负压伤口治疗技术联合皮肤牵张器在皮肤软组织缺损中的应用

Application of negative pressure wound therapy combined with skin stretching device in the skin soft tissue defect

目的探讨负压伤口治疗技术(negative pressure wound therapy,NPWT)联合皮肤牵张器治疗大面积皮肤缺损创面的临床效果。方法皮肤软组织缺损患者60例依据治疗方法分为3组,行皮肤牵张器治疗20例为牵张器组,行NPWT治疗20例为NPWT组,行NPWT+皮肤牵张器治疗20例为联合组。比较3组治疗第1、5、7天伤口面积、分泌物细菌计数、创面引流液透明质酸(hyaluronic acid,HA)及血管内皮生长因子(vascular endothelial growth factor,VEGF)水平差异。结果随治疗时间延长,3组创面均呈缩小趋势,联合组治疗第1、5、7天伤口面积[(36.79±2.58)、(5.18±2.06)、(1.55±1.17)cm2]小于牵张器组[(41.73±3.07)、(11.01±2.43)、(4.34±1.32)cm^2]和NPWT组[(74.40±4.57)、(67.98±3.48)、(64.50±1.92)cm^2](P<0.05);随治疗时间延长,3组创面分泌物中HA、VEGF表达逐渐增强,治疗第1、5、7天NPWT组HA[(101.73±5.52)、(152.24±7.57)、(182.75±6.55)μg/L]、VEGF[(1.46±0.14)、(5.28±0.21)、(7.33±0.36)μg/L]及联合组HA[(111.23±4.96)、(163.62±5.82)、(193.42±6.07)μg/L]、VEGF[(2.38±0.18)、(6.04±0.26)、(8.11±0.30)μg/L]均高于牵张器组[HA(82.89±4.33)、(121.82±4.26)、(151.21±4.75)μg/L;VEGF(0.84±0.12)、(2.97±0.27)、(4.79±0.38)μg/L](P<0.05),且联合组高于NPWT组,差异均有统计学意义(P<0.05);治疗第1、5、7天,NPWT组患者伤口分泌物细菌计数[(1 057±46)×10~3cfu/mL、(68±18)×10~3cfu/mL、(19±8)×10~3)cfu/mL]低于牵张器组[(1 640±34)×10~3cfu/mL、(472±23)×10~3cfu/mL、(179±10)×10~3cfu/mL](P<0.05),NPWT组与联合组[(1 014±32)×10~3cfu/mL、(59±14)×10~3cfu/mL、(16±7)×10~3cfu/mL]比较差异均无统计学意义(P>0.05)。结论 NPWT联合皮肤牵张器技术可更好促进创面愈合。

Objective To explore the clinical application of negative pressure wound therapy （NPWT） combined with skin stretching device in repairing large area skin defect. Methods Sixty patients with skin soft tissue defect were divided into TopC｜osure group, NPWT group and NPWT ＋ TopClosure group, with 20 patients in each group. The wound size, bacterial count, hyaluronic acid （HA） level and vascular endothelial growth factor （VEGF） level were compared among three groups before and after 1-, 5-, and 7-day treatment. Results The wound size in three groups all showed a decreasing trend with the prolonging of time. The wound sizes after 1-, 5- and 7-day treatment were significantly smaller in NPWT ＋ TopClosure group （（36.79±2.58）, （5.18±2.06）, （1.55±1. 17） cm2） than those in TopClosure group （（41.73±3.07）, （11.01±2.43）, （4.34±1.32） cm^2） and NPWT group （（74.40±4.57）, （67.98±3.48）, （64.50±1.92） cm^2） （P〈0.05）. In three groups, the levels of HA and VEGF in wound secretion increased with the prolonging of time. The HA and VEGF levels after 1-, 5- and 7-day treatment were significantly higher in NPWT group （HA： （101.73±5.52）, （152. 24±7. 57）, （182. 75±6. 55） μg/L; VEGF： （1. 46±0. 14）, （5. 28±0. 21）, （7. 33±0.36） μg/L） and TopClosure ＋ NPWT group （HA：（111. 23±4.96）, （163. 62±5. 82）, （193. 42±6. 07） μg/L; VEGF： （2.38±0.18）, （6.04±0.26）, （8.11±0.30）μg/L） than those in TopClosure group （HA： （82.89±4.33）, （121.82±4.26）, （151.21±4.75） μg/L; VEGF： （0.84±0.12）, （2.97±0.27）, （4.79±0.38） μg/L） （P〈0.05）, and significantly higher in TopClosure ＋ NPWT group than those in NPWT group （P〈0.05）. The bacterial count of wound secretion after 1-, 5- and 7-day treatment were significantly lower in NPWT group （（1 057±46） ×10^3 , （68±18）×10^3 , （19±8））×10^3 cfu/mL） than those in TopClosure group （（1 640±34）×10^3 , （472±23）×10^3 , （179- 10）×10^3 cfu/mL） （P（0.05）, and there were no significant differences between NPWT group and TopClosure ＋ NPWT group （1 014± 32）×10^3, （59±14）×10^3, （16±7）×10^3 cfu/mL） （P）0.05）. Conclusion NPWT combined with skin stretching device can promote wound healing more effectively.