传统纱布开放换药与负压封闭引流技术临时治疗不同软组织缺损的疗效比较

A comparison of traditional open gauze dressing versus vacuum sealing drainage in temporary covering of different soft tissue wounds

目的比较传统纱布开放换药与负压封闭引流（VSD）装置临时覆盖创面的疗效。方法回顾性分析2000年3月至2011年9月收治的2153例四肢软组织缺损患者资料，男1548例，女605例；年龄3～68岁，平均35．3岁，平均创面大小为195．9cm2。创面类型：无菌创面53例，污染创面1388例，感染创面712例；根据临时覆盖创面的方法，分为纱布开放换药组（开放组，793例）和VSD创面封闭组（VSD组，1360例），后期行直接缝合、游离植皮或显微外科手术永久覆盖闭合创面。比较两组患者临时覆盖创面的时间及后期不同永久覆盖方法的选择。结果开放组与VSD组各类创面平均临时覆盖时间分别为：无菌创面（9．7±3．1）d和（7．0±1．9）d，污染创面（25．8±6．3）d和（17．8±3．7）d，感染创面（32．0±9．3）d和（21．7±4．0）d。开放组后期直接缝合9例，游离植皮137例，显微外科组织瓣移位（移植）647例；VSD组后期直接缝合47例，游离植皮580例，显微外科组织瓣移位（移植）733例。两组患者3种不同类型创面的临时覆盖时间及永久覆盖方法的选择比较差异均有统计学意义（P〈0．05）。2132例患者术后获1—6个月（平均3个月）随访。永久覆盖术后创面愈合良好，大部分感觉恢复，对患肢功能无不良影响。结论与传统纱布开放换药临时覆盖创面比较，VSD技术能明显减少临时覆盖时间，对无菌创面可增加二期直接缝合创面的比例，对污染及感染创面可降低二期组织瓣移植闭合创面的比例。

Objective To compare traditional open gauze dressing and vacuum-sealing-drainage （VSD） in temporary coveting of different soft tissue wounds. Methods The clinic data of 2153 patients with soft tissue defect at the limbs from March 2000 to September 2011 were retrospectively studied. They were 1548 males and 605 females, with an average age of 35.5 years （range, 3 to 68 years） . The average wound area was 195.9 cm2. There were 53 sterile wounds, 1388 dirty wounds and 712 infected wounds. As a temporary coveting, traditional open gauze dressing was used in 793 cases while VSD in 1360 cases. The wounds were finally closed by suturing, free skin grafting or tissue flap grafting. Time for temporary coveting and final closure were compared between the 2 groups. Results The mean time for temporary covering in the traditional group and VSD group was respectively 9.7 ± 3.1 days versus 7.0 ± 1.9 days for sterile wounds, 25.8 ± 6. 3 days versus 17.8 ± 3.7 days for dirty wounds and 32. 0 ：t： 9.3 days versus 21.7 ± 4.0 days for infected wounds. In the traditional group, 9 wounds got sutured directly, 137 wounds repaired with free skin grafts and 647 wounds treated with tissue grafts while in the VSD group, 47 wounds got sutured directly, 580 repaired with free skin grafts and 733 treated with tissue grafts. The were significant differences between the 2 groups in the temporary coveting time and final closure methods for the 3 sorts of wounds （ P 〈 0. 05）. 2132 cases were followed up from 1 to 6 months （average, 3 months）. All wounds healed well after final closure, resulting in recovery of most sensation and little interference with the function of the injured-limb. Conclusion Com- pared with traditional gauze dressing, VSD technique may obviously reduce the time for temporary covering, and lead to increased possibility of direct secondary suturing for sterile wounds and decreased necessity for secondary tissue grafting for dirty and infected wounds.