创伤性软组织缺损的负压封闭治疗

TREATMENT OF TRAUMATIC SOFT TISSUE DEFECT BY VACUUM SEALING

目的 探讨创伤致软组织缺损负压封闭 (VS)治疗的临床效果。 方法 1 998年 8月～ 2 0 0 1年 1 2月 ,对 49例 55个大面积软组织缺损或 /和感染者 ,创面范围为 1 0 cm× 1 0 cm～ 30 cm× 30 cm;清创后将 Vacuseal材料覆盖在相应大小的创面上或填入创腔内 ,持续 50～ 60 k Pa负压引流 ,5～ 7天后二期缝合、植皮或皮瓣移位修复。1 2 6例采用传统换药或引流的患者为对照组。 结果 治疗组有 4例 (4个创面 )死亡未完成治疗 ,余 45例 51个创面治愈 ,无全身和局部并发症。在二期缝合时间、换药次数、创面缩小程度及总体治疗费用等方面 ,与对照组比较 ,均有统计学意义 (P<0 .0 1 )。创面或创腔直接通过 VS治愈 6个 ,采用游离皮瓣修复 4个 ,局部皮瓣移位修复 8个 ,植皮覆盖 2 7个 ,二期缝合 6个。 结论 VS能充分引流和刺激创面肉芽组织快速生长 ,缩短治愈时间和消除感染。是治疗创伤后急、慢性软组织缺损的一种简便。

Objective To investigate the clinical effect of vacuum sealing in treatment of traumatic soft tissue defect. Methods From 1998.8 to 2001.2, 49 patients with 55 traumatic soft tissue defects were treated by vacuum sealing after debridement. Among them, there were 39 males and 10 females with mean age 38.4 years. The wound area varied from 10 cm×10 cm to 30 cm×30 cm. In the experimental group, the wound surfaces or cavities were filled with polyvinyl alcohol foams with embedded drainage tubes connected with vacuum bottle (negative pressure of 50 60 kPa).Wound closure was performed with secondary suturing, or skin transplantation, or local flap grafting after 5 7 days. Besides,126 patients were managed by traditional dressing as the control group. Results Out of 51 traumatic soft tissue defects(45 patients), the wound closure was performed with a free flap in 4, with local flap in 8, with skin grafting in 27, with secondary suturing in 6, and with vacuum sealing directly in the other 6 defects. Forty five patients recovered and no complications (systemic and located) occurred. There were significant differences in time of secondary suturing, times of dressing, wound shrink and total therapeatic cost between two groups ( P< 0.01). Conclusion Vacuum sealing can protect the wound against contamination, evacuate the wound exudates completely, stimulate the growth of granulation tissue, and facilitate the wound healing; so vacuum sealing is a simple and effective method in treatment of traumatic soft tissue defect.