VAC联合腓肠神经营养血管皮瓣修复足踝部创面的疗效观察

目的探讨封闭负压引流技术（vacuum—assisted closure,VAC）联合腓肠神经营养血管皮瓣修复足踝部损伤,皮肤缺损创面的临床疗效。方法2005年12月至2009年3月本科收治的22例腋部皮肤缺损的患者,男16例,女6例。年龄18～58岁;早期扩创后采用VAC待肉芽组织形成后,用腓肠神经营养血管皮瓣修复足踝部创面。皮瓣范围5cm×8cm至8cm×12cm。结果1例远端皮瓣下出现慢性瘘道,经换药后创口闭合,皮瓣成活良好。其余患者皮瓣成活,切口均一期愈合,小腿供区愈合良好。结论VAC促进创面局部血运,肉芽形成,清洁创面,抑制细菌生长,减少感染,为皮瓣修复提供了良好的组织床。VAC联合腓肠神经营养血管皮瓣是修复足踝部创面的良好方法之一。     

Use of vacuum assisted closure therapy in the palliation of a malignant wound

Vaccum assisted closure (VAC) therapy is a novel method of wound healing using topical negative pressure across the wound bed and containing all exudate within a sealed system. We report the use of VAC therapy to control pain and exudate of a malignant wound.     

持续性封闭式负压引流装置用于皮肤移植术的临床疗效

目的观察持续性封闭式负压引流装置(VAC)用于皮肤移植术的临床疗效,评判其价值。方法选择68例需要进行皮肤移植手术的患者进行VAC辅助治疗,采用随机数字表的方法将之分为治疗组(34例)与对照组(34例)。两组植皮后,对照组常规外用碘伏清洗、油纱包扎处理,治疗组使用VAC辅助治疗。10~14 d后,对比两组临床疗效。结果治疗组植皮后总成活率、上皮化程度、创面细菌抑制率均高于对照组,差异具有统计学意义(P0.05);住院时间及术后并发症发生率较对照组较低,差异具有统计学意义(P0.05)。结论 VAC可提高烧伤后残余创面植皮成活率,促进创面的愈合。     

负压伤口治疗技术用于53例慢性伤口的效果评价

目的 评价负压伤口治疗技术用于各类慢性伤口的效果.方法 入选Ⅳ度压疮、外伤伤口、术后切口和糖尿病足溃疡共计53例69处,清创后采用一致性操作流程和- 125mmHg(1 mmHg=0.133kPa)负压及间歇吸引模式治疗21d,有手术指征者转外科治疗,无手术指征者按标准湿性疗法治疗至愈合.观察治疗7d、14d、21d后伤口面积、深度、温度、pH值变化及100％肉芽覆盖时间和治愈率.结果 负压封闭辅助闭合(VAC)治疗后伤口治愈率78.26％(54/69),平均愈合时间(94.00±63.26)d,其中30例43处伤口负压治疗结束后继续接受湿性疗法治愈,10例11处伤口负压治疗结束后转外科手术治愈.12例负压治疗好转后回家继续治疗,随访5个月,愈合5例5处.总治愈率85.51％(59/69).负压治疗4类慢性伤口21d时的伤口温度较治疗前明显升高,pH值明显降低,差异均有统计学意义(P＜0.01);100％肉芽覆盖时间平均为(22.96±12.20)d.结论 VAC治疗对不同类型慢性伤口均有效,能够营造有利于伤口愈合的温度和酸碱度,促进肉芽组织生长和伤口收缩及愈合.     

两种不同方法处理坏死黑痂创面的疗效观察

目的探讨两种不同方法处理坏死黑痂创面的疗效。方法选择2010年5月～2011年6月23例（创面25处）坏死黑痂创面患者作为对照组．2011年7月～2012年7月19例（创面24处）坏死黑痂创面患者作为实验组，两组均在基础疾病及抗感染治疗同时，对照组患者创面给予一次性清创加改良封闭式负压引流治疗，实验组患者创面给予直接或黑痂深层切开加改良封闭式负压引流治疗，并适时逐次清创．肉芽组织生长好部位点状植皮。比较两组患者创面完成清创时间、清创出血量及8周治疗效果。结果两组患者创面完成清创时间、清创出血量及8周治疗效果比较，均P〈0．05，差异具有统计学意义，实验组患者完成清创时间明显短于对照组，清创出血量明显少于对照组、8周治愈率明显高于对照组。结论坏死黑痂创面采用直接或黑痂深层切开后加改良封闭式负压引流治疗，并适时逐次清创．肉芽组织生长好部位给予点状植皮治疗效果优于一次性清创加改良封闭式负压引流治疗。     

Using vacuum-assisted closure (VAC) in wound management

A new method for wound management, vacuum-assisted closure (VAC) is a technique that applies negative pressure to a wound bed through a porous, open-cell foam that fills the wound cavity. Its advantages include rapid wound healing, reduced pain, shorter hospital stays, lower medical costs, and fewer nursing responsibilities. It can also be used with patients suffering from multiple wounds. The tool may be used to address wounds that are appearing more frequently now that technological advancements are prolonging the lives of elderly patients. Reducing costs associated with wound treatments is therefore becoming an increasingly important issue in health care.     

封闭式负压引流技术在人压力性溃疡创面治疗中的临床应用

目的:探讨封闭式负压引流技术治疗人压力性溃疡的疗效。方法:将30例Ⅲ-Ⅳ期压力性溃疡患者随机分成实验组和对照组各15例,对照组创面应用常规敷料换药治疗。采用压力性溃疡PUSH Tool 3.0评分分别于治疗前,治疗后7 d、14 d评估创面愈合情况,并观察创缘全层皮肤组织愈合过程中的镜下HE染色表现。结果:随着治疗时间延长,实验组创面渗液减少,创缘新生上皮及肉芽组织逐渐增多,治疗第14 d,实验组创面Push Tool评分明显低于对照组(7.40±0.27 VS 12.53±0.22,P0.01)。结论:封闭式负压引流疗法较普通换药更能够减少创面渗液,有利于肉芽组织生长,促进创面愈合。     

组织瓣转移或结合皮片移植术修复胫骨前区骨外露创面

目的对胫骨前区骨外露创面的修复方法进行总结。方法对21例胫骨前区骨外露创面采用组织瓣转移或结合皮片移植术进行修复。结果本组21例转移的组织瓣及移植皮片成活良好，胫骨前区骨外露创面完全修复。结论对胫骨前区骨外露创面采用组织瓣转移或结合皮片移植术进行修复，是一种较好的修复方法。     

负压吸引治疗糖尿病合并压疮的疗效观察

目的探讨封闭式负压引流技术(VAC)治疗糖尿病合并压疮的临床效果。方法回顾性分析2011年1月至2013年2月间28例糖尿病合并压疮患者彻底清创术后行VAC治疗的临床资料。结果所有患者经(4.8±1.6)d引流后,创面缩小,可见新鲜肉芽组织生长。25例患者愈合,愈合率为89.3%;3例压疮明显好转,好转率为10.7%,行局部植皮治疗后愈合。全组患者平均(4.5±0.8)d天更换一次VAC装置,平均VAC治疗(14.5±5.2)d。结论封闭式负压引流技术可以缩小创面,促进肉芽组织生长,加快压疮愈合,值得临床推广应用,维持有效的负压吸引是成功的关键。     

Strategies and challenges in the treatment of chronic venous leg ulcers

Evaluating patients with chronic venous leg ulcers (CVLUs) is essential to find the underlying etiology. The basic tenets in managing CVLUs are to remove the etiological causes, to address systemic and metabolic conditions, to examine the ulcers and artery pulses, and to control wound infection with debridement and eliminating excessive pressure on the wound. The first-line treatments of CVLUs remain wound care, debridement, bed rest with leg elevation, and compression. Evidence to support the efficacy of silver-based dressings in healing CVLUs is unavailable. Hydrogen peroxide is harmful to the growth of granulation tissue in the wound. Surgery options include a high ligation with or without stripping or ablation of the GSVs depending on venous reflux or insufficiency. Yet, not all CVLUs are candidates for surgical treatment because of comorbidities. When standard care of wound for 4 wk failed to heal CVLUs effectively, use of advanced wound care should be considered based on the available evidence. Negative pressure wound therapy facilitates granulation tissue development, thereby helping closure of CVLUs. Autologous split-thickness skin grafting is still the gold standard approach to close huge CVLUs. Hair punch graft appears to have a better result than traditional hairless punch graft for CVLUs. Application of adipose tissue or placenta-derived mesenchymal stem cells is a promising therapy for wound healing. Autologous platelet-rich plasma provides an alternative strategy for surgery for safe and natural healing of the ulcer. The confirmative efficacy of current advanced ulcer therapies needs more robust evidence.     

The benefits of VAC therapy in the management of pressure ulcers

This study investigates whether vacuum-assisted closure (VAC) therapy, alginate or hydrocolloid dressing are most effective in the treatment of pressure ulcers. A total of 281 patients were included in this study. The response of each patient's wound was monitored, satisfactory wound closure was examined and the time taken to attain satisfactory wound closure was also taken into consideration. An original analysis of the published data was carried out. Most of the pressure ulcers showed some response in all of the categories investigated, with pressure ulcers in the VAC therapy group showing a greater response in all aspects than those in the other two groups.     

Vacuum-assisted closure use in calciphylaxis

Calciphylaxis-induced chronic wounds are difficult to heal. The value of vacuum-assisted closure (VAC) was assessed in two patients with calciphylaxis. Two middle-aged females with type 2 diabetes were transferred to the burn unit with a clinical diagnosis of necrotizing fasciitis, although the pathologic diagnosis was calciphylaxis. With extensive debridement, antibiotics, and meticulous wound care, one patient had progressive necrosis of her skin from 18 to 48% TBSA, whereas the other progressed from 5 to 10% TBSA only. The patient with the smaller chronic wound healed well and left the hospital at 72 days after admission. Although there was some success with the use of VAC, the patient with the extensive progressive wounds developed a fungal wound infection that did not respond to treatment; she died 78 days after initiation of burn center treatment. Some disadvantages to the usefulness would be extensive contiguous wounds and the lack of an intact skin surface. The VAC system was of value in healing wounds resulting from calciphylaxis.     

严重会阴部软组织缺损应用封闭式负压引流联合结肠造口治疗的护理

目的：评价会阴部软组织缺损行封闭式负压引流（vacuum sealing drainage,VSD）联合结肠造口治疗的护理效果。方法：总结我科对16例严重会阴部软组织缺损患者行VSD联合结肠造口治疗,评价治疗效果,分析护理体会。结果：13例患者经过一次VSD治疗后肉芽组织生长新鲜,3例患者经过多次VSD治疗后创面肉芽生长新鲜,经过植皮完全闭合,16例完全愈合。结论：对严重会阴部软组织缺损行VSD能够减少炎症反应,促进肉芽生长,促进愈合。联合结肠造口可以避免会阴部创面粪便污染,同时满足患者营养摄入,是此类患者的首选方法。     

负压封闭辅助闭合技术用于伤口治疗的流程设计

目的探讨负压封闭辅助伤口闭合技术（vacuum—assisted closure,VAC）在门诊伤口治疗中的操作流程及其合理性。方法参照负压伤口治疗的相关指南报告和流程优化及再造的文献,设计了“十步法”操作流程。2007年1月至2008年12月对门诊伤口护理中心工作和进修的护士共22人进行了流程应用培训,并筛选12例慢性伤口进行应用评价,针对问题每6个月修改1次,持续性改良。评价方法：计算平均操作时间;每月考核每名护士VAc流程操作;每月调查每名护士对流程操作的满意度;每周调查每例患者对护士流程操作的满意度。使用SPSS11．0软件进行统计学处理。结果2007年和2008年护士流程操作考核成绩差异无统计学意义,分别为89．65±3．37、89．80±4．39（P〉0．05）,护士平均操作时间2008年较2007年明显缩短（P〈0．05）。护士和患者对流程合理、便捷、有效的满意率分别为98．90％、96．13％和97．24％。结论用理论指导实践制定VAC操作流程和培训护士有助于流程准确规范使用,在VAC治疗实践中评价和修改流程有助于提高流程管理的效果。12例慢性伤口患者接受“十步法”操作流程进行VAC结果表明,流程合理实用,值得推广。     

Soft-tissue coverage for the treatment of osteomyelitis of the lower part of the leg

For treatment of chronic osteomyelitic wounds of the lower part of the leg, a three-stage approach is necessary: (1) adequate debridement of bone and soft tissue, (2) control of infection by open packing with frequent dressing changes and use of intravenously administered antibiotics, and (3) healthy soft-tissue coverage and obliteration of dead space. If the bone is unstable, it can be immobilized temporarily by means of external fixation. Bone grafting can be accomplished by use of conventional bone grafting after healing of the soft tissues, a vascularized bone graft, or open bone grafting. Soft-tissue coverage is provided by a local muscle flap or a free muscle flap. We prefer to cover the muscle with a skin graft. The muscle flaps described in this article obliterate dead space, provide soft-tissue coverage, act as a bed for skin grafts, and improve the vascularity of the wound.     

封闭负压引流技术用于肛瘘术后30例临床观察及护理

目的:探讨封闭负压引流技术(VAC)用于肛瘘术后的治疗效果及护理方法.方法:对30例肛瘘行小切口手术患者术后采用VAC,并给予密切观察与精心护理.结果:本组应用VAC后全部上皮化愈合.行VAC治疗5～10 d,平均7 d;切口愈合时间12～21 d,平均14.5 d.结论:VAC治疗肛瘘术后切口,具有引流通畅、不易堵塞管腔、防止大便污染切口的优点,操作简便,疗效可靠,值得临床推广应用.     

负压封闭引流技术在骨科创面修复中的临床应用

目的探讨负压封闭引流术(VSD)治疗严重皮肤损伤的临床疗效;总结VSD技术在骨科损伤中的修复特点。方法对韶关市粤北人民医院骨科收治的45例严重皮肤损伤(复杂创面)患者均使用VSD治疗。结果所有患者创面均得到了完全愈合,其中28例患者行1次VSD引流术后,创面肉芽组织生长良好,肉芽组织红润,颗粒细小,血运丰富,行第2次植皮后植皮成活,创面闭合良好,手术均取得了成功;13例患者行第2次VSD负压引流后,创面肉芽组织生长良好,肉芽组织红润,颗粒细小,血运丰富,行邮票植皮后取得成功;3例骨髓炎患者,经过2次清创VSD引流后,第3次使用皮瓣转移技术最后闭合创面;1例足背肌腱外露的患者因不愿做皮瓣,用VSD负压技术促进肉芽组织生长,经过3次VSD负压引流后,肉芽组织生长良好,配用生肌膏后肌腱全部覆盖肉芽组织,植皮后创面闭合。结论 VSD技术是治疗严重四肢大面积皮肤损伤较好的处理方法。     

伤口床准备原则在Ⅲ、Ⅳ期压疮患者中的应用效果观察

目的9例Ⅲ、Ⅳ期压疮患者创面处理效果。针对患者压疮创研大,感染严重,机体营养状况差,创面难愈合的特点,运用伤口床准备原则,为压疮创面进一步愈合提供良好创基。方法根据伤口床准备原则对压疮伤口进行处理,局部清创后用银离子藻酸盐填充溃疡创口,隔日换药,分泌物多时每日换药。伤口被污染时随时换药,并做记录。结果18周后肉芽组织覆盖整个创面,伤口愈合快。结论运用伤口准备原则处理Ⅲ、Ⅳ期压疮效果显著。     

封闭负压引流技术对加速慢性创面愈合的机制

摘要:目的研究封闭负压引流技术对人慢性创面中活性形式明胶酶(活性MMP-2、活性MMP-9)的影响。方法对5例慢性创面患者给予创面封闭负压引流(-120mmHg压力)150d,分别于吸引前和吸引后24h、3、5、10、15d收集创面渗出液。另以10例乳腺癌切除术后第3天的创面引流液为急性创面对照。用Zymography法测明胶酶活性,并用薄层分析仪分析试验结果。结果封闭负压引流治疗前,1例的活性MMP-2和另1例的活性MMP-9较对照组高,两例的活性形式明胶酶总活性(两种酶活性之和)较对照组活性高。封闭负压引流治疗后,慢性创面渗出液中活性MMP-2、活性MMP-9及活性形式明胶酶总活性与对照组比较无统计学差异(P>0.05)。结论人慢性创面中活性形式明胶酶的活性过低或活性过高均可能是慢性创面长期不愈的原因,封闭负压引流能调节慢性创面中活性形式明胶酶的活性。     

The role of the nurse in wound bed preparation

This article explores the role of the nurse in wound bed preparation. Wounds cannot be tended to in isolation--many patient factors will influence healing. The nurse needs to have an understanding of the process of wound healing and have undertaken a full patient assessment before focusing on the patient's wound. Recognising and managing problems at the wound bed, for example necrotic tissue and excess exudate, can result in a better prepared wound bed and optimal healing. If the concept is to be valuable to nurses, they need to be part of the debate that defines wound bed preparation, how it is being implemented in clinical practice and how patients can benefit. This debate needs to include all nurses involved in wound care.