负压封闭引流联合游离皮瓣移植治疗长期慢性溃疡创面的效果观察

The Effect of VSD Combined with Free Skin Flap Transplantation on Long-term Chronic Ulcer Wound

目的探讨负压封闭引流(vacuum sealing drainage, VSD)联合游离皮瓣移植治疗长期慢性溃疡创面的临床效果。方法选取2016年3月—2017年11月秦皇岛军工医院普外科收治的长期慢性溃疡创面患者73例为研究对象,根据治疗方法的不同分为观察组38例和对照组35例。两组均给予传统清创治疗,在此基础上观察组给予VSD联合游离皮瓣移植治疗,对照组仅联合游离皮瓣移植治疗。治疗后7 d比较两组治疗前后疼痛视觉模拟评分(visual analogue scale, VAS);治疗后21 d比较两组临床疗效;观察比较两组疼痛缓解时间、创面愈合时间及住院天数;随访2～3个月,观察并记录两组治疗期间不良反应发生情况及皮瓣成活情况。结果与治疗前比较,治疗后7 d两组患者VAS评分均显著降低,且观察组治疗后VAS评分低于对照组,差异均有统计学意义(P<0.05或P<0.01);治疗后观察组治疗总有效率为94.74%高于对照组的74.29%,差异有统计学意义(P<0.05);观察组疼痛缓解时间、创面愈合时间、住院天数均短于对照组,差异均有统计学意义(P<0.05);观察组治疗期间再次感染、出血、薄膜下积液、创缘皮损张力性水疱及静脉危象发生率均显著低于对照组,差异均有统计学意义(P<0.05或P<0.01);随访2～3个月,观察组皮瓣均成活,对照组有3例失活需择期行二次移植术。结论 VSD联合游离皮瓣移植治疗长期慢性溃疡创面效果可靠,可明显减轻患者疼痛症状,缩短创面愈合时间、住院时间,降低治疗期间不良反应发生率。

Objective To explore the clinical effect of vacuum sealing drainage (VSD) combined with free skin flap transplantation on long-term chronic ulcer wound. Methods Seventy-three patients with long-term chronic ulcer wounds admitted to Department of General Surgery, Qinhuangdao Cerebrovascular Disease Hospital from March 2016 to November 2017 were selected as subjects. According to the different treatment methods, they were divided into the observation group ( n =38) and the control group ( n =35). Both groups received traditional debridement treatment. The observation underwent VSD combined with free skin flap transplantation on this basis, while the control group was exclusively given free skin flap transplantation. Visual analogue scale (VAS) pain score before and after treatment was compared at 7 d after treatment. The clinical efficacy of the two groups was compared at 21 d after treatment. The clinical indicators of the two groups were observed and compared, including time of pain relief, wound healing time, and length of hospitalization. They were followed up for 2-3 months, and the incidence of adverse reactions and flap survival during the treatment were observed and recorded. Results Compared with those before treatment, the VAS pain scores of the two groups were significantly reduced after treatment, which were lower in the observation group than in the control group, suggesting significant differences ( P <0.05 or P <0.01). After treatment, the total effective rate was 94.74% in the observation group, which was higher than that (74.29%) in the control group, and the difference was statistically significant ( P <0.05). The time of pain relief, wound healing time and length of hospitalization were shorter in the observation group than in the control group ( P <0.05). The incidence of reinfection, hemorrhage, subdural effusion, and tension vesicles and venous crisis was significantly lower in the observation group than in the control group, and the differences were statistically significant ( P <0.05 or P <0.01). After 2-3 months of follow-up, the flaps of the observation group survived. In the control group, 3 cases of inactivation required secondary transplantation due to inactivation. Conclusion VSD combined with free skin flap transplantation is effective in treating long-term chronic ulcer wounds, which can significantly alleviate pain symptoms, shorten wound healing time and length of hospitalization, and reduce the incidence of adverse reactions during treatment.