负压封闭引流术在整形外科皮瓣坏死后的应用与护理

Nursing experience of vacuum sealing drainage applied for plastic surgery post skin flap necrosis

目的：总结整形外科术后皮瓣坏死患者应用负压封闭引流术（VSD）的护理方法。方法对中国医学科学院整形外科医院中二病房4例整形术后皮瓣坏死后清创的患者使用 VSD 治疗，并进行回顾性总结和分析。结果2例行肋间动脉穿支皮瓣的患者经过2个周期 VSD 处理，创面大量新鲜肉芽组织生长，呈细小颗粒状，毛细血管丰富，无水肿，创面面积缩小至2 cm×2 cm，植皮修复后伤口愈合良好；1例行扩张的脐旁皮瓣的患者经过1个周期的 VSD 处理，创面面积缩小至1 cm×1 cm，经过4次换药后伤口愈合；1例肩胛皮瓣的患者经过3个周期的 VSD 处理，创面面积缩小至2 cm ×3 cm，植皮修复后伤口愈合良好。4例患者整个 VSD 治疗过程无全身及局部毒性、过敏反应，且无并发症发生。结论对整形外科术后皮瓣坏死患者清创后采用 VSD 治疗，是一种操作简便、疗效显著的治疗方法，值得临床推广使用。

Objective To summarize nursing methods of vacuum sealing drainage （VSD）for plastic surgery patients with skin flap necrosis.Methods VSD was applied to 4 plastic surgery patients with skin flap necrosis in Middle Second Ward of Plastic Surgery Hospital,Chinese Academy of Medical Sciences.The effectiveness of VSD was retrospectively summarized and analyzed.Results Two patients with intercostalartery perforator flap had been treated with VSD for two cycles.There were massive fresh granulation tissue characterized with fine granules,abundant capillaries and no edema.The area of wound had decreased to 2 cm ×2 cm.Moreover,the wound recovered well after skin-graft repairing. One patient with ectatic sensate paraumbilical flap had been treated with VSD for one cycle.The area of wound had decreased to 1 cm ×1 cm and recovered after four times dressing change.The last case of patient with scapular flap had been treated with VSD for 3 cycles and the area wound had decreased to 2 cm ×3 cm.The wound recovered favorably after skin-graft repairing.There were no systemic or local toxicity,allergic reaction and complications in all four cases. Conclusions Application of VSD,which is worth of clinical expansion,is a simple-handling and effective treatment for plastic surgery patients with skin flap necrosis after debridement.