Novel Application of Vacuum Sealing Drainage with Continuous Irrigation of Potassium Permanganate for Managing Infective Wounds of Gas Gangrene

Summary： Traumatic gas gangrene is a fatal infection mainly caused by Clostridium perfringens. It is a challenge to manage gas gangrene in open wounds and control infection after debridement or amputa- tion. The aim of the present study was to use vacuum sealing drainage （VSD） with continuous irrigation of potassium permanganate to manage infective wounds of gas gangrene and observe its clinical effi- cacy. A total of 48 patients with open traumatic gas gangrene infection were included in this study. Am- putations were done for 27 patients, and limb salvage procedures were performed for the others. After amputation or aggressive debridement, the VSD system, including polyvinyl alcohol （PVA） foam dress- ing and polyurethane （PU） film, with continuous irrigation of 1：5000 potassium permanganate solutions, was applied to the wounds. During the follow-up, all the patients healed without recurrence within 8-18 months. There were four complications. Cardiac arrest during amputation surgery occurred in one pa- tient who suffered from severe septic shock. Emergent resuscitation was performed and the patient re- turned to stable condition. One patient suffered from mixed infection of Staphylococcal aureus, and a second-stage debridement was performed. One patient suffered from severe pain of the limb after the debridement. Exploratory operation was done and the possible reason was trauma of a local peripheral nerve. Three cases of crush syndrome had dialysis treatment for concomitant renal failure. In conclusion, VSD can convert open wound to closed wound, and evacuate necrotic tissues. Furthermore, potassium permanganate solutions help eliminate anaerobic microenviroument and achieve good therapeutic effect on gas gangrene and mixed infection. VSD with continuous irrigation of potassium permanganate is a novel, simple and feasible alternative for severe traumatic open wounds with gas gangrene infection.

Recombinant human epidermal growth factor combined with vacuum sealing drainage for wound healing in Bama pigs

Background:Vacuum sealing drainage(VSD)and epidermal growth factor(EGF)both play an important role in the treatment of wounds.This study aims to explore the effects of the combination of VSD and EGF on wound healing and the optimal concentration and time of EGF.Methods:We tested the proliferation and migration capacity of HaCaT and L929 cells at different EGF concentrations(0,1,5,10,and 100ng/ml)and different EGF action times(2,10,and 30min).A full-thickness skin defect model was established using male,30-week-old Bama pigs.The experiment included groups as follows:routine dressing change after covering with sterile auxiliary material(Control),continuous negative pressure drainage of the wound(VSD),continuous negative pressure drainage of the wound and injection of EGF 10min followed by removal by continuous lavage(V+E 10min),and continuous negative pressure drainage of the wound and injection of EGF 30min followed by removal by continuous lavage(V+E 30min).The wound healing rate,histological repair effect and collagen deposition were compared among the four groups.Results:An EGF concentration of 10ng/ml and an action time of 10min had optimal effects on the proliferation and migration capacities of HaCaT and L929 cells.The drug dispersion effect was better than drug infusion after bolus injection effect,and the contact surface was wider.Compared with other groups,the V+E 10min group promoted wound healing to the greatest extent and obtained the best histological score.Conclusions:A recombinant human epidermal growth factor(rhEGF)concentration of 10 ng/ml can promote the proliferation and migration of epithelial cells and fibroblasts to the greatest extent in vitro.VSD combined with rhEGF kept in place for 10min and then washed,can promote wound healing better than the other treatments in vitro.

Microscopic properties and sealing performance of new gas drainage drilling sealing material

The geological condition of Chinese coal mines are complex and high gassy,which account for ffty percent to seventy percent.Because of the abundant pores and cracks around the drainage drilling hole,the gas concentration attenuates rapidly,and the effective gas drainage period is short.The traditional sealing materials of yellow mud and cement-sand grout will readily shrink after the drilling hole is sealed,the sealing length is short and the sealing quality is not satisfactory.Currently widely used polyurethane material will shrink when it comes into contact with water,and the price is also very high.In this study,taking cement as a base material,a novel composite sealing material mixed by expansion admixture,additive,and fbrin and coupling agent was developed and the sealing performance and expansion property of the material were also studied and analyzed.The FEI Quanta TM 250 environmental scanning electron microscope was used to investigate the microstructure of material.The results revealed that the new composite sealing material had a desirable expansion performance and a defnite fluidity convenient for grouting.The solidifed material,combining closely with the drilling wall,possessed an adequate strength and was not easy to shrink.Compared to the conventional polyurethane,the gas drainage concentration by drilling sealing exceeded 40 percent,and the sealing capacity improves5 times,the sealing effect increases signifcantly.

Salvage of vascular graft infections via vacuum sealing drainage and rectus femoris muscle flap transposition: A case report

BACKGROUND The management of vascular graft infections continues to be a significant challenge in a clinical situation.The aim of this report is to illustrate the novel vacuum sealing drainage(VSD)technique and rectus femoris muscle flap transposition for vascular graft infections,and to evaluate the prospective of future testing of this surgical procedure.CASE SUMMARY We report the case of a 32-year-old male patient,who presented a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure.Using the VSD and muscle flap transposition,the groin wound and vascular graft infection were finally treated successfully.CONCLUSION Our case report highlights that VSD technique and rectus femoris muscle flap transposition could be considered in patients presenting with a severe infected groin wound with biological vascular graft Acinetobacter baumannii infection resulting in extensive graft exposure,especially in consideration of treatable conditions.

Method for designing the optimal sealing depth in methane drainage boreholes to realize efficient drainage

The purpose of underground methane drainage technology is to prevent methane disasters and enable the efficient use of coal mine methane(CMM),and the sealing depth is a key factor that affects the performance of underground methane drainage.In this work,the layouts of in-seam and crossing boreholes are considered to analyze the stress distribution and failure characteristics of roadway surrounding rock through a numerical simulation and field stress investigation to determine a reasonable sealing depth.The results show that the depths of the plastic and elastic zones in two experimental coal mines are 16 and 20 m respectively.Borehole sealing minimizes the air leakage through the fractures around the roadway when the sealing material covers the failure and plastic zones,and the field test results for CMM drainage at different sealing depths indicate that the CMM drainage efficiency increases with increasing sealing depth but does not change once the sealing depth exceeds the plastic zone.Moreover,sealing in the high-permeability roadway surrounding rock does not have a strong influence on the borehole sealing performance.Considering these findings,a new CMM drainage system for key sealing in the low-permeability zone was developed that is effective for improving the CMM drainage efficiency and prolonging the high-concentration CMM drainage period.The proposed approach offers a valuable quantitative analysis method for selecting the optimum sealing parameters for underground methane drainage,thereby improving considerably the drainage and utilization rates of CMM.

Effect of Ilizarov external fixation combined with negative pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion

Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective nonunion who were treated in our hospital from August 2016 to August 2018 were divided into two groups according to random number table,with 39 patients in the control group treated with Ilizarov external fixation technology and 40 patients in the study group treated with vacuum pressure sealing drainage and antibiotics on the basis of the control group.Bone healing time and daily walking were recorded.Rasmussen score,serum intercellular adhesion molecule-1(ICAM-1)and IL-6 levels,lower limb Fugl-Meyer motor function score and lower limb BI index score were compared at different time.Results:The daily walking condition of the study group was significantly better than that of the control group(P<0.05),and the healing time of bone was significantly shorter than that of the control group(P<0.05);the Rasmussen score of the study group was higher than that of the control group at 1 month,6 months and 12 months after treatment(P<0.05);the levels of serum ICAM-1 and IL-6 in the two groups after treatment were lower than those before treatment(P<0.05),and the levels of serum ICAM-1 and IL-6 in the study group were lower than those in the control group after treatment(P<0.05).The lower limb Fugl-Meyer motor function score and lower limb BI index score of the two groups after treatment were higher than those before treatment(P<0.05),and the lower limb Fugl-Meyer motor function score and lower limb BI index score of the study group after treatment were higher than those of the control group(P<0.05).Conclusions:Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics can promote the bone healing of patients with infective tibial nonunion,significantly improving their daily walking condition,alleviating inflammation,and recovering the knee joint function and lower limb function well.

Effect of vacuum sealing drainage combined with biological dressings on the angiogenesis and inflammatory response after diabetic foot ulcer wound grafting

Objective: To study the effect of vacuum sealing drainage combined with biological dressings on the angiogenesis and inflammatory response after diabetic foot ulcer wound grafting. Methods: Patients with diabetic foot who were treated in Sichuan Provincial People's Hospital between May 2014 and February 2017 were selected and randomly divided into vacuum drainage group and normal control group who received vacuum sealing drainage combined with biological dressings as well as conventional debridement and dressing change to deal with the wound respectively. Before treatment as well as 1 d, 3 d and 5 d after treatment, the wound tissue was collected to determine the expression of angiogenesis molecules, angiogenesis signaling pathway molecules and inflammatory response molecules. Results: 1 d, 3 d and 5 d after treatment, VEGF, VEGFR, CD105, MMP9, PI3K, AKT, cyclinD1, p38MAPK and NF-kB protein expression in wound tissue of vacuum drainage group were significantly higher than those of normal control group while COX-2, iNOS, TNF-α and IL-6 mRNA expression were significantly lower than those of normal control group. Conclusion: Vacuum sealing drainage combined with biological dressings promotes the angiogenesis and inhibits the inflammatory response after diabetic foot ulcer wound grafting.

Assessment of the trauma degree and bone metabolism after external fixation combined with vacuum sealing drainage treatment of open tibiofibula fracture

Objective: To evaluate the effect of external fixation combined with vacuum sealing drainage on the trauma degree and bone metabolism in patients with open tibiofibula fracture. Methods:A total of 116 patients with open tibiofibula fracture who received surgical treatment in Luzhou People's Hospital between February 2015 and January 2017 were divided into control group (n=58) and study group (n=58) by random number table. Control group received debridement + external fixation, and study group received debridement + external fixation +vacuum sealing drainage. The differences in the levels of trauma indexes and bone metabolism indexes were compared between the two groups before and after treatment. Results: Before surgery, there was no statistically significant difference in serum levels of trauma indexes and bone metabolism indexes between the two groups. 1 week after surgery, serum acute phase protein Tf level of study group was higher than that of control group whereas CER, Hp and CRP levels were lower than those of control group;stress indexes NE and Cor levels were lower than those of control group;bone metabolism indexes P1NP, BGP and BALP levels were higher than those of control group whereas β-CTX level was lower than that of control group. Conclusion: External fixation combined with vacuum sealing drainage can effectively reduce fracture trauma and promote fracture end healing in patients with open tibiofibula fracture.

Application of vacuum sealing drainage in skin graft of calf pedicle island flap donor-site

Objective: To explore the clinical effect of vacuum sealing drainage on free dermatoplasty in the donor-site of calf pedicled island flap. Method: From January 2016 to January 2018, a total of 70 patients undergoing reconstruction of skin and soft tissue defects in ankles and legs with calf pedicle island flap in Foshan Traditional Chinese Medicine Hospital were selected into our research. Selected patients were divided into VSD group and pressure dressing group according to the order of surgery. The VSD group was treated with free skin grafting and vacuum sealing drainage after separation of donor-site flap. The pressure dressing group was treated with free skin grafting and traditional pressure dressing technology after the separation of donor-site flap. Visual acuity simulation scores (VAS) were observed and recorded on the 1st, 7th, and 14th day after surgery. The unpacking time, skin graft healing time, skin graft survival rate, infection rate and incidence of subcutaneous hematoma were compared between the two groups. Results: The VAS scores on the 7th and 14th day after surgery in the VSD group were lower than those in the pressure dressing group. The unpacking time and skin graft healing time of the VSD group were shorter than those of the pressure dressing group. The survival rate of skin graft in VSD group was higher than that in the pressure dressing group. The infection rate and the incidence of subcutaneous hematoma in the VSD group were lower than those in the pressure dressing group. Conclusion: Vacuum sealing drainage is beneficial to promote the healing of free skin grafts in the donor site of the calf pedicle island flap, relieve pain, reduce adverse reactions, safe and effective, and worthy of clinical promotion.

Effect of vacuum sealing drainage combined with intermittent insulin flushing on expression of inflammatory factors and apoptosis factors in diabetic lower limb ulcer wound

Objective: To discuss the effect of vacuum sealing drainage combined with intermittent insulin flushing on the expression of inflammatory factors and apoptosis factors in diabetic lower limb ulcer wound. Methods: A total of 48 patients with diabetic lower limb ulcer who were treated in the Endocrine Department of the hospital between January 2016 and January 2017 were divided into the control group and research group by random number table, 24 cases in each group. Control group received vacuum sealing drainage, and research group received vacuum sealing drainage combined with intermittent insulin flushing. The differences in the expression of inflammatory factors and apoptosis genes in the wound exudate were compared between the two groups before and after treatment. Results: Before treatment, the differences in the inflammatory factor contents and apoptsis gene expression in wound exudate were not statistically significant between the two groups of patients. After treatment, inflammatory factors IL-6, IL-1β, TNF-α, CRP, VCAM-1 and FGF2 contents in wound exudate of research group were lower than those of control group;apoptosis gene Bcl-2 mRNA expression in wound exudate of research group was higher than that of control group while Bax, p53 and Fas mRNA expression were lower than those of control group. Conclusions: Vacuum sealing drainage combined with intermittent insulin flushing can effectively reduce the local inflammatory response and promote the granulation cell proliferation in wound of patients with diabetic lower limb ulcer.

Research of chamber local dry underwater welding system and drainage properties

Because of relatively large protective area and good underwater welding quality, chamber underwater welding has a great using prospect in spent fuel pool maintenance at nuclear power plant. A chamber local dry automatic underwater welding test system with a data acquisition platform is developed, drainage seal tests in a water tank are carried out and the data acquired from the tests are analyzed. The results show that the chamber local dry underwater welding test system can achieve good drainage seal, the drainage effect is enhanced with the increase of the drainage gas flow rate and the drainage time. The results establish the foundation of the research of chamber local dry underwater welding.

归因分析理论下护理流程再造对骨折负压封闭引流术术后患者的恢复影响

目的 分析归因分析理论下护理流程再造对骨折负压封闭引流术(VSD)术后患者恢复的影响。方法 选取我院2022年2月至2023年3月收治的82例骨折VSD术后患者,随机分为参照组和试验组,每组各41例,参照组采用一般性护理干预,试验组采用归因分析理论下护理流程再造模式,对比两组骨折VSD术后患者二期植皮天数、创面缩小面积、平均骨折愈合时间、住院时间和并发症发生率及两组疼痛评分、焦虑评分改善情况。结果 试验组二期植皮天数、平均骨折愈合时间、住院时间明显短于参照组(P <0.05),创面缩小面积明显大于参照组(P <0.05);试验组骨折患者疼痛评分、焦虑评分改善情况明显优于参照组(P <0.05),并发症发生率低于参照组(P <0.05)。结论 归因分析理论下护理流程再造对骨折VSD术后患者恢复具有良好的应用效果,更有利于缩短患者恢复时间,改善患者疼痛程度和焦虑心理,减少并发症发生。

自体富血小板血浆联合负压封闭引流对糖尿病足溃疡患者创面愈合情况的影响

目的探究自体富血小板血浆联合负压封闭引流对糖尿病足溃疡患者创面愈合情况的影响。方法选取2018年1月至2020年12月大连大学附属中山医院收治的100例Wagner 2~4级糖尿病足溃疡患者作为研究对象,使用抽签法分为对照组与研究组,每组50例。对照组采用常规方案治疗,研究组采用自体富血小板血浆联合负压封闭引流治疗。比较两组临床疗效、瘙痒评分、疼痛评分[数字评分法(NRS)]、肉芽组织血管生成因子[碱性成纤维细胞生长因子(bFCF)、表皮生长因子(EGF)、血管内皮生长因子(VEGF)]水平、临床指标、血糖指标[空腹血糖(FPG)、糖化血红蛋白Alc(HbAlc)、餐后2 h血糖(2 h PBG)]、胰岛素水平[空腹胰岛素(FIns)、稳态模型评估-胰岛素抵抗指数(HOMA-IR)]。结果研究组治疗总有效率为98.00%,高于对照组的80.00%,差异有统计学意义(P<0.05)。治疗后,两组瘙痒评分、NRS评分均低于治疗前,且研究组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组bFCF、EGF、VEGF水平均高于治疗前,且研究组高于对照组,差异有统计学意义(P<0.05)。研究组创面愈合时间、住院时间均短于对照组,差异有统计学意义(P<0.05)。治疗后,两组FPG、HbAlc、2 h PBG、HOMA-IR水平均低于治疗前,FIns水平均高于治疗前,且研究组FPG、HbAlc、2 h PBG、HOMA-IR水平均低于对照组,FIns高于对照组,差异有统计学意义(P<0.05)。结论自体富血小板血浆联合负压封闭引流治疗糖尿病足溃疡效果显著,可促进患者创面愈合,改善患者临床症状,值得临床推广应用。

福尼尔坏疽负压清创治疗并阴囊重建一例

福尼尔(Fournier)坏疽是一种罕见且进展迅速的生殖器和会阴组织坏死性筋膜炎,该病起病急、病程短、发展快,严重者向盆腔和下腹壁蔓延,病死率高,为泌尿生殖系统的急重症之一。早期治疗是防治Fournier坏疽的关键。Fournier坏疽治疗有清创后缝合、重建和负压吸引等治疗方式。本病例通过VSD负压吸引以及局部清创缝合,应用常规抗生素的方式进行治疗,效果显著,预后良好。

老年营养风险指数、血清25羟维生素D水平与糖尿病足溃疡VSD治疗效果的关系

目的探讨老年营养风险指数(GNRI)、血清25羟维生素D[25(OH)D]水平与糖尿病足溃疡(DFU)患者负压封闭引流(VSD)治疗效果的关系。方法选取接受VSD术的DFU患者106例为DFU组,根据VSD治疗效果分为无效组(27例)和有效组(79例);同期另选取55例单纯2型糖尿病(T2DM)患者为单纯T2DM组,55名健康体检志愿者为对照组。计算GNRI,检测血清25(OH)D。用多因素Logistic回归分析DFU患者VSD治疗效果的影响因素,受试者工作特征曲线分析GNRI联合血清25(OH)D对DFU患者VSD治疗效果的评估价值。结果DFU组、单纯T2DM组、对照组GNRI、血清25(OH)D水平比较差异均有统计学意义(P均<0.05),三组GNRI、血清25(OH)D水平依次降低(P均<0.05)。Wagner分级4级、HbA1c升高为DFU患者VSD治疗无效的独立危险因素(P均<0.05),踝肱指数、GNRI、25(OH)D升高为DFU患者VSD治疗有效的独立保护因素(P均<0.05)。GNRI联合血清25(OH)D水平评估DFU患者VSD治疗效果的曲线下面积为0.879,大于二者单独评估的0.800、0.879(P均<0.05)。结论GNRI、血清25(OH)D水平低的DFU患者VSD治疗效果差,二者联合对DFU患者VSD治疗效果的评估价值较高。

自体富血小板血浆联合封闭负压引流治疗胫前慢性难愈性创面的临床疗效观察

目的 研究应用自体富血小板血浆(platelet-rich plasma, PRP)联合持续封闭负压引流(vacuum sealing drainage, VSD)治疗胫前慢性难愈性创面患者的临床治疗效果。方法 选择2018年1月至2022年12月武汉市第一医院收治的胫前慢性难愈性创面患者40例,按随机数字表法分为PRP+VSD组和VSD组,每组20例。PRP+VSD组采用PRP联合VSD治疗,VSD组采用VSD治疗。比较两组患者的住院时间、抗菌药物使用时间、创面愈合时间、医疗费用和创面愈合情况。结果 两组患者均获随访,PRP+VSD组随访时间2~12个月(平均3.72个月),VSD组随访时间3~14个月(平均4.25个月)。PRP+VSD组的住院时间、抗菌药物使用时间、创面愈合时间均低于VSD组(P<0.05)。PRP+VSD组医疗费用高于VSD组,但两组比较差异无统计学意义(P>0.05)。PRP+VSD组20例患者创面全部愈合,其中16例患者一次性愈合,4例患者经过2次PRP+VSD治疗后愈合。VSD组9例患者一次性愈合,其余11例患者均经多次清创和VSD治疗才使创面完全愈合。结论 自体PRP联合VSD治疗胫前慢性难愈性创面可缩短创面愈合时间、患者住院时间和抗菌药物使用时间,降低二次手术率。自体PRP联合VSD是治疗胫前慢性难愈性创面的有效方法,为慢性难愈性创面的修复治疗提供了临床指导。

慢性难治性创口清创减张缝合VSD综合治疗方案临床分析

目的:分析27例通过清创减张缝合封闭式负压引流技术(VSD)综合治疗方案在解决慢性难治性创口术后愈合不良问题中应用的疗效。方法:回顾性分析27例2019年12月-2023年11月我院骨科应用VSD综合治疗方案治疗慢性难治性创口的临床资料,记录患者创面不愈合时间、VSD次数、愈合时间、血红蛋白含量、白蛋白含量,评估VSD综合治疗方案在治疗慢性难治性创口术后愈合不良问题中的作用。结果:共27例不同原因导致大面积或复杂创面不愈合的病人,在经过平均2.1次VSD引流术后采用多层减张缝合闭合创面。在入我科行VSD综合治疗后,创面愈合时间5-56(平均23.2)天,术后随访2-36月,伤口均愈合良好,无复发。结论:清创减张缝合VSD综合治疗方案在治疗慢性难治性创口术后愈合不良问题中有着良好的疗效。

胸壁窦道病人应用富血小板血浆凝胶联合负压封闭引流的临床疗效观察

目的 探讨胸壁窦道病人应用富血小板血浆凝胶(APG)联合负压封闭引流(VSD)的临床疗效。方法 2019年10月~2021年3月收治的胸壁窦道病人89例,采用随机数表法分为观察组(45例)及对照组(44例),对照组采用VSD治疗,观察组采用APG联合VSD治疗,比较两组胸壁窦道愈合情况。结果 观察组和对照组总有效率分别为97.78%和86.36%,两组比较差异有统计学意义(P<0.05);观察组窦道封闭时间、创面愈合时间、住院时间分别为(15.26±2.33)天、(25.19±3.54)天和(41.26±5.33)天,短于对照组的(27.26±3.05)天、(43.26±5.17)天和(58.64±6.11)天,差异有统计学意义(P<0.05),观察组二次修复手术率、窦道复发率均为0,低于对照组的11.36%和13.64%,差异有统计学意义(P<0.05);治疗后2周观察组C反应蛋白(CRP)、白细胞计数(WBC)、肿瘤坏死因子(TNF)-α、疼痛评分(VAS)分别为(20.36±3.41)mg/L、(5.23±0.64)×10~9、(15.26±3.24)pg/ml和(1.23±0.25)分,低于对照组的(26.54±3.57)mg/L、(8.17±0.93)×10~9、(24.16±3.94)pg/ml、(3.04±0.41)分,差异有统计学意义(P<0.05);观察组治疗后1周、2周创面细菌培养阳性率分别为37.78%、11.11%,低于对照组的59.09%、29.55%,差异有统计学意义(P<0.05);观察组创面愈合后1个月、2个月瘢痕评分(VSS)分别为(7.33±0.85)分、(3.26±0.41)分,低于对照组的(8.64±0.91)分和(5.14±0.62)分,差异有统计学意义(P<0.05);观察组不良反应发生率为8.89%,低于对照组的25.00%,差异有统计学意义(P<0.05)。结论 胸壁窦道病人采用APG联合VSD治疗,可促进窦道修复,抑菌效果较佳,减轻疼痛及瘢痕增生状态,并降低不良反应。

负压封闭吸引对结核术后难愈性创面中相关因子表达及预后的研究

目的探讨应用负压封闭引流(VSD)治疗结核术后出现难愈性创面的患者,研究其相关因子的表达及预后。方法选取2016年1月-2022年5月我院胸外科结核术后出现伤口愈合不良的患者76例,按数字表格法分为观察组和对照组,每组38例,观察组接受VSD治疗,对照组接受外科换药治疗,在治疗前和治疗后第7天用ELISA法测定血清中TNF-α、IL-4、IL-8、IL-10的含量和伤口肉芽组织中TGF-β1、VEGF、HIF-1α的含量及伤口愈合拆线时间。结果比较两组治疗前TNF-α、IL-4、IL-8、IL-10及TGF-β1、VEGF、HIF-1α水平,差异无统计学意义(P>0.05)。治疗后第7天检测,TNF-α、IL-8较治疗前均降低,其中观察组较对照组降低更明显(P<0.05);IL-4、IL-10较治疗前均升高,其中观察组较对照组升高更明显(P<0.05);TGF-β1、VEGF较治疗前均升高,其中观察组较对照组升高更明显(P<0.05);HIF-1α较治疗前均降低,其中观察组较对照组降低更明显(P<0.05)。观察组愈合拆线时间较对照组明显缩短,差异有统计学意义(P<0.05)。结论应用VSD治疗结核术后出现的难愈性创面,可以减轻炎症反应,促进增殖、修复,加速创面愈合。

复合皮移植联合VSD修复碾压伤致肘关节外露

目的:探讨复合皮移植联合负压封闭引流(Vacuum sealing drainage,VSD)在碾压伤伴关节外露创面修复中的临床应用效果及可行性。方法:2020年12月,笔者科室收治1例因左上肢车祸伤致皮肤坏死伴肿胀1 d的患者,入院时查体左上肢肿胀,左前臂、肘部可见约15.0 cm×20.0 cm皮肤坏死,左手感觉功能减退,桡动脉尚可触及,急诊手术探查见肘关节外露、脱位,肱三头肌自肱骨大范围撕脱,尺神经外露、移位,肘关节、尺骨外露范围约3.0 cm×5.0 cm。根据患者病史、临床表现、左上肢X线片及手术探查体征诊断左上肢碾压伤,肘关节外露。应用复合皮移植两步法联合VSD覆盖创面,自体中厚皮片移植修复皮肤缺损。结果:患者左上肢皮肤缺损处愈合良好,术后4个月复查,肘关节屈曲、伸直、旋转功能均恢复良好。结论:对于此例肘关节、骨外露创面,应用复合皮移植后可覆盖骨外露创面,大大降低了手术难度及患者的痛苦,为以后相对小面积骨外露创面的修复提供了新思路。