负压引流技术联合富血小板血浆治疗慢性创面的临床观察

Clinical application of vacuum-assisted closure technique combined with platelet-rich plasma on treatment of chronic refractory wounds

目的分析负压封闭辅助伤口闭合技术结合富血小板血浆在治疗慢性难愈性创面中的临床应用效果,探讨该方案在临床推广的可行性。方法2017年2月-2018年2月河南省人民医院收治的36例年龄为(46.5±10.46)岁患有慢性难愈性创面的患者,创面均存在不同程度的感染,且伴有骨质、神经或肌腱等组织外露,经长期换药无明显效果甚至有加重倾向。采用负压封闭辅助伤口闭合技术结合富血小板血浆的方法予以治疗,首先创面予以清创后行持续负压引流,7 d后拆除负压引流装置,然后制备富血小板血浆凝胶,并将之覆盖或填充创面(创腔),如此为一个治疗周期。经过一个或多个治疗周期后如创面(创腔)仍有部分骨质、神经或肌腱等组织外露,但已达到皮瓣转移的条件,为缩短治疗时间应及时予以手术封闭创面。结果本组36例患者的创面经过治疗全部愈合,愈合时间为19~62 d,平均为(32.94±8.59)天,随访时间术后1~2年不等,在随访期内该组内慢性难愈性创面无复发。结论负压封闭辅助伤口闭合技术联合富血小板血浆治疗慢性难愈性创面的效果较好,且该方案简单易行、安全可靠,在临床上可以推广应用。

Objective To analyze the clinical effect of vacuum-assisted closure(VAC)technique combined with platelet-rich plasma(PRP)in the treatment of chronic refractory wounds,and to explore the feasibility of the scheme in clinical promotion.Methods From February 2017 to February 2018,a total of 36 patients with an average age of(46.5±10.46)years with chronic refractory wounds were enrolled in the observation group.These wounds were infected to varying degrees,with exposure of bone,nerves or tendons.After long-term dressing change,there was no obvious effect or even aggravation.They were treated with vacuum-assisted closure technique combined with platelet-rich plasma.First,the wound was debrided and then treated with vacuum-assisted closure technique.After 7 days,the negative pressure drainage device was removed,and then the platelet-rich plasma gel was prepared.Cover or fill the wound(creative cavity)with the platelet-rich plasma gel,so for a treatment cycle.After one or more treatment cycles,if the wound(wound cavity)still has some bone,nerve or tendon exposed,but it has reached the condition of flap transplantation.In order to shorten the treatment time,the wound should be closed in time.Results The wounds of 36 patients in this group healed completely after treatment.The healing time ranged from 19-62 days,with an average of(32.94±8.59)days.The follow-up time ranged from 1-2 years.During the follow-up period,there was no recurrence of chronic refractory wounds in this group.Conclusion The effect of vacuum closed wound closure combined with platelet rich plasma in the treatment of chronic wounds is effective,and the scheme is simple,safe and reliable,which can be widely used in clinic.