波动式负压封闭引流技术在皮瓣移植修复囊腔型褥疮术中的应用

目的探讨应用波动式负压封闭引流（vacuum sealing drainage，VSD）减少皮瓣移植修复囊腔型褥疮的并发症的临床效果。方法彻底清创后，根据缺损的部位、大小及深浅，遵循就近原则，设计皮瓣、肌皮瓣修复缺损，皮瓣及供区皮下放置半圆环形引流条，安装VSD系统，40kPa（300mmHg）负压3h与16．6～17．3kPa（125～130mmHg）负压0．5h，持续性交替抽吸，若创面较深，渗出较多，适当增大高压，同时缩短间隔，主动吸引出皮瓣下腔隙内积液，使皮瓣与受区创面紧密贴合，3d拆除VSD系统，拔出引流条。结果共治疗14例患者，1例术后翻身不当，撕裂伤口，延迟愈合。其余13例创面均I期修复，皮瓣存活良好，无皮瓣下积液或假性囊肿形成。结论VSD既解决了皮瓣下积血、积液等并发症的发生，又避免了皮瓣受压过度坏死，并且促进皮瓣与受区创面的粘连，加速血供建立，是提高皮瓣移植修复大而深的囊腔型褥疮疗效及减少并发症的有效方法。

Application of vacuum sealing drainage in wave suction in treatment of huge pressure sore with flap

Objective To discuss the clinical application of vacuum sealing drainage in wave suction to prevent the complication of repairing huge pressure sore with flap. Methods Necrotic tis sues were debrided entirely, and then skin flaps or myocutaneous flaps were rotated to repair defect surfaces, which were designed by the position, size, and depth, close to the lesion and the convenience to rotate and suture the defect. Drainages were placed which came from half of the drainage tube （length wise） bellow flap after repairing the tissue defect, and the drainage looked like a semicircle, and vacuum sealing drainage was placed over the flap and donor size, then aspirate blood detaining bel- low flap on negative pressure initiatively and alternatively from 16.6～ 17.3 kPa （125 ～ 130 mmHg） 3 hours to 40 kPa （300 mmHg） 0.5 hour. Vacuum sealing drainage was dismantled after 3 days, and then drainages were pulled out. Results 14 cases were treated, and one flap was torn and healed late ly because of turning the body over rudely, and the other flaps survived with good texture and no effu sion and pseudocystic formation under the flap. Conclusions The application of vacuum sealing drain age in wave suction can solve hematocele, pseudocyst and the necrosis of flap because of pressure sim ultaneously, and it promotes the union and blood supply between flap and recipient site, and therefore it is a good option to promote curative effect and reduce complications in repairing huge pressure sore with flap.