负压封闭引流促进创面愈合机制的研究进展

创面修复是医学中古老的问题之一。封闭负压引流（vacuum sealing drainage,VSD）技术的发明与应用,改变了创面的被动愈合过程,促进伤口愈合。该技术自1992年德国Ulm大学创伤外科Fleischman博士首创以来[1],在临床医学各个学科得到了广泛应用,但其促进创面愈合的确切作用机制尚未完全清楚,本文将就其研究进展进行综述。     

间歇封闭负压创面治疗技术在急慢性创面修复中的应用

目的探讨间歇封闭负压创面治疗（suction wound closure therapy,SWCT）技术在创面修复中的应用,比较其与传统换药治疗的优缺点。方法将不同深度及大小的急、慢性创面220例随机分为两组,对比采用间歇封闭负压创面治疗（治疗组）和传统换药治疗（对照组）两种方法的应用。其中治疗组彻底清创后使用无菌生物半透膜覆盖创面,使用间歇负压泵调节负压（80～100mmHg）,治疗时间（治疗5min,间歇2～3min）、持续时间依创面情况而定,3～7d换药一次。对照组使用无菌敷料覆盖创面,根据渗出量每天换药1～2次。比较两种治疗方法的效果、操作难易程度、患者耐受性、住院时间、住院费用等。结果急性创面愈合时间：治疗组1～2周（平均1．5周）,对照组2～12周;慢性创面愈合时间：治疗组2～4周（平均3周）,对照组2～32周。平均换药治疗费用：治疗组约1200元左右,对照组约2000元左右。治疗组创面愈合快、操作简单、患者易耐受、住院时间短、住院费用低。也有极少数患者出现贴膜过敏现象。结论间歇封闭负压创面治疗技术具有操作简单、无需特殊用药、创面愈合速度加快、减少医务人员工作量、减少交叉感染、降低医疗费、减少患者痛苦、患者易耐受等优点。     

封闭负压疗法促进创面愈合的研究进展

封闭负压疗法（vaetluln—assisted closure,VAC）是近几年来兴起的一种促进创面愈合的前沿技术,被用于各种难愈性的急性和慢性创口。它还有一些其他的命名,     

封闭式负压引流技术的原理与创面修复

封闭式负压引流（vacuum-assisted closure，VAC）疗法亦称负压创面（Negative pressure wound therapy，NPWT）疗法，是利用负压吸引装置与特殊创面敷料连接，间歇地或持续地在创面处产生低于大气压的压力，促进创面愈合的新颖的、日趋成熟的治疗方法。1993年德国外科医师Fleischmann等^[1]博士最先提出封闭负压引流，并用于四肢感染性创面的治疗，取得了明显效果。     

封闭负压引流促进猪腹部爆炸伤创面愈合的实验研究

目的探讨在猪腹部爆炸伤合并内脏外露时,使用封闭负压引流(VSD)控制腹腔、创面感染的作用以及对腹部爆炸创面愈合是否有促进作用。方法爆炸伤导致的全层腹壁缺损的动物随机分为实验组(VSD组)和对照组(盐水纱布组),实验组在6 h清创后置入压力为-125 mmHg VSD装置;对照组在6 h清创后使用盐水纱布覆盖爆炸创面,常规换药治疗。分别采集治疗前6 h和治疗后1、3、5、7 d的创面肌肉组织进行细菌检测,分析2组的细菌量;ELISA检测伤后1、3、5、7 d的腹部引流液肿瘤坏死因子-α(TNF-α),白细胞介素-1(IL-1)、IL-6的表达水平;采集2组治疗后第7天的皮肤、肌肉组织标本,用实时定量PCR分析血管内皮细胞生长因子(VEGF)、碱性成纤维细胞生长因子(bFGF)、表皮生长因子(EGF)及基质金属蛋白酶-9(MMP-9)相对表达量。结果 VSD组在治疗后1、3、5、7 d创面的细菌数(CFU/g)明显少于对照组,两组比较有统计学差异(P0.01)。猪腹部引流液中TNF-α,IL-1,IL-6的表达量在伤后治疗第1天两组没有显著性差异,在第3、5、7天VSD组明显低于同时间对照组,三个时间点两组比较均有显著性差异(P0.01)。VSD组在第7天皮肤软组织中VEGF、EGF、bFGF的表达量均高于对照组(P0.01),但MMP-9的表达无明显差异(P0.05)。结论 VSD可以有效控制创面的细菌量,减少腹腔引流液中TNF-α、IL-1、IL-6的表达量,促进创面生长因子表达。     

负压封闭引流技术用于四肢创伤复杂创面治疗价值评价

目的：观察负压封闭引流技术对四肢创伤复杂创面治疗的临床疗效。方法选取来我院就诊的四肢创伤性骨折伴有严重皮肤损伤的患者84例,随机分为两组,观察组42例、对照组42例。对照组采用传统的方法进行治疗,观察组采用负压封闭引流技术方法进行治疗。记录治疗前后患者的创伤面积变化以及创面清洁时间,植皮后临床效果,换药次数,住院时间,并发症的情况等。结果两组患者植皮后的临床疗效相比,观察组的优良率为92.86%,对照组的优良率为64.29%,两者的差异具有统计学意义(<0.05);两组患者的创面清洁时间,换药次数,治疗前后创面面积情况以及住院时间,并发症率比较得到观察组的效果都较对照组的效果好(<0.05)。结论负压封闭引流技术在四肢创伤复杂创面的治疗效果显著,较传统的单用换药方式效果好,且并发症发生率较低。因此,在临床的工作过程中要积极的应用该方法进行四肢创伤复杂创面的治疗。     

封闭负压疗法在难治创面中的应用

封闭负压引流（vacuum—assisted closure,VAC）是目前治疗各种急性创伤、各种难治性慢性创面新方法,通过专用的引流管和敷料,将负压作用于急慢性溃疡创面,可以加快创面闭合,缩短住院时间。     

封闭负压引流技术VSD治疗复杂四肢开放性骨折感染创面的护理体会

目的 探讨使用持续负压封闭引流(vacuum sealing drainage,VSD)治疗四肢开放性骨折感染创面的护理方式.方法 回顾性分析2007年至今在我院住院的36例严重的四肢开放性骨折伴大面积伤口感染患者,清创后VSD敷料覆盖创面,应用VSD技术5～7d,待内芽生长、创面新鲜后行中厚皮片植皮治疗.结果 36例有创面患者使用VSD观察和护理,1周后去除VSD敷料,伤口感染控制,局部创面肉芽组织新鲜,愈合良好.结论 该治疗方法操作简单,护理方便,做好观察和护理,可以改善局部微循环,促进内芽组织生长及有效地避免交叉感染的发生,促进大面积皮肤缺损及感染伤口的愈合.     

封闭负压技术治疗各种创面的临床应用体会

自2005年12月～2007年12月，我们应用封闭负压治疗技术治疗各种急慢性、顽固难治、经久不愈创面联合后期植皮取得了良好的效果，现报告如下：     

骨科复杂创面修复应用负压封闭引流技术57例总结

目的 探讨骨科复杂创面修复中应用负压封闭引流技术的临床效果.方法 收集广东医学院附属三水医院骨二科2011年1月至2013年6月57例患者在骨科复杂创面修复治疗中应用负压封闭引流技术的临床资料,分析患者的治疗效果.结果 57例患者的复杂创面均修复、愈合良好,8例患者出现并发症,其中引流通路堵塞5例,膜下发生积液者3例,经过生理盐水冲洗,更换引流管后情况得到改善.结论 骨科复杂创面修复中应用负压封闭引流技术取得了非常好的临床效果,通过负压的作用,更彻底地将创面的坏死组织和渗出液等引流出来,为创面的修复创造了良好的环境.     

A retrospective study: clinical experience using vacuum-assisted closure in the treatment of wounds

We report the results of our wound care experience using the wound vac as an adjunct therapy in the treatment of sternal, spinal, and lower-extremity wounds. This is a retrospective study in which 42 patients were evaluated between 1999 and 2002 for nonhealing sternal, spinal, and lower-extremity wounds. There were 12 patients with sternal wounds with a variety of pathogens who were treated with antimicrobials along with the wound VAC. The VAC was applied for an average of 12 days, and all 12 patients went onto complete closure by the end of four weeks. There were 14 patients in the lower-extremity wound group, again, with a variety of pathogens. The VAC was placed for an average of 29.3 days to achieve closure along with the wound VAC. There were 16 spinal wound patients with a variety of pathogens. All the patients received antimicrobial therapy, with the average duration of the VAC beings 27.6 days and closure taking about eight weeks. The wound VAC, along with appropriate antimicrobial therapy and surgery, appears to help reduce the number of days to healing, along with a reduction in the number hospital days and possibly costs to the health system.     

自制便携式简易负压辅助闭合疗法在下肢慢性溃疡治疗中的应用

目的探讨自制便携式简易负压辅助闭合疗法对下肢慢性溃疡的治疗效果以及可行性。 方法选取徐州市中心医院烧伤整形科2016年1月至2017年1月收治的30例下肢慢性溃疡患者,采用随机数字表法将患者分为对照组和试验组,每组15例,对照组外用重组人表皮生长因子凝胶＋湿润烧伤膏包扎,根据创面渗出情况每1～2 d换药1次,待创面肉芽组织新鲜且无明显渗出后可3 d换药1次。试验组采用凡士林纱布、无菌纱布、输液皮管、注射器及手术贴膜,自制便携式简易负压辅助闭合装置进行治疗,每更换1次简易负压为1个疗程,前期每4～5 d更换1次简易负压,创面基底条件好转、肉芽组织生长良好后每5～7 d更换1次简易负压。观察2组患者创面换药次数及愈合时间。对数据行t检验。 结果试验组换药次数为(4.1±0.8)次,创面愈合时间为(16.5±2.5) d,对照组换药次数为(11.4±2.3)次,创面愈合时间为(22.9±4.5) d, 2组之间比较,差异均有统计学意义(t＝11.698、4.838,P值均小于0.05)。 结论自制便携式简易负压辅助闭合疗法是一种创新性的实用型设计,对下肢慢性溃疡的治疗效果显著,能减少换药次数,缩短创面愈合时间,操作简单,携带方便,在病房及门诊均值得进一步推广应用。     

负压封闭吸引对糖尿病溃疡愈合的促进作用

目的 在"创而床准备(WBP)"理论指导下,观察负压封闭吸引局部处理糖尿病溃疡的疗效.方法 收集2000年1月至2005年1月间收治的27例糖尿病溃疡患者作对照组,2005年1月至2007年6月的8例糖尿病溃疡患者为试验组.两组患者均经常规系统的治疗,试验组在创面的黑、黄期采用清创后负压吸引治疗.观察两组创而各分期间的演进情况.比较两组手术Ⅰ期修复率、入院首次及实施负压治疗后1、2、3周创面细菌学检查结果 .观察各期创面组织标本的HE染色和黄、红两期Ⅰ、Ⅲ型胶原纤维苦味酸-天狼猩红染色结果 及对其含量进行图像分析.结果 试验组患者创面各分期的演进速度、于术Ⅰ期修复率均优于以照组(100%比46%,P<0.05).治疗2周后试验组创面末检出致病菌,对照组检出率为66.7%(P<0.05).HE染色显示试验组各期间的演进类似于急性创面愈合过程,且试验组黄期Ⅰ、m型胶原总含量为12.28%,对照组为24.77%(P<0.01).结论 基于WBP方案的负压吸引治疗能促进糖尿病溃疡的创面愈合过程.     

改良封闭负压引流疗法在压力性溃疡治疗中的临床应用

目的探讨改良封闭负压引流疗法治疗压力性溃疡的临床效果。方法 2006～2008年中山大学附属第一医院收治骶尾部压力性溃疡患者32例,分为治疗组15例和对照组17例,治疗组采用改良封闭负压引流疗法治疗,对照组采用聚维酮碘换药治疗。观察两组压力性溃疡创面的愈合情况,并分别于治疗前,治疗8周采用压力性溃疡PUSHTool3.0评分评估两组压力性溃疡创面。结果治疗4周时,治疗组创面局部新鲜肉芽组织生长,创缘有新生上皮爬行覆盖创面,而对照组创面局部仍有坏死组织覆盖,创缘上皮爬行不活跃。治疗8周时,治疗组创面上皮化和肉芽组织生长进一步增加,优于对照组。治疗8周时PUSHTool评分治疗组(8.53±4.88)低于对照组(11.06±3.38),差异具有统计学意义(P0.05)。结论较之传统换药方法,改良封闭负压引流疗法更有利于创面肉芽组织的生长和上皮化,从而促进压力性溃疡创面的愈合。     

慢性病所致的慢性创面的防治

慢性创面是慢性病、创伤、感染等疾病常见的并发症.近年来,慢性病所致的慢性创面发生率呈逐渐增加趋势,且大部分慢性创面得不到规范治疗,创面长期不愈合,给患者带来巨大痛苦,给社会带来很大负担.此类慢性创面的愈合是一个从凝血、炎症反应、肉芽组织形成(增殖)到塑性的有序过程,任何破坏该过程的因素都会导致创面难以愈合.慢性创面主要...     

Apligraf--a living human skin equivalent for the treatment of chronic wounds

Apligraf, a manufactured living human skin equivalent, was the first true composite tissue analog to become commercially available. It has been approved by the FDA for the treatment of venous leg ulcers and diabetic foot ulcers. The tissue engineered bi-layered skin equivalent has both an epidermis and a dermis, which consist of keratinocytes and fibroblasts derived from neonatal foreskin and bovine collagen. The skin equivalent produces a great number of cytokines and growth factors and is immunologically well tolerated. The product is easy to handle in clinical use and can be applied in an outpatient setting.     

ADAM12: a potential target for the treatment of chronic wounds

Wound healing is a complex process involving multiple cellular events, including cell proliferation, migration, and tissue remodeling. A disintegrin and metalloprotease 12 (ADAM12) is a membrane-anchored metalloprotease, which has been implicated in activation-inactivation of growth factors that play an important role in wound healing, including heparin-binding epidermal growth factor (EGF)-like growth factor (HB-EGF) and insulin growth factor (IGF) binding proteins. Here, we report that expression of ADAM12 is fivefold upregulated in the nonhealing edge of chronic ulcers compared to healthy skin, based on microarrays of biopsies taken from five patients and from healthy controls (p = 0.013). The increase in ADAM12 expression in chronic ulcers was confirmed by quantitative real-time polymerase chain reaction (RT-PCR). Moreover, immunohistochemical analysis demonstrated a pronounced increase in the membranous and intracellular signal for ADAM12 in the epidermis of chronic wounds compared to healthy skin. These findings, coupled with our previous observations that lack of keratinocyte migration contributes to the pathogenesis of chronic ulcers, prompted us to evaluate how the absence of ADAM12 affects the migration of mouse keratinocytes. Skin explants from newborn ADAM12-/- or wild-type (WT) mice were used to quantify keratinocyte migration out of the explants over a period of 7 days. We found a statistically significant increase in the migration of ADAM12-/- keratinocytes compared to WT control (p = 0.0014) samples. Taken together, the upregulation of ADAM12 in chronic wounds and the increased migration of keratinocytes in the absence of ADAM12 suggest that ADAM12 is an important mediator of wound healing. We hypothesize that increased expression of ADAM12 in chronic wounds impairs wound healing through the inhibition of keratinocyte migration and that topical ADAM12 inhibitors may therefore prove useful for the treatment of chronic wounds.     

Case series: clinical management of persistent mechanical assist device driveline drainage using vacuum-assisted closure therapy

Percutaneous driveline lead and pocket sites are potential sources of drainage that can lead to infection. Some patients experience a slower closure of tissue growth into the driveline. The management of chronically open and or draining driveline wounds is a challenge. The KCI vacuum-assisted closure (VAC) device is a noninvasive negative-pressure therapy that promotes the healing of wounds not responding to conventional treatment. Vacuum-assisted closure therapy has proven safe, effective, and cost efficient by decreasing the number of dressing changes and length of stay. The left ventricular assist device (LVAD) team initiated VAC therapy in 3 patients. The tunneling method allowed the wound to heal from the inside out. The dressing was changed every 3 days, and the size and depth of the wound was monitored. Patients may be sent home using a portable VAC device until wound closure is obtained, which decreases the hospital length of stay. Our experience with three patients suggests the VAC device can be used for draining and tunneling LVAD driveline-site wounds and may prevent fistula formation. It is especially useful for patients with ascites that may be draining along the driveline tract. The sites showed increased granulation, decreased drainage, and a reduced bacterial burden after having the device in place.