 8 months.The skin tone of the transplanted skin grafts showed no difference from the skin tone of the surrounding areas-no lesion or significant dent.Conclusion The skin grafts under VAC therapy pressure dressing in the free transplant operations have a reliably high survival rate and the VAC therapy is an effective,practical and dependable dressing method.