应用负压封闭引流技术治疗复杂创面的效果观察

我们对32例复杂创面患者应用负压封闭引流技术（VSD）治疗, 效果良好,报告如下.     

负压创面治疗技术应用的研究进展

创面修复是一个包括凝血、炎症、组织充填、再上皮化和重塑等阶段的复杂过程,涉及不同类型细胞在空间和时间上的不同演化[1].负压创面治疗(negative-pressure wound therapy,NPWT)技术为这些不同类型细胞参与各种急、慢性创面的修复过程提供了重要的条件,使大面积创面、深度创面和慢性难愈合创面(慢...     

不同负压创面治疗技术对糖尿病足的修复效果比较

目的：分析比较负压辅助闭合（Vacuum-assistedclosure,VAC）、负压封闭引流（Vacuumsealingdrainage,VSD）两种负压创面治疗（Negativepressurewoundtherapy,NPWT）对糖尿病足（Diabeticfoot,DF）的修复效果。方法：纳入2018年1月-2020年7月收治的80例DF患者作为研究对象,采用随机数表法进行简单随机抽样,将患者分为VAC组和VSD组,每组40例。两组均对创面进行NPWT,VAC组采用VAC法,VSD组采用VSD法。比较两组患者疗效,评估患者恢复情况,比较两组治疗前、治疗2周后血清细胞因子水平[内皮素-1(Endothelin-1,ET-1)、血管内皮生长因子（Vascular endothelial growth factor,VEGF）、肿瘤坏死因子α(Tumor necrosis factor α,TNF-α)]、氧化应激标志物[超氧化物歧化酶（Superoxidedismutase,SOD）、一氧化氮（Nitricoxide,NO）、脂质过氧化物丙二醛（Lipidperoxide malo...     

封闭负压引流技术对人慢性创面中胶原酶活性的影响

目的研究人慢性创面经封闭负压引流（vacuum—assisted closure，VAC）治疗前后，创面渗出液中胶原酶活性的变化，以部分阐明VAC促进慢性创面愈合的机理。方法取4例急性创面在术后1、2、3d的创面引流液（乳癌术后），同时收集6例慢性创面（4例静脉性溃疡，2例压力性溃疡）在VAC治疗前以及治疗后2、4、6d的创面渗出液，利用酶谱分析的方法，观察各时间点的渗出液对可溶性Ⅲ型胶原的降解情况，同时应用强力霉素抑制实验来分析渗出液中胶原酶的类型。结果急性创面引流液可以部分降解Ⅲ型胶原，随时间推移变化较小，慢性创面渗出液中的胶原酶活性较高，VAC治疗前基本将Ⅲ型胶原全部降解，随时间推移、降解减少，胶原酶活性下降，强力霉素抑制实验证明在100μmol／L浓度时无抑制，在600μmol／L浓度时出现部分抑制。结论在慢性创面渗出液中胶原酶活性增高，VAC的应用可以降低胶原酶的活性，阻止胶原蛋白大量降解，利于创面愈合，在慢性创面渗出液中胶原酶应主要是MMP-1型（成纤维细胞型）。     

负压封闭引流技术在烧伤科常见难治性创面治疗中的应用

负压封闭引流（vacuum sealing drainage,VSD）是一种治疗急、慢性创伤创面和（或）创腔的新技术,于1992年由德国ULM大学创伤外科Fleisehmann博士首创[1]。2008年10月至2009年10月我们采用封闭负压引流技术结合常规治疗手段治疗烧伤科常见难治性创面,疗效良好,现报道如下。     

负压封闭引流治疗损伤感染创面的护理观察

<正>四肢皮肤缺损是临床常见的急性损伤之一,对污染较重和部分复合组织缺损的病例暂时无法Ⅰ期行皮瓣和植皮修复,可考虑为Ⅱ期手术治疗创造条件,我们于2009-04—2010-10对68例四肢皮肤缺损的创面应用负压封闭引流技术治疗,其术后取得良好疗效,现总结如下。     

自制简易负压封闭吸引装置在外科感染创面的应用

目的:探讨自制简易负压吸引装置对外科感染创面的治疗效果以及可行性。方法:对31例外伤后感染的患者采用自制的简易负压封闭吸引装置进行治疗,观察其治疗效果。结果:31例感染患者治疗效果均明显,感染得到尽快控制,肉芽组织生长迅速。结论:简易负压吸引装置对感染创面的治疗效果显著,能明显减轻患者负担,缩短换药时间,减少抗生素用量,促进肉芽组织生长,降低医务人员工作量。     

负压吸引技术治疗皮肤软组织创面的进展

近年来负压创面治疗技术广泛应用于治疗各种急慢性创面,并取得了确切疗效。负压创面治疗技术可以促进各种复杂创面的愈合,减少住院治疗时间,并减轻患者的经济负担。现总结最近几年关于负压创面治疗技术在各种复杂创面治疗中的进展,包括颌面部术后的软组织缺损和瘘,腹部术后出现的瘘或感染、压疮等导致的皮肤复杂创面、患儿烧伤创面以及肿瘤术后的难愈创面。同时也介绍一些成功的临床操作方法,并分析了负压创面治疗技术在治疗这些复杂创面上的优势。     

整形外科复杂创面的负压吸引治疗

目的：探讨局部负压吸引技术处理整形外科复杂创面的方法和效果。方法：总结2007年～2009年笔者因复杂创面采用负压治疗的患者53例,男性33例,女性20例,年龄26～7l岁,创面面积6cm2～80cm2。结果：2例负压治疗后,新生上皮组织覆盖创面,治疗开始至愈合时间均为21天;51例行负压治疗后创面情况明显改善,二期行植皮或组织瓣转移等常规方法关闭创面（其中15例负压治疗后行全麻下清创）,术后创面均一期愈合,治疗时间最短者14天,最长者30天,平均治疗时间19天。结论：负压治疗是创面治疗的一次新进展,操作简便,易于掌握,能够彻底去除创面分泌物和坏死组织,优化创面条件,为整形修复提供良好组织基础,加速创面愈合。     

封闭式负压引流治疗慢性创面的护理

慢性创面的愈合是一个复杂的生物学过程 ,受许多因素影响。封闭式负压引流技术是近年来报道的新的创面处理方法 [1 ,2 ]。1 998年 1 1月至 2 0 0 0年 3月 ,我科采用封闭式负压引流技术对 31例病人的慢性创面进行治疗 ,取得满意疗效 ,报告如下。1　临床资料1 .1　一般资料31例中 ,男 1 4例、女 1 7例 ,年龄 9～ 88岁 ,平均 39.4岁。均为伤后 1个月以上、创面无明显愈合趋势者。致伤原因 :皮肤挫裂伤 1 7例 ,乳癌根治术后皮肤坏死 3例 ,糖尿病骶尾部褥疮 5例 ,小腿静脉瘀滞性溃疡 3例 ,糖尿病足溃疡 2例 ,结核性脓胸术后伤口裂开并发巨大瘘道 …     

儿童负压伤口治疗的研究进展

针对儿童患者如何安全有效地选择负压压力值、泡沫类型、伤口接触层、治疗模式、负压引流装置更换频率及负压伤口引流 的应用持续时间进行综述,提出儿童应用负压治疗创面时需考虑材料、负压值设置、模式的选择、负压引流装置更换时间和负压伤 口引流应用持续时间等方面。     

Deconstructing negative pressure wound therapy

Since its introduction 20 years ago for the treatment of chronic wounds, negative pressure wound therapy use has expanded to a variety of other wound types. Various mechanisms of action for its efficacy in wound healing have been postulated, but no unifying theory exists. Proposed mechanisms include induction of perfusion changes, microdeformation, macrodeformation, exudate control and decreasing the bacterial load in the wound. We surmise that these different mechanisms have varying levels of dominance in each wound type. Specifically, negative pressure wound therapy is beneficial to acute open wounds because it induces perfusion changes and formation of granulation tissue. Post‐surgical incisional wounds are positively affected by perfusion changes and exudate control. In the context of chronic wounds, negative pressure wound therapy removes harmful and corrosive substances within the wounds to affect healing. When skin grafts and dermal substitutes are used to close a wound, negative pressure wound therapy is effective in promoting granulation tissue formation, controlling exudate and decreasing the bacterial load in the wound. In this review, we elucidate some of the mechanisms behind the positive wound healing effects of negative pressure wound therapy, providing possible explanations for these effects in different wound types.     

负压创面治疗法作用原理及临床应用研究进展

<正>负压创面治疗法(negative pressure wound therapy,NPWT)也称为封闭负压引流(vacuum seal drainage,VSD)或真空辅助闭合(vacuum-assisted closure,VAC),是近10余年来提出并开展的一种外用的促进急性和慢性创面愈合的新治疗方法。目前,已成为治疗各种急性创伤、难愈性慢性创面最先进的技术之一。该方法以带有多孔     

Lymphorrhea responds to negative pressure wound therapy

Lymphoceles and lymph fistulas are common complications of femoral exposure for vascular procedures. Three patients who required readmission after their vascular interventions were treated with negative pressure wound therapy. Once adequate control of the drainage was obtained, the patients were discharged home with a portable suction unit. The mean time to stop lymph leak was 14 days, and the mean length of hospital stay was 7.3 days. This method of management offers early control of fluid drainage, rapid control of the wound, earlier closure, and the potential for reduced length of stay. Patient acceptance and convenience may be enhanced by outpatient management and return to work in appropriately motivated individuals.     

The effect of negative wound pressure therapy on haemodynamics in a laparostomy wound model

We have recently shown that negative pressure wound therapy (NPWT) induces a decrease in microvascular blood flow in the small intestinal loop close to the dressing. The effect of NPWT is thus thought to be local. In this study, we investigate whether the application of NPWT in laparostomy affects the haemodynamics. Midline incisions were made in six pigs followed by NPWT at ?120 mmHg for 20 minutes. The cardiac output, mean systemic arterial pressure, mean pulmonary artery pressu re, central venous pressure, left atrial pressure and superior mesenteric artery blood flow were recorded. The blood flow in a small branch of the superior mesenteric artery was then recorded under NPWT between ?50 and ?175 mmHg. Cardiac output was not affected by NPWT [P = not significant (n.s.)]. Neither the mean arterial pressure nor the mean pulmonary artery pressure was affected by NPWT (P = n.s.). Negative pressures of ?50, ?75, ?100 and ?125 mmHg did not alter the blood flow in the small branch of the superior mesenteric artery (P = n.s.). After application of ?150 mmHg, a significant decrease in blood flow was seen (P < 0·01), while the application of ?175 mmHg resulted in only a slight decrease in blood flow (P = n.s.). The effect of NPWT in laparotomy seems to be local and to have no influence on central haemodynamics or the blood flow to the superior mesenteric artery.     

The fluid dynamics of simultaneous irrigation with negative pressure wound therapy

Saline irrigation has been shown to be both experimentally and clinically efficacious in decreasing bacterial contamination as well as decreasing infection rates. The dynamics of irrigation delivery fall into two primary categories: simultaneous and intermittent irrigation. An important component to irrigation therapy is distribution of irrigation solution to hard‐to‐reach areas of a wound bed, including undermining and fissure‐like structures. Here we test the effectiveness of simultaneous irrigation to fill the irregular structures of a wound bed. In order to visualise the dynamic movement of irrigation solution, three‐dimensional wound models were constructed using clear synthetic ballistic gel. Wounds with the aforementioned characteristics were carved into the ballistic gel with varying area, depth and volume. All three wounds were dressed as per manufacturer's instructions. Data demonstrate that simultaneous irrigation is effective in reaching all parts of a wound bed in wound models that have both undermining and tunnelling, and irrigation effectively saturates bridged wounds. Finally, this study shows that there is constant turnover of irrigation solution in the wound that is driven more by administration volume and less by flow rate. These data show that simultaneous irrigation is an effective technique for delivering irrigation solution to both simple and complex wounds.