负压封闭引流联合皮瓣移植在四肢大面积皮肤缺损中的应用

目的 探讨负压封闭引流联合皮瓣移植在四肢大面积皮肤缺损中的应用价值.方法 选择2013年6月至2016年12月本院收治的四肢大面积软组织缺损患者80例,按照随机数字法分为两组,各40例;对照组行常规清创缝合术,观察组则行负压封闭引流联合Ⅰ期皮瓣移植治疗;对所有患者进行为期3个月的随访,并统计2周内换药情况、创面恢复情况及患者伤口愈合情况,测定患者干预前及干预后2周,机体炎症性细胞因子水平.结果 观察组观察期间换药次数为(3.8±0.6)次,少于对照组的(7.3±1.2)次(f=16.499,P＜0.05),创面恢复比例为(47.4±2.9)％,大于对照组的(16.4±1.2)％(t=62.470,P＜0.05),创面愈合时间为(25.3±1.8)d,早于对照组的(33.2±2.7)d(t=15.397,P＜0.05),干预后观察组TNF-0、IL-1、hs-CRP水平分别为(12.1±0.2) ng/ml、(0.61±0.1)μg/rml、(10.5±1.0)mg/L,均低于对照组的(18.3±0.5) ng/ml、(0.93±0.2)μg/ml、(31.1±2.0) mg/L(t=72.815、9.051、58.266,均P＜ 0.05).结论 负压封闭引流治疗四肢大面积皮肤缺损,能显著降低机体炎症反应,减少换药次数,促进创面愈合时间.

Closed drainage under negative pressure combined with flap transplantation for large area skin defects in limbs

Objective To evaluate the value of closed drainage under negative pressure combined with flap transplantation for large area skin defects in limbs.Methods 80 patients with large area skin defects in limbs treated at our hospital from June,2013 to December,2016 were randomly divided into a control group and an observation group,40 for each group.The control group were treated with routine debridement and the observation group closed drainage under negative pressure and Ⅰ stage flap transplantation.All the patients were followed up for 3 months.The dressing,wound recovery,and wound healing before and 2 weeks after intervention were calculated.Results The dressing times was (3.8 ± 0.6)in the observation group and (7.3 ± 1.2) in the control group (t=16.499,P ＜ 0.05).The wound recovery rate was (47.4 ± 2.9)％ in the observation group and (16.4 ± 1.2) in the control group (t=62.470,P ＜ 0.05).The wound healing time was (25.3 ± 1.8) d,in the observation group and (33.2 ± 2.7) d in the control group (t=15.397,P ＜ 0.05).The levels of TNF-α,IL-1,and hs-CRP were (12.1 ± 0.2) ng/ mL,(0.61 ± 0.1) μg / mL,and (10.5 ± 1.0) mg / L in the observation group and were (18.3 ± 0.5) ng/ml,(0.93 ± 0.2) μg / ml,and (31.1 ± 2.0) mg/L in the control group (t=72.815,9.051,58.266,all P ＜ 0.05).Conclusion Negative pressure drainage can improve the inflammation and reduce dressing times and shorten the wound healing time.