波动式负压封闭引流在复杂创面植皮术中的应用

Application of vacuum sealing drainage in wave suction to repair severe defects with free dermatoplasty

目的 探讨应用波动式负压封闭引流（vacuum sealing drainage,VSD）防治复杂创面皮片移植术并发症的临床效果.方法 彻底清创,待创面新鲜时,取中厚或全厚皮片,整张移植皮片,VSD敷料结合半透膜覆盖.皮片移植区周围皮肤乙醇脱碘后,植皮区安装VSD装置,40 kPa（300 mmHg）负压0.5h与16.6～17.3 kPa（125～130mmHg）负压3h,交替抽吸,若渗出液较多,适当增大负压,同时缩短间隔,主动吸引出皮片下及周围腔隙内积液,使皮片与受区紧密贴合,7d拆除VSD.结果 共治疗22例,1例患者肌腱裸露部位少许皮肤坏死渗出,清创后,应用VSD促进创面愈合;其余21例皮片存活良好,无皮片下积液或感染.随防6～18个月,效果满意.结论 采用VSD与皮片移植术相结合,既能抽吸渗液,避免感染,促进皮片与基底愈合,缩短病程;又可避免皮片及周围皮肤因长时间肿胀的大压力而致的组织坏死,对于部分复杂创面是一种较理想的修复手段.

Objective To discuss the application of vacuum sealing drainage in wave suction to prevent the complications in repairing severe defects with free dermatoplasty.Methods Necrotic tissues were debrided entirely,and the fresh defects received dermatoplasty with moderate thickness or full thickness free skin graft and VSD was equipped.VSD aspirated the effusion bellow free skin and lacouna around free skin on negative pressure initiatively and alternatively from 16.6～ 17.3 kPa （125-130 mmHg） （3 hours） to 40 kPa （300 mmHg） （0.5 hour）.Vacuum sealing drainage was removed after 7 days.Results A total of 22 cases were treated,and the follow-up time was between 6 months and 18 months,and the result was ideal.A little necrosis of the dermatoplasty on tendon in one patient was seen after removal of VSD,the skin graft reactivated after applying VSD again and changing dressings,and the other free skin survived well without effusion and infection.Conclusions The application of vacuum sealing drainage in wave suction combined with free dermatoplasty to repair a part of patients with severe defects is a good choice.This method can aspirate the effusion to reduce the infection,promote the sealing between skin and recipient site.At the same time,it can prevent the necrosis of free skin and the tissue of skin around defects owing to heavy pressure in a long time.