负压封闭引流在组织损伤创面修复中的作用

Effect of vacuum sealing drainage in wound repair of tissue damage

目的研究探索负压封闭引流技术在难治性急、慢性组织损伤创面修复中的作用和临床疗效。方法对93例不同因素导致严重组织创伤的患者,根据组织损伤程度及创面感染情况,彻底清除创面的坏死失活组织、分泌物和异物等,尽量保留间生态组织,开放所有腔隙。使用Vacuseal材料和生物透性薄膜在组织创伤部位行持续负压封闭引流。结果 93例患者持续负压引流5～7d后,取出Vacuseal材料,有77例形态学观察创面缩小约≥20%,创腔完全消失,创面肉芽组织新鲜平坦,无水肿、渗出。感染创面经培养均为阴性。其余16例患者创面较大、创腔较深或感染较重,多次重新更换Vacuseal材料,继续负压引流,创面创腔肉芽组织生长均鲜活平整。采用Ⅱ期缝合19例,自体皮片移植修复23例,游离皮瓣转移修复27例,网状皮片覆盖14例,中厚皮片植皮覆盖10例,皮瓣(片)成活率100%。结论负压封闭引流能够彻底清除腔隙或创面分泌物和坏死组织,可显著提高肉芽创面血流量,改善局部微循环和组织水肿的消退,促进修复细胞增殖,刺激肉芽组织生长,加速急、慢性组织损伤创面修复愈合的速度。鲜活的肉芽组织能有效的使皮瓣(片)紧贴创面,防止皮片的移动并有利于皮瓣(片)的存活。

Objective To study and explore the clinical efficacy of vacuum sealing drainage technology in a variety of refractory acute and chronic wound repair of tissue injury. Methods According to tissue injury and wound infection, 93 patients with different factors leading to severe tissue trauma were removed inactivation of the wound of necrotic tissue, secretions and foreign bodies, so as to retain between ecological tissue, open to all cavities. Vacuseal materials and biological membrane permeability parts of the line were used in tissue trauma sustained VSD. Results 93 patients were treated continuous negative pressure drainage for 5 to 7 days, and removed the vacuseal materials. There were 77 cases whose narrow morphology wound was higher than 20%.Wound cavity completely disappeared. Granulation tissue was fresh and flat without edema and exudation. Wound infection was negative by culture. The remaining 16 patients with large wounds, deep wound cavity or severe infection, multiple materials to replace vacuseal continue drainage.Wound cavity formation of granulation tissue growth were fresh. 19 cases were treated with suture in phase II. 23 cases were repaired by autologous skin grafts. 27 cases were repaired by free flap. 14 cases were treated with mesh skin covering. 10 cases were treated with thickness skin graft skin graft covering. The survival rate of flap or piece was 100%. Conclusion VSD can completely remove cavities or wound secretions and necrotic tissue.Wound granulation can significantly improve blood flow, improve microcirculation and tissue edema subsided and promote the proliferation of repair cells, stimulate granulation tissue growth, acceleration of acute and chronic healing of wound repair tissue damage rate. Fresh granulation tissue of the flap can be effective close to the wound, and prevent skin and facilitate the movement of the flap survival.