负压对四肢瘢痕切除创面成纤维细胞的生长环境影响

Effect of Negative Pressure on the Growth Environment of Excision Wounds of Extremities

目的探究持续封闭负压引流技术(VSD)对瘢痕切除创面成纤维细胞生长环境的影响。方法回顾性分析2014年1月~2015年11月于笔者医院行植皮手术的四肢瘢痕切除术后患者60例,根据植皮手术前是否接受VSD治疗分为负压组(n=30)和包扎组(n=30),负压组均于一期植皮前接受VSD治疗,包扎组未接受VSD治疗。回顾性分析对比两组患者并发症发生率、首次植皮存活率、创面感染率、住院时间之间的差异。并用TUNEL染色、CD34染色法对比瘢痕标本中成纤维细胞凋亡指数及血管生成情况。结果负压组菌培养阳性率明显低于包扎组(P<0.05),植皮存活率明显高于包扎组(P<0.05)。两组并发症发生率、住院时间、疼痛评分、随访VSS评分间比较,负压组均明显较低(P<0.05)。负压组成纤维细胞凋亡指数明显较低,微血管计数明显较高(P<0.05)。结论负压封闭引流可以减轻瘢痕切除创面感染率,有效减轻炎性水肿,且可以通过改变局部血液循环微环境以及机械应力作用促进成纤维细胞增殖分裂,提高创面恢复效果。

Objective To explore the effect of continuous vacuum sealing drainage（VSD） on the growth environment of fibroblasts in scar excision wound. Methods We carryied out a retrospective analysis of 60 cases of patients with limb scar excision after skin grafting in our hospital from January 2014 to November 2015, and divided the patients into negative group （n=30） and control group （n=30） according to the skin grafts whether or not to accept the treatment of VSD.Negative pressure groups all received VSD treatment before the first period of grafting skin while the control group did not.Retrospective analysis was performed to compare the two groups in the complication rate for the first time, the survival rate of skin graft, wound infection rate and time difference of hospitalization. And we compared the index of apoptosis and angiogenesis in the scar specimens by TUNEL staining and CD34 staining. Results Bacteria culture positive rate in negative pressure group was significantly lower than the control group （P〈0.05）. And the graft survival rate was significantly higher than that of the control group （P〈0.05）.The incidence of complications,hospitalization time, pain score and VSS score were significantly lower in negative group （P〈0.05）. Conclusion VSD can reduce the infection rate in scar excision wound, effectively alleviate the inflammatory edema and can also promote fibroblast proliferation and improve wound healing effect by changing the local blood circulation and micro environment and mechanical.