封闭负压引流技术联合人工真皮修复慢性创面的临床研究

Clinical analysis of vacuum sealing drainage combined with artificial dermis in repairing chronic wounds

目的 观察封闭负压引流技术（VSD）联合人工真皮修复慢性创面的临床疗效.方法 66例慢性创面患者随机分成两组.对照组33例：予抗感染,改善微循环,聚维酮纱外敷,经换药治疗创面未愈者行植皮或皮瓣修复术.观察组33例：予抗感染,改善微循环,早期应用VSD处理创面,创面有新鲜肉芽组织后植入人工真皮（皮耐克）,待其肉芽生长满意后行植皮术.结果 对照组平均住院天数（55.3±1.2）天,其中植皮或皮瓣修复术修复30例,创面换药愈合者3例,创面愈合后疤痕增生明显.观察组平均住院天数（31.6±1.2）天,其中20例患者创面较大,经外敷人工真皮,肉芽生长满意后予植皮手术,其余患者经植入人工真皮换药,创面治愈后外观满意,疤痕增生轻或不明显.结论 VSD联合人工真皮修复慢性创面可以有效的促进慢性创面愈合,减少疤痕增生,缩短住院时间.

Objective To observe the clinical efficacy of vacuum sealing drainage （VSD） combined with artificial dermis in repairing chronic wounds.Methods 66 cases of chronic wounds were randomly divided into control group and observation group,33 cases in each group.Control group was treated by antiinfection,microcirculation improvement,and wounds were covered by gauze soaked with povidone iodine cream with regular dressing change.Observation group was treated by anti-infection,microcirculation improvement and early vacuum sealing drainage （VSD）,wounds were covered by artificial dermis （PELNAC） to induce dermal reconstruction after granulation tissue grew.Some bigger wounds were treated by skin grafting on base of satisfying growth of granulation tissue.Results In control group,the average hospital stay was （55.3 ± 1.2） days,30 cases received skin grafting or skin flap transplantation,wounds in 3 cases healed by wound dressing with remarkable scar formation.In observation group,the average hospital stay was （31.6 ± 1.2） days,bigger wounds in 20 cases were treated by skin grafting after wound bed preparation （granulation tissue growth） by artificial dermis,wounds in other patients were covered by artificial dermis with little scar formation.Conclusion Vacuum sealing drainage combined with artificial dermis in repairing chronic wounds can accelerate the healing speed of chronic wounds,reduce scar formation and shorten hospital stay.