间歇封闭负压改善皮瓣术后静脉回流障碍的临床研究

Study of Effects of Intermittent Negative Pressure Wound Therapy on Improving the Venous Congestion Disorder of Postoperative Flaps

目的：评价间歇封闭负压技术在治疗皮瓣术后静脉回流障碍中的应用价值。方法：总结我科自2010年8月至2014年lO月治疗的30例皮瓣移植术后静脉回流障碍的病例，其中男19例，女11例，年龄25～65岁，平均38岁。所有皮瓣均表现为不同程度的青紫、肿胀、水疱、皮温低、充盈反应迟缓或创缘出血（淤血）等，且淤斑的面积大于皮瓣面积的20％。治疗组给予间歇封闭负压治疗（120mmHg负压，治疗3min，间歇2min）。对照组采用常规换药治疗。两组均隔日换药，创面摄影并利用图像分析软件测量瘀斑面积。比较两组皮瓣淤血高峰时间、皮瓣血运恢复时间、远端坏死率及二次手术率。结果：间歇负压治疗组皮瓣淤血高峰时间（2．7±0．82d）小于对照组（4．5±1．08d）（P〈0．05）；治疗组皮瓣血运恢复时间（10．8±2．15d）也小于对照组（15．9±2．85d）（P〈0．05）。此外，治疗组皮辩远端坏死率（13．3％，2／15）显著低于对照组（60．0％，9／15）（P〈0．05）。结论：应用间歇封闭负压技术治疗皮瓣术后静脉回流障碍效果优于常规治疗。

Objective： To evaluate the application value of the intermittent negative pressure wound therapy （INPWT） on improving the venous congestion disorder of postoperative flaps. Methods： Analyze 30 cases of postoperative flaps with venous congestion disorder in our department from August 2010 to October 2014, including 19 males and 11 females, aged 25 to 65 years （mean=38）. All the flaps showed purple-color, swelling, blisters, low skin-temperature, slow filling-response or wound bleeding （congestion） etc, and the congest- ed area accounted larger than 20% of the whole area of the flap. In the INPWT treatment group, the flaps were treated by 120 mmHg neg- ative pressure working 3 minutes and breaking for 2 minutes. In the control group, flaps were treated by routine dressing change methods. All the flaps were dressing changed and photographed every two days, and the congesting area of the flaps were measured by an image analyzing software. The peek time of venous congestion, the recovery time of flaps, the ratio of flap necrosis at the end and the ratio of secondary surgical procedures were compared between the two groups. Results： The peak time of venous congestion and the recovery time of flaps in the INPWT group were 2.7± 0.82 d and 10.8± 2.15 d, respectively, which were all shorter compared with those in the control group （4.5±1.08 d and 15.9± 2.85 d, respectively） （P all 〈0.05）. The ratio of flap necrosis at the end in the INPWT group （13.3%, 2/15） was also lower than that in the control group （60.0%, 9/15） （P〈0.05）. Conclusion： INPWT showed better effects on im- proving the venous congestion of the postoperative flaps than the routine dressing change methods.