VSD技术与综合护理对难愈性压疮创面的护理效果

目的探讨封闭负压引流(VSD)技术联合综合护理模式在慢性难愈性压疮创面中的应用。方法选取我科收治的难愈性压疮创面患者64例作为研究对象,按照随机数字表法分为对照组和VSD组,各32例。对照组采用常规的护理方式进行护理,VSD组患者采用VSD技术,并联合综合护理模式进行护理。观察指标包括两组患者治疗后2周、4周的创面愈合率、护理满意度、住院总费用、住院天数和细菌培养情况,统计并进行比较分析。结果 VSD组治疗后2周、4周创面愈合率均高于对照组,对照组合并感染例数高于VSD组,差异有统计学意义(P 0.05)。VSD组患者的护理满意度,包括服务态度、工作责任心和专业技术能力的满意度均高于对照组(P 0.05)。VSD组患者的平均住院费用高于对照组,而住院天数、换药次数显著低于对照组(P 0.05)。两组患者治疗2周后创面的细菌培养结果表明,VSD治疗组患者细菌阳性率远远低于对照组(P 0.05)。结论慢性难愈性压疮创面实施VSD技术联合综合护理模式,可有效促进创面愈合,提高患者对护理工作的满意度。     

1例重型颅脑爆炸伤术后残余创面负压封闭引流的临床应用

总结1例应用负压封闭引流（VSD）技术对爆炸伤致重型颅脑损伤术后残余创面的治疗。经过对患者整体临床资料及术后残余创面的评估,在硬脑膜已经严密缝合前提下,查阅国内外相关文献,应用负压封闭引流技术对术后残余创面进行封闭式负压吸引治疗,期间考虑中心负压的不稳定性及残腔创面的特点,将负压维持在300 mmHg以内的安全范围,预防脑脊液漏的发生。在保证负压及引流的有效性方面,对残腔的冲洗、泡沫敷料的填塞、创面的封闭以及残余创面和引流管道的间断冲洗等方面都做了一系列精细的护理对策,负压装置每周更换一次。经过4次负压封闭引流技术的治疗创面恢复效果显著,残留潜行创面均愈合,剩余残腔创面新鲜,可见新生肉芽组织,为后期皮瓣移植做好了充分的创面准备,同时也缩短了患者住院时间,减少了医患矛盾,值得临床借鉴。     

可调便携负压吸引装置与传统负压材料在治疗上肢皮肤缺损患者中的对比研究

目的：比较上肢软组织缺损患者经传统与可调便携负压吸引装置的治疗效果。方法：选取2016年1月-2020年1月我院收治的108例上肢软组织缺损患者，依据随机数表法分为试验组和对照组，各54例，对照组采用传统封闭式负压引流系统覆盖创面，试验组采用爱纳苏可调便携负压吸引装置系统覆盖创面。比较两组患者的创面愈合情况、肉芽情况、舒适度和满意率评分。结果：试验组的创面甲级愈合率高于对照组，差异有统计学意义（P<0.05）。试验组超过75%的患者肉芽红润、颗粒状，血液循环良好，无炎性分泌物，创面培养无细菌生长；对照组多数患者肉芽暗红、颗粒状，血液循环差，部分肉芽糜烂、坏死，创面培养有细菌生长，差异有统计学意义（P<0.05）。试验组的舒适度评分为（83.28±11.77）分高于对照组的（56.98±10.52）分，试验组的满意率为92.59%高于对照组的72.22%，差异有统计学意义（P<0.05）。结论：相较于传统VSD而言上肢软组织缺损患者经爱纳苏可调间歇独立负压系统覆盖创面，可促进愈合，改善患者舒适度和满意率。     

长效抗菌材料治疗压力性损伤效果观察

目的观察长效抗菌材料对(2~3)期压力性损伤的临床治疗效果。方法对2018年1月至2019年12月某三级甲等综合医院肾内科44例(2~3)期及混合期压力性损伤患者,随机分为实验组和对照组。对照组应用传统换药方法碘伏和表皮生长因子或康复新治疗,实验组在传统的换药方法再加上长效抗菌材料治疗,应用压疮愈合评估表PUSH测评表.观察两组间临床治疗效果。结果实验组:2期压力性损伤患者7例,3d显效6例,达85%,7d愈合4例,达57%;3期压力性损伤患者6例,3d显效4例,达66%,7d愈合3例,达50%;混合压力性损伤9例,3d显效8例,达88%,7d愈合3例,达33%。对照组:2期压力性损伤患者7例,3d显效4例,达57%,7d愈合2例,达28%;3期压力性损伤患者6例,3d显效4例,达66%,7d愈合0例;混合压力性损伤9例,3d显效4例,达44%,7d愈合1例,达11%。结论使用长效抗菌材料在治疗压力性损伤时具有促进伤口愈合及抑制伤口感染的临床效果。     

负压封闭引流辅助的二期游离植皮修复皮肤黑素瘤术后创面1例

患者男,77岁。右足跟黑色斑块40余年,反复破溃渗液半年。结合临床表现及组织病理学诊断为:皮肤黑素瘤。入院后予相关术前检查,未发现明确肿瘤转移。排除相关手术禁忌后行右足跟皮肤黑素瘤扩大切除术,术中行多点病理监测,显示创面无肿瘤组织残留。术后创面予封闭负压引流(VSD),待肉芽组织增生良好后行二期游离植皮修复。经治疗,患者创面愈合良好,外形及功能基本保留完好。术后随访至今,未见肿瘤复发及转移。     

负压封闭引流技术在隆突性皮肤纤维肉瘤治疗中的应用及效果分析

目的:探讨负压封闭引流(VSD)技术在隆突性皮肤纤维肉瘤术后创面治疗中的应用及效果。方法:选择2011年1月—2017年1月收治的隆突性皮肤纤维肉瘤患者26例,根据创面修复方式分为A组:植皮+VSD治疗组,共11例;B组:传统打包植皮组,共7例;C组:游离减张缝合组,共8例。通过比较3组患者的相关临床指标来探讨VSD技术在隆突性皮肤纤维肉瘤治疗中的应用价值。结果:A组与B+C组植皮区感染情况比较差异无统计学意义(P0.05),局部皮片坏死情况比较差异有统计学意义(P0.05),A组与B组修复创面面积比较差异有统计学意义(P0.05)。结论:采用植皮+VSD技术封闭隆突性皮肤纤维肉瘤术后创面,能最大限度扩大切除范围,减少供皮区创伤,提高皮片成活率,提高患者术后生活质量,未发现增加肿瘤复发率。     

负压创面治疗技术治疗坏死性筋膜炎29例

目的:回顾性总结应用负压创面治疗技术(NPWT)治疗坏死性筋膜炎(NF)伴脓毒性休克患者的临床效果。方法:29例坏死性筋膜炎(NF)伴脓毒性休克患者,入院后均在积极抗感染、纠正休克、生命支持的同时,给予早期清创后应用封闭负压引流(VSD)技术进行创面引流,经1~3次VSD治疗后,创面感染控制良好,生命体征和全身情况稳定后,利用真空辅助闭合(VAC)技术联合游离皮片移植或各种皮瓣成形术修复创面。结果:29例患者中,2例死亡,27例痊愈;无1例截肢。结论:早期NPWT治疗NF合并脓毒性休克,具有充分引流、有效控制感染、促进修复创面,降低死亡率及截肢率的显著疗效。     

下肢慢性溃疡治疗模式的探讨

目的探讨下肢慢性溃疡的治疗方法,为下肢慢性溃疡寻求系统的治疗模式。方法 2016年1月～2018年6月期间,就诊于我院整形外科的30例下肢慢性溃疡患者,随机分成传统治疗组(A组)、封闭负压引流技术VSD治疗组(B组),在控制患者原有疾病的基础上,A组给予常规清创换药处理,采用中厚或全厚皮片植皮修复创面;B组清创后使用VSD治疗(1～2)个疗程,待创面肉芽组织生长良好后给予植皮修复加VSD治疗,即VSD-SG(植皮Skin grafting)-VSD模式,观察比较两组治疗效果。结果 B组平均创面准备时间为(8.50±1.63)天,A组平均创面准备时间为(10.9±5.33)天;B组总换药天数(5.73±3.19)天,A组总换药天数(17.00±12.38)天;B组总住院天数为(18.40±5.40)天,A组总住院天数为(27.13±15.00)天,通过统计学分析,差异均具有统计学意义(t=3.11、3.41、2.21,P 0.05)。B组的治愈率为86.6%,A组的治愈率为67.3%,(χ~2=3.89,P 0.05),差异有统计学意义;B组的术后并发症发生率为13%,A组的术后并发症发生率为33%,(χ~2=1.29,P 0.05),差异无统计学意义,通过以上各项观察指标,B组的治疗方式明显优于A组。结论对于下肢慢性溃疡的治疗,在控制患者原有疾病的基础上,应用VSD-SG-VSD模式治疗疗效显著,优于传统治疗方法,值得推广。     

负压引流联合二期减张缝合治疗巨大皮肤表皮囊肿并发感染患者的临床观察

目的探讨负压引流联合二期减张缝合治疗巨大皮肤表皮囊肿并发感染患者的有效性及安全性。方法参照入选标准,收集至陆军特色医学中心皮肤性病科住院的巨大皮肤表皮囊肿并发感染患者20例,给予抗生素及手术清创后,均行2次负压引流治疗,后期创面行二期减张缝合。结果 20例患者囊肿最长直径平均为(6.09±0.63)cm,平均住院时间为(17.55±4.37)d,创周红肿在第1次负压引流治疗后明显消退,二期减张缝合后伤口愈合可,均择期拆线,治愈率为100%。两次负压引流视觉模拟量表(VAS)评分分别为(2.25±0.64)分、(1.45±0.51)分,疼痛程度能被患者所接受。结论负压引流联合二期减张缝合可用于治疗巨大皮肤表皮囊肿并发感染患者,有效缩小愈合时间,减轻患者痛苦,对临床治疗具有参考价值。     

VSD联合三氧疗法在竹叶青属毒蛇咬伤救治中的应用

目的 分析负压封闭引流技术(VSD)联合三氧疗法在竹叶青属毒蛇咬伤救治中的应用。方法 选取2019年4月—2021年4月联勤保障部队第910医院收治的竹叶青属毒蛇咬伤患者53例,采用随机数字表法分为对照组(n=26)与观察组(n=27)。对照组给予VSD治疗,观察组给予VSD联合三氧疗法。观察并记录两组患者治疗前后凝血功能指标、肿胀评分、疼痛评分及治疗相关指标,并进行统计学分析。结果 (1)两组患者治疗前凝血功能指标(Fg、PT、APTT、TT及INR)比较无明显差异,不具有统计学意义(P>0.05),治疗后观察组PT、APTT、TT及INR水平均低于对照组,Fg水平高于对照组,差异具有统计学意义(P<0.05);(2)两组患者治疗前肿胀及疼痛评分比较无统计学意义(P>0.05),治疗后观察组肿胀及疼痛评分较对照组明显降低,差异具有统计学意义(P<0.05);(3)观察组在肉芽组织生成率、创面细菌清除率及Ⅱ期创面修复成活率等指标上均明显优于对照组,差异具有统计学意义(P<0.05)。结论 竹叶青属毒蛇咬伤采取VSD联合三氧疗法可有效改善患者凝血功能,加速消...     

Short-contact topical tretinoin therapy to stimulate granulation tissue in chronic wounds

BACKGROUND: The use of retinoids in wound healing is increasing. It has been shown that retinoic acid reverses the inhibitory effects of glucocorticoids on wound healing and accelerates the formation of healthy granulation tissue. Pretreatment with tretinoin before epidermal injury such as chemical peeling and dermabrasion has shown accelerated wound healing. Enhanced healing of full-thickness skin wounds has also been demonstrated in early wound healing studies. However, tretinoin therapy can be quite irritating. OBJECTIVE: Our purpose was to observe the clinical and histologic effects of topical tretinoin solution 0.05% applied directly to the wound beds of chronic leg ulcerations. METHODS: We report on the cases of 5 patients with long-standing leg ulcerations. All were treated with topical tretinoin solution 0.05% applied directly to the wound bed. The tretinoin solution was left in contact with the ulcer bed for a maximum of 10 minutes daily and then rinsed with normal saline. Punch biopsy specimens were obtained from the wound beds at baseline and mid therapy. Standard wound care was continued throughout the study. RESULTS: In this study we found that as early as 1 week after treatment with topical tretinoin solution 0.05%, there was increased granulation tissue first noted at the wound's edge. After 4 weeks of therapy with tretinoin, there was further stimulation of granulation tissue, new vascular tissue, and new collagen formation. CONCLUSION: Short-contact tretinoin therapy is a novel modality in which to treat chronic ulcers and stimulate the formation of granulation tissue.     

Polypoid granulation tissue in pressure ulcers: Significance of describing individual ulcers

Granulation tissue formation is required for the healing of deep pressure ulcers. The wound healing process is often delayed at the stage of granulation tissue formation. The pathogenesis of pressure ulcers showing granulation tissue may vary; however, no terminology has been defined to describe existing ulcers. Thus, we previously defined terminology for granulation tissue to describe individual ulcers. Based on these terms, we retrospectively evaluated the findings of deep pressure ulcers. In particular, we focused on polypoid granular tissue, a unique morphological feature. Polypoid granulation tissues were frequently observed in pressure ulcers over the sacrum compared with those over the foot. Chronological observation of a few cases indicated that external forces from specific directions during the healing process caused the development of polypoid granulation tissue. In addition, most pressure ulcers showing polypoid granulation tissue exhibited a trench-like appearance in individual wounds. Based on these observations, polypoid granulation tissue may generate from specific external forces, which lead to wound deformity. Morphological findings in an individual wound may be useful to predict the mechanical factors on existing pressure ulcers.     

Topical negative pressure devices: use for enhancement of healing chronic wounds

Chronic wounds present a significant challenge, because there are few available treatment options for timely healing. Topical negative pressure devices have been used in a number of different types of wounds, including chronic wounds. They are believed to hasten wound healing by (1) maintaining a moist environment, (2) removing wound exudates, (3) increasing local blood flow, (4) increasing granulation tissue formation, (5) applying mechanical pressure to promote wound closure, and (6) reducing bacterial loads in the wound. Multiple nonrandomized, noncontrolled studies have reported that the use of these devices results in faster healing times and more successful closures. Five small randomized, controlled trials have also shown favorable outcomes with the use of topical negative pressure devices compared with conventional treatment. Adverse effects include discomfort, pain, and excessive tissue growth into the dressing. Complications are limited if the device is used properly. In light of the current treatment options, topical negative pressure devices may be considered useful as adjuvant therapy for chronic wounds; however, there is inadequate definitive evidence that wound healing is substantially better with these devices than with traditional therapy.     

Spatial and temporal expression of basic fibroblast growth factor protein during wound healing of rat skin

BACKGROUND: Basic fibroblast growth factor (bFGF) stimulates the mitogenesis of various cells and plays a key part in wound healing. OBJECTIVES: To determine the spatial and temporal expression of bFGF protein during wound healing after burning of rat skin. METHODS: Immunohistochemical methods were used. RESULTS: The immunostaining for bFGF in the normal epidermis was faint and sporadic in the basal cell layer. However, significant staining for bFGF was found in four locations: regenerated epidermis, a band-like zone near the regenerated epidermis, renewed capillaries, and cells infiltrating into the granulation tissue at the inflammatory to proliferative stages after the burn. The intensity of immunostaining of regenerated epidermis, the band-like zone and renewed capillaries was maximal during the proliferative stage and decreased to normal levels or disappeared simultaneously with wound closure. Immunopositive macrophage-like cell numbers in the granulation tissue increased during the proliferative stage and promptly decreased after wound closure, but such cells were only poorly visible in the scar tissue until 42 days postburn. CONCLUSIONS: bFGF may affect the proliferation, differentiation and migration of regenerated keratinocytes and the recruitment of inflammatory cells, as well as neovascularization in granulation tissue during wound healing. Macrophages may play a pivotal role in cutaneous wound repair by producing bFGF not only during the inflammatory or proliferative stages but also during the remodelling stage.     

Polydeoxyribonucleotide improves wound healing of fractional laser resurfacing in rat model

Background: Polydeoxyribonucleotide (PDRN) is an active compound that can promote wound healing. PDRN stimulates wound healing by enhancing angiogenesis and increasing fibroblast growth rates. Laser skin resurfacing is a popular cosmetic procedure for skin rejuvenation. Despite excellent improvement of photo-damaged skin and acne scarring, it is accompanied with drawbacks, such as prolonged erythema and crusting. Objective: This study was designed to assess the effect of PDRN on wounds induced by fractional laser resurfacing. Methods: Twelve male rats aged 8 weeks were randomly assigned to the PDRN treatment group and the control group. Wounds were induced using a fractional ablative CO₂ laser. The treatment group received daily injections of PDRN and the control group received injections of the vehicle. Wound healing assessed by clinical features and histopathologic findings. Results: The process of wound healing was faster in the treatment group than in the control group. In the histopathological examination, the granulation tissue thickness score of the treatment group was significantly higher than that of the control group. Results of immunohistochemical staining showed a marked increase of VEGF-positive cells and PECAM-1/CD31-positive microvessels in the treatment group. Conclusion: PDRN may be a beneficial option to promote wound healing after laser treatment.     

Toll-like receptor 3 ligand polyinosinic:polycytidylic acid promotes wound healing in human and murine skin

Toll-like receptors (TLRs) are pattern-recognition receptors and have a critical role in both innate and adaptive responses to tissue injury. Our previous study showed that wound healing was impaired in TLR3-deficient mice. In this study, we investigated the capacity of the TLR3 agonist polyriboinosinic-polyribocytidylic acid (poly(I:C)) to promote the healing of skin wounds in humans and mice. We found that topical application with poly(I:C) accelerated the closure of wounds in patients with laser plastic surgery. In a mouse model, topical application of poly(I:C) markedly enhanced re-epithelialization, granulation, and neovascularization required for wound closure. Further studies revealed that poly(I:C) treatment resulted in enhanced recruitment of neutrophils and macrophages in association with upregulation of a chemokine, macrophage inflammatory protein-2 (MIP-2/CXCL2), in the wounds. The effect of poly(I:C) was abolished in TLR3-deficient mice or by treatment with MIP-2/CXCL2-neutralizing antibodies. These results suggest a potential therapeutic value of the TLR3 activator poly(I:C) for wound healing.     

Expression and function of keratinocyte growth factor and activin in skin morphogenesis and cutaneous wound repair

Reepithelialization and granulation tissue formation during cutaneous wound repair are mediated by a wide variety of growth and differentiation factors. Recent studies from our laboratory provided evidence for an important role of keratinocyte growth factor (KGF) in the repair of the injured epithelium and for a novel function of the transforming growth factor-beta superfamily member activin in granulation tissue formation. KGF is weakly expressed in human skin, but is strongly upregulated in dermal fibroblasts after skin injury. Its binding to a transmembrane receptor on keratinocytes induces proliferation and migration of these cells. Furthermore, KGF has been shown to protect epithelial cells from the toxic effects of reactive oxygen species. We have identified a series of KGF-regulated genes that are likely to play a role in these processes. In addition to KGF, activin seems to be a novel player in wound healing. Activin expression is hardly detectable in nonwounded skin, but this factor is highly expressed in redifferentiating keratinocytes of the hyperproliferative wound epithelium as well as in cells of the granulation tissue. To gain insight into the role of activin in wound repair, we generated transgenic mice that overexpress activin in basal keratinocytes of the epidermis. These mice were characterized by a hyperthickened epidermis and by dermal fibrosis. Most importantly, overexpression of activin strongly enhanced the process of granulation tissue formation, demonstrating a novel and important role of activin in cutaneous wound repair.     

腐植酸钠促进大鼠伤口愈合的实验观察

目的探讨腐植酸钠对大鼠皮肤创伤愈合的作用。方法建立大鼠皮肤切创模型,以不同浓度的腐植酸钠(0.5%,1%,2%)作用于伤口,分别于术后3,6,9,14,21d时间点观测创面愈合率和平均愈合时间,HE常规染色观察新生肉芽组织及形态学改变。结果腐植酸钠各剂量组的创伤平均愈合时间为(13.7±0.65)d,明显快于空白组的(15.95±1.13)d和阴性组的(15.72±1.24)d,差异均有统计学意义(P均<0.05);术后3,6,9,14d腐植酸钠各剂量组的伤口皮肤平均愈合率显著高于空白组和阴性组,差异均有统计学意义(P均<0.01)。HE染色表明,与空白组和阴性组相比,术后3,6,9d的腐殖酸钠各剂量组的炎症细胞明显减少,新生肉芽组织较厚、新生毛细血管密集、表皮愈合速度较快。结论不同剂量腐植酸钠均能促进实验性皮肤创伤的修复。     

Double-blind placebo-controlled study with topical 2% ketanserin ointment in the treatment of venous ulcers

Previous animal and human data have shown that ketanserin, the first specific serotonin2 antagonist, may have beneficial effects on peripheral vascular diseases and on the healing of ulcers. In this double-blind study a 2% ketanserin ointment in a polyethylene glycol base was used to treat 23 patients with venous ulcers (13 ketanserin, 10 placebo). Classical wound care measures were maintained in both groups; therefore, conventional ulcer therapy (with placebo in a polyethylene glycol base) was in reality compared with conventional ulcer treatment plus ketanserin. The most important parameter for evaluation in this study was the development of granulation tissue (first sign of successful wound healing). The evolution of granulation was significantly better with ketanserin than with placebo (p less than 0.05, Mann-Whitney U test). According to the investigator's evaluation, ketanserin showed a response in 10 out of 11 patients as opposed to 5 out of 10 placebo patients at the end of the study. This first double-blind placebo-controlled study suggests that topically applied ketanserin promotes the healing of venous ulcers.     

Collagen-poly glycolic acid hybrid matrix with basic fibroblast growth factor accelerated angiogenesis and granulation tissue formation in diabetic mice

Because poor skin wound healing associated with diabetes is thought to be partly a result from impaired angiogenesis, treatments that improve angiogenesis could have important clinical applications. We herein report the effects of novel developed material, collagen-poly glycolic acid fiber hybrid matrix, being used together with basic fibroblast growth factor to promote wound healing of full-thickness skin defects on the back of type 2 diabetic Lepr(db) mice. Our data indicates that this therapeutic approach markedly promotes angiogenesis and granulation tissue formation in comparison with other conditions 14 days after wounding.