封闭负压引流与打包加压植皮成活效果的比较

THERAPEUTIC COMPARISON BETWEEN VACUUM-ASSISTED CLOSURE AND PRESSURE DRESSING FOR SKIN GRAFTING

目的探讨封闭负压引流术(VAC)与打包加压术对植皮皮片成活及瘢痕形成的影响。方法将12只SPF级标准化实验用兔随机分为两组,背部进行自身带真皮下血管网植皮,打包加压组采用打包加压术包扎,VAC组采用VAC负压引流包扎,术后即刻测量植皮压力。术后10d拆线,观察皮片愈合情况,比较两组皮片成活率;取植皮区皮肤及皮下组织,分别行苏木精-伊红和免疫组织化学染色,检测新生毛细血管分布情况,判断两组皮片成活质量。结果打包加压组植皮中心区域压力高于周边区域,差异有显著性(F=6.979,P<0.05);VAC组中心区域与周边区域压力分布差异无统计学意义(F=1.647,P>0.05)。术后10d,VAC组皮片成活率高于打包加压组(t=8.539,P<0.05),皮片单位面积内新生毛细血管数目多于打包加压组,差异有统计学意义(t=11.107,P<0.05)。与VAC组比较,打包加压组皮片炎性细胞浸润明显,成纤维细胞过度增生,纤维粗大、排列紊乱,丛束状分布。结论 VAC较打包加压术可有效促进皮片成活,减轻瘢痕组织形成。

Objective To compare the impact between vacuum sealing drainage （VAC） and pressure dressing （PD） on skin-graft survival and scar formation. Methods Twelve SPF grade standardized experimental rabbits were randomized to VAC group and PD group. Skingrafting with subdermal vascular plexus was performed on the back of rabbit. In PD group, compress bandaging was applied, in VAC group, VAC suction drainage was carried out. Pressure distribution on skin grafting area was mea- sured immediately upon completion of surgery. Stitches were removed 10 days after surgery. The healing of free skin flap was ob- served and the survival of the flap between the two groups compared. Postoperative survival condition of flaps were compared. The skin and subcutaneous tissue in skingrafting area were taken for HE and immunohistostaining to detect the distribution of new blood capillaries and assess the quality of skin graft survival in the two groups. Results In PD group, the pressure in central zone of skingrafting was higher than its peripheral area （F = 6.979,P〈0.05） In VAC group, the difference of pressure distribu- tion between the two areas was not significant （F = 1.647,P 〈0.05）. Ten days after surgery, the survival rate of the skin graft in VAC group was higher than PD group （t = 8.539, P 〈 0.05）, and the number of new capillaries per unit area was more （t = 11.107, P〈0.05）. Compared with VAC group, inflammatory cell infiltration was more obviously seen in PD group, showing hyperplasia of fibroblast with thick fiber, disorganized alinement and bundled distribution. Conclusion Vacuum sealing drainage is more effec- tive than pressure dressing in facilitating the survival of free skin graft and relieving the formation of scar tissue.