负压封闭引流联合人工真皮治疗难愈性溃疡的疗效观察

Evaluation on combination of vacuum-assisted closure and artificial dermis grafting for treatment of refractory wounds

目的探讨负压封闭引流技术联合人工真皮治疗难愈性溃疡的临床疗效。方法收集41例难愈性溃疡病人的临床资料,根据治疗类型分A、B、C组,对创面清洁时间,术后8 d皮片成活率,植皮后住院天数以及术后6个月瘢痕评分进行分析,并将结果进行对比。结果 A、B、C三组创面清洁时间、皮片成活率、植皮后住院天数、瘢痕评分比较,差异有统计学意义(均P<0.01);A、B组创面清洁时间、植皮后住院天数相比差异无统计学意义(P>0.05);A、B组皮片成活率、瘢痕评分比较差异有统计学意义(均P<0.05);C组创面清洁时间,皮片成活率,植皮后住院天数与B组相比差异有统计学意义(均P<0.05),瘢痕评分与B组比较差异无统计学意义。结论负压封闭引流技术联合人工真皮应用于难愈性创面在清洁创面,提高皮片成活率,减少植皮后住院天数,改善术后瘢痕方面具有一定优势,值得推广应用。

Objective To investigate the clinical effects of combination of vacuum-assisted closure and artificial dermis grafting for treatment of refractory wounds.Methods A total of 41 cases of patients with refractory wounds,which were assigned into three groups （group A,group B and group C） according to the treatment types.Statistical data such as the time of wound cleaning,the survival rate of skin graft on the 8th day after surgery,hospital stay after skin graft and scores of scar score vancouver scale （VSS） assessment 6 months after operation were analyzed.Results There were statistically significant differences among all groups in the time of wound cleaning,the survival rate of skin graft on the 8th day after surgery,hospitalstay after skin graft and scores of VSS assessment 6 months after operation （P〈0.01）.There were no differences between group A and group B in the time of wound cleaning and hospitalstay after skin graft （P〉0.05）.However,group A had much higher survival rate of skin graft on the 8th day after surgery and lower score of VVS assessment when compared with group B.Although there were no difference between two groups in the score of VVS assessment,group B had much higher survival rates of skin graft,shorter hospitalstay after skin graft and wound cleaning time when compared with group C （P〈0.05）.Conclusions The combination of vacuum-assisted closure and artificial dermis grafting for treatment of refractory wounds has advantages in keeping wound clean,improving the survival rate of skin graft,reducing the hospital stay after skin graft and the postoperative scar,which worth to be popularized and applied.