负压引流联合显微外科技术在复杂感染性创面修复中对皮瓣存活及感染控制影响

Influence of negative pressure drainage combined with microsurgical technique on flap survival and infection control in complex infectious wound repair

目的:分析在复杂感染性创面修复中实施负压引流联合显微外科技术对皮瓣存活及感染控制的影响。方法:对本院收治的40例复杂感染性创面患者的临床资料进行回顾性分析,患者就诊时间为2017年1月至2020年10月;对患者实施清创处理后采用负压引流技术将伤口封闭,二期采取岛状皮瓣、游离皮瓣等显微外科技术修复创面;观察患者皮瓣存活及感染控制情况。结果:治疗后,40例皮瓣中完全存活39例,1例腓肠神经皮瓣远端部分出现表皮水泡,经换药处理后完全愈合,皮瓣存活状况良好;微生物培养结果显示,40例患者中出现59株微生物,共27种,其中,金黄色葡萄球菌、铜绿假单胞菌、表皮葡萄球菌占据致病菌前三位,有12例患者存在双重致病菌。结论:在清创及抗感染治疗基础上,采用负压引流联合显微外科技术能够加快完成复杂感染性创面基底床的建立,有利于提高皮瓣存活率、降低感染。

Objective:To analyze the effect of negative pressure drainage combined with microsurgical technique on flap survival and infection control in complex infectious wound repair.Methods:Retrospective analysis was performed on the clinical data of 40 patients with complicated infectious wound treated in our hospital.The patients visited our hospital from January 2017 to October 2020.After debridement,negative pressure drainage was used to close the wound.In the second stage,island flaps and free flaps were used to repair the wound.The survival and infection control of the flap were observed.Results:After treatment,39 of the 40 skin flaps survived completely,and 1 skin vesicle appeared in the distal part of sural nerve flap,which healed completely after dressing change.The results of microbial culture showed that 59 strains of microbes,a total of 27 species,were found in the 40 patients,among which Staphylococcus aureus,Pseudomonas aeruginosa and Staphylococcus epidermosus occupied the top three pathogenic bacteria,and there were 12 patients with dual pathogenic bacteria.Conclusion:On the basis of debridement and anti-infection treatment,negative pressure drainage combined with microsurgical technique can accelerate the establishment of the basement bed of complex infectious wound,which is beneficial to improve the survival rate of skin falp and reduce infection.