负压封闭引流技术治疗糖尿病足溃疡的效果及护理

目的观察负压封闭引流技术(VSD)治疗糖尿病足溃疡患者的临床效果及护理措施。方法选择该院2012年5月—2013年12月收治的糖尿病足溃疡患者42例,采用VSD进行治疗,并总结相应的护理措施。结果该组所有患者术后创面感染均得到有效的控制;其中35例(83.33%)患者经过1次VSD治疗后,有新鲜的肉芽组织生长,创面明显的缩小,经术后Ⅱ期缝合后,创面完全愈合;其余7例(16.67%)术后由于创面分泌物较多,肉芽组织生长较为模糊,经2次VSD手术后,感染得到控制,新鲜的肉芽组织长出,创面2期缝合后,完全愈合。结论对采用VSD进行治疗的糖尿病足溃疡患者做好充分的术前准备,术后密切观察引流装置是否正常,保证引流的畅通,加强功能锻炼,可以明显的提高手术的成功率。     

负压封闭引流技术治疗骶尾部褥疮33例分析

目的观察负压封闭引流（VSD）技术治疗Ⅲ、Ⅳ期骶尾部褥疮的疗效。方法对2010-02～2012-07临床收治的33例骶尾部褥疮患者行清创手术,应用负压封闭引流敷料覆盖创面,封闭创面后持续负压吸引治疗7～10d,拆除敷料行再次手术,直到创面炎症消退、肉芽组织生长良好。结果17例使用VSD治疗1～2次,13例治疗3—4次,3例治疗5～6次后均治愈;其中27例患者VSD治疗后可以直接缝合愈合,6例VSD治疗后需行皮瓣转移修复后愈合。经随访,所有病例均无复发,效果满意。结论VSD技术可以有效地解决困扰褥疮治疗中面临的难题,是治疗褥疮较为理想的方法。     

常规疗法加负压封闭引流技术治疗糖尿病足坏疽疗效观察

目的 探讨常规疗法加负压封闭引流技术（VSD）治疗糖尿病足坏疽的临床疗效.方法 对40例糖尿病足坏疽患者采用抗感染、降血糖、局部清创等常规治疗,在其分泌物细菌培养阴性前提下,加行VSD治疗,待创面肉芽填充丰满后行常规换药至伤口愈合.结果 VSD治疗1～4个疗程,患者创面肉芽组织生长新鲜、平整,无感染、水肿、渗出,创面愈合时间30～172 d、平均80.2 d.结论 VSD治疗糖尿病足坏疽可改善其局部血运,减轻局部水肿,促进创面肉芽组织生长,缩短创面愈合时间.     

应用VSD技术和腓肠神经皮瓣逆行转移治疗严重的足踝部损伤

选择50例严重足外伤骨外露患者,对感染皮肤缺损先行清创及封闭负压引流（VSD）治疗1—3个疗程,后期应用腓肠神经营养皮瓣逆行移位修复足部的皮肤缺损骨外露,并且术中对小隐静脉和腓肠神经进行处理。结果发现,经VSD治疗后,患者感染均得到控制,骨外露创面有部分肉芽生长,其余创面肉芽组织生长新鲜,触之易出血,行细菌培养均阴性。行腓肠神经营养血管皮瓣移位后,1例皮瓣远端1／4坏死伤口感染外,其余均无感染发生,皮瓣均成活,恢复大部分感觉。认为封闭负压吸引可以控制感染、免除换药、刺激肉芽组织生长,为腓肠神经皮瓣移植提供良好的条件。腓肠神经皮瓣能为足部皮肤缺损提供很好的覆盖和足部耐磨功能恢复。     

负压封闭引流技术辅助治疗糖尿病难治性足溃疡的临床观察

在全身治疗的基础上加局部创面清创,应用VSD治疗使溃疡愈合。结果：30例Wagner分级4级的糖尿病足患者经VSD治疗1～4个疗程后,创面肉芽组织生长新鲜被肉芽组织覆盖,创面平均愈合时间（75±21）d,较较长规换药组平均愈合时间（80±22）d明显缩短。结论：VSD治疗糖尿病足溃疡可改善局部血运,减少局部水肿,促进创面肉芽组织生长,缩短创面愈合时间。     

负压封闭引流技术在难治性褥疮中的应用及护理

目的探讨负压封闭引流（vaecum sealing drmnage,VSD）技术在难治性褥疮中应用的疗效及护理方法。方法对26例难治性骶尾部褥疮患者行清创手术,应用VSD敷料覆盖创面,封闭创面后持续负压吸引治疗7～10d,拆除敷料行再次手术,直到创面炎症消退、肉芽组织生长良好。结果13例使用VSD治疗1～2次,10例使用VSD治疗3～4次,3例使用VSD治疗5～6次;22例患者可以直接缝合治愈,4例VSD治疗后行皮瓣转移修复,效果满意。结论应用VSD技术治疗难治性褥疮效果满意,护理上应密切观察引流装置,保证有效的VSD,同时给予心理护理、饮食护理及康复护理,促进褥疮创面的愈合。     

病灶清除加持续负压封闭引流术治疗胫骨慢性骨髓炎疗效观察

目的：观察比较病灶清除加持续负压封闭引流术（ VSD）与传统灌洗对胫骨慢性骨髓炎的治疗效果。方法胫骨慢性骨髓炎患者29例,其中19例（ VSD组）采用彻底病灶清除、骨皮质开槽并髓腔内持续负压封闭引流14～21 d,二次手术闭合创面;10例（对照组）同期病灶清除加传统灌洗引流治疗,比较两组疗效。结果与对照组相比,VSD组住院时间缩短,引流液细菌培养阳性例数更少,引流管阻塞、脱管减少,引流时间缩短、治愈率高、复发率低。结论病灶清除加髓腔内持续负压封闭引流术治疗慢性骨髓炎安全、有效,效果优于传统灌洗法。     

负压封闭引流技术在创伤骨科术后感染中的应用

目的探讨负压封闭引流技术（VSD）在创伤骨科术后感染治疗中的应用效果。方法应用VSD治疗创伤骨科术后感染患者15例,包括骨盆1例、股骨3例、髌骨3例、跟腱1例、胫骨4例、肱骨1例、踝关节2例。均先行彻底清创再用VSD。7-12 d后,若引流量仍较多或引流管堵塞,则更换引流装置,VSD应用次数为1-3次。若引流量较少且伤口局部红肿消退,体温正常,血常规、C反应蛋白和ESR降至正常水平,则再次手术清创并封闭创面。结果本组13例创面经清创后应用VSD 7-12 d后,发现创面水肿减轻,出现新鲜肉芽组织,10例直接缝合修复创面,3例行组织瓣移植。随访12-20个月感染无复发,局部无窦道、无疼痛,感染得到有效控制。2例胫骨感染患者严重难以控制最终行截肢术。结论彻底清创后应用VSD可以改善局部微循环、抑制局部细菌增殖、刺激肉芽组织生长,为直接闭合或组织瓣移植消灭创面提供了良好的条件。彻底清创、高效引流、恰当的固定及敏感抗炎药物的综合应用是治疗骨感染的有效措施。     

自制简易封闭负压引流联合异种脱细胞真皮基质在老年Ⅳ期压力性溃疡治疗中的应用

目的探讨自制简易封闭负压引流联合异种脱细胞真皮基质对老年Ⅳ期压力性溃疡(压疮)的治疗效果及可行性。方法对24例老年Ⅳ期压疮患者采用自制的简易封闭负压吸引装置联合异种脱细胞真皮基质治疗,观察创面愈合效果。结果12例治疗45～70 d后创面完全愈合;8例疗效显著,出院时创面缩小75%左右,肉芽新鲜,随访20～35 d创面愈合;4例好转,创面缩小30%～50%,有少量至中等渗液或脓液,部分肉芽水肿。结论自制简易封闭负压引流联合异种脱细胞真皮基质对老年Ⅳ期压疮的治疗效果显著,能明显减轻患者经济负担,缩短换药时间,促进肉芽组织生长及创面愈合。     

负压封闭引流联合皮瓣移植治疗慢性跟骨骨髓炎临床观察

目的探讨慢性跟骨骨髓炎的有效治疗方法。方法采用初次清创并负压封闭引流7—21d、二次手术皮瓣修复的方法治疗慢性跟骨骨髓炎伴溃疡或皮肤软组织缺损23例。结果经清创、负压封闭引流7—21d,创面肉芽新鲜,无脓性分泌物,移植皮瓣全部成活,骨髓炎无复发,足跟部外形良好,18例感觉恢复好,耐磨擦能力尚可,能够负重。结论采用初次清创并负压封闭引流、二次皮瓣移植的方法治疗慢性跟骨骨髓炎伴有溃疡或皮肤软组织缺损,手术操作简单,供区损伤小,疗效好。     

负压封闭引流与外支架固定及邮票植皮术治疗上肢开放性骨折并软组织缺损

目的 探讨联合应用负压封闭引流(VSD)与外支架固定及邮票植皮术治疗上肢开放性骨折合并大面积软组织缺损的临床疗效.方法 2009-01～2011-08,对本院收治的16例上肢开放性骨折合并大面积软组织缺损患者,清创后骨折用外支架固定,创面用VSD材料覆盖,接负压封闭吸引,二期邮票植皮.结果 本组16例创面均愈合,其中创面感染6例.随访时间为6个月～1年6个月,平均8个月,骨折一期临床愈合13例,延迟愈合3例,平均愈合时间4.6个月.结论 联合应用VSD、外支架固定及邮票植皮术治疗上肢开放性骨折伴大面积软组织缺损,能迅速有效地稳定骨折,患者可以提前活动患肢,同时安全有效地封闭创面,局限感染灶,促进骨折愈合;VSD术后肉芽组织新鲜,二期植皮易活,取皮方便.该方法 治疗周期短,并发症少,是一种简便有效的治疗方法.     

封闭式负压引流联合植皮术治疗四肢皮肤软组织感染性缺损

目的观察封闭式负压引流（VSD）术治疗四肢皮肤软组织感染性缺损中的临床应用效果。方法对83例四肢皮肤软组织感染性缺损患者局部采用VSD术治疗;感染控制后行二期植皮术。结果术后7～10d感染均得以控制,创面缩小,肉芽新鲜。49例行二期植皮术后创面愈合;34例感染未控制者再次行VSD术,术后植皮或行皮瓣修复术,创面均愈合。结论VSD治疗四肢软组织感染性缺损,可在短期内控制感染,为进一步行植皮术创造条件;手术简单,疗效可靠。     

封闭负压引流术结合重组人表皮生长因子治疗老年性糖尿病溃疡创面疗效分析

目的 探讨封闭负压引流术(VSD)结合重组人表皮生长因子(rhEGF)治疗老年性糖尿病溃疡创面的临床疗效.方法 选择2017年8月—2019年6月64例老年性糖尿病慢性溃疡创面患者为研究对象,随机分成观察组32例与对照组32例,观察组采用封闭负压引流术+重组人表皮生长因子的方法,对照组采用封闭负压引流术+常规换药的方法...     

两种伤口负压治疗模式对糖尿病足溃疡治疗作用的比较

目的比较两种伤口负压治疗模式对糖尿病足溃疡的治疗作用。方法选取2018年4至8月广西壮族自治区人民医院内分泌科收治的糖尿病足溃疡患者,经全身综合治疗和创面评估、清创后,对创面床适合伤口负压治疗的16例患者(男10例,女6例)按入组时间顺序进行随机分组,采用开放、平行、交叉方法,分为先负压辅助闭合(VAC)组(8例)和先负压封闭引流(VSD)组(8例),先VAC组第一周采用VAC治疗,第二周接受VSD治疗;先VSD组第一周采用VSD治疗,第二周接受VAC治疗。分别于治疗前、治疗1周末及治疗2周末对所有患者足部溃疡创面拍照,采用Image J软件分析溃疡面积及肉芽组织面积变化,同时采用丹麦雷度经皮氧分压测定仪测定2个部位的组织氧分压。运用两阶段交叉设计的方差分析方法,对治疗期间第1周和第2周两种治疗模式的溃疡面积及肉芽组织面积变化、经皮氧分压变化进行比较。结果(1)16例糖尿病足溃疡患者与治疗前比较,治疗后溃疡面积缩小[4.61(3.11)比9.51(6.55)cm^2,Z=3.517]、肉芽面积增加[4.08(2.49)比0.90(1.12)cm^2,Z=-3.516],2个部位的经皮氧分压值均升高[(54.19±6.91)比(32.16±10.16)mmHg(1 mmHg=0.133 kPa)、(56.75±12.95)比(30.56±11.93)mmHg,t=-11.814、-14.028],差异均有统计学意义(均P<0.05)。(2)VSD和VAC两种不同负压治疗模式对患者的溃疡面积、肉芽组织面积及2个部位的经皮氧分压变化有统计学意义(F=5.763~22.090,均P<0.05),且VAC治疗后的经皮氧分压增大值、溃疡面积缩小值及肉芽组织面积增加值要大于VSD治疗后(P<0.05)。(3)无论采用哪种负压治疗模式,治疗第1周后的2个部位的经皮氧分压增大值均大于治疗第2周后,差异有统计学意义(F=13.254、11.205,均P<0.05)。结论VAC在缩小糖尿病足溃疡面积,增加创面肉芽组织面积及提高溃疡周围组织氧分压方面要优于VSD,VAC治疗模式在治疗糖尿病足溃疡上更具有优势。     

Vacuum-sealed mesh graft transplantation in chronic cutaneous ulcers of the lower leg

BACKGROUND: The covering of defects caused by chronic ulcers on limbs affected by peripheral arterial disease or chronic venous insufficiency is often difficult due to extensive secretion and edema, while chronic bacterial contamination of the wound bed further compromises the conditions for successful healing. PATIENTS AND METHODS: Vacuum-sealed dressing (VSD) offers the option of a closed dressing system for moist wound care that assures firm contact with the wound surface and protection against contamination with nosocomial microbes and decontamination of existing bacteria by means of constant drainage of secretion independent of gravity. VSD is particularly useful in difficult wounds featuring extensive secretion and unfavorable localization and offers many advantages over conventional dressing techniques in terms of improved healing of skin transplants. A total of 35 patients with chronic leg ulcers were treated with vacuum-sealed mesh graft transplantation. RESULTS: Complete healing of the mesh graft transplant was observed in 20 patients (57%). Twelve patients (34%) experienced partial healing (75-90%) of the transplant, while three patients exhibited less than 75% healing of the graft and therefore required a second mesh graft transplantation. CONCLUSIONS: VSD is a simple, quick and inexpensive technique that promotes excellent healing of skin transplants. It is particularly useful in difficult wounds with extensive secretion and/or contamination or infection.     

Efficacy and tolerance of calcium alginate versus vaseline gauze dressings in the treatment of diabetic foot lesions

BACKGROUND: The study aimed at comparing the efficacy and tolerance of an alginate wound dressing with a vaseline gauze dressing in the treatment of diabetic foot lesions. METHODS: This open-label randomized multicenter controlled study was designed to assess the effect of an up to 6-week treatment with either calcium alginate or vaseline gauze dressings. Lesions were either acute or chronic, under cleansing, and with a surface area of 1-50 cm(2); osteomyelitis and severe hypovascularization were non-inclusion criteria. Dressings were changed every day then, once granulation had occurred, every 2 to 3 days. Primary outcome was the proportion of patients with granulation tissue over 75% of the wound area and having a 40% decrease in wound surface area; secondary outcomes were pain on dressing changes, the number of dressing changes, and adverse events. RESULTS: Seventy-seven patients were enrolled. Due to the premature cessation of treatment in 13 patients, it was decided to reduce the period of the efficacy analysis to 4 weeks (without revising the criteria of efficacy). The success rate was of 42.8% in the calcium alginate group and of 28.5% in the vaseline gauze group (not significant difference). A subsequent analysis of granulation tissue surfaces covering the wounds at week 4 (all surfaces taken together) showed a superiority of calcium alginate (p=0.04). Pain on dressing change was lower in the calcium alginate group (p=0.047) and the total number of dressing changes tended also to be lower (p=0.07). Adverse events, which occurred 4 times in the calcium alginate group and 6 times in the other, were judged independent of the treatments. CONCLUSIONS: As compared with vaseline gauze, calcium alginate appears to be more appropriate for topical treatment of diabetic foot lesions in terms of both healing and tolerance.     

The effect of collagenase on ischemic wound healing: results of an in vivo study

Many chronic wounds have a limited blood supply and contain necrotic tissue that must be debrided. The effect of collagenase, an enzymatic debriding agent, has been studied in acute but not in chronic wounds. The purpose of this in vivo study is to evaluate the effect of collagenase on wound healing in ischemic wounds. The ears of eight young New Zealand White rabbits were rendered ischemic by ligation of caudal and central arteries and dermal circulation circumferentially so both ears were perfused only by the rostral artery, preserving the caudal, central, and rostra veins. Three 6-mm, full-thickness dermal punches were made on the inner surface of both ears down to perichondrium. One ear on each rabbit was treated with either collagenase or petrolatum ointment covered with a semi-occlusive dressing; wounds on the other ear of the same rabbit were covered with a semi-occlusive dressing only (control). On post-wounding day 8, wound samples were collected and processed for histological analysis of reepithelialization (epithelial gap, percentage healed, epithelial height, and epidermal area) and granulation tissue formation (peak height, granulation tissue distance, and area). Within-animal comparison showed no significant differences between the petrolatum and control wounds but epithelial height, epidermal area, wound peak height, and granulation tissue distance and area were significantly different between the collagenase and control-treated wounds. Between-animal comparison of petrolatum- and collagenase-covered wounds showed statistically significant (P <0.05) differences for the following outcomes: epithelial gap, percenatge healed, epithelial height, epidermal area, wound peak height, and granulation tissue distance and area. In this ischemic wound model, outcomes for most of the variables associated with healing were significantly better in wounds covered with collagenase and a semi-occlusive dressing than in the control or petrolatum group. Additional in vivo studies are warranted to confirm these results.     

The clinical and cost effectiveness of externally applied negative pressure wound therapy in the treatment of wounds in home healthcare Medicare patients

Pressure ulcers, a devastating and costly healthcare problem, often occur in home healthcare settings. We sought to determine if these and other chronic wounds treated at home with negative pressure wound therapy close faster and reduce treatment costs compared to conventional therapies. Records for 1,032 Medicare home healthcare patients with 1,170 wounds that failed to respond to previous interventions--and were subsequently treated with negative pressure wound therapy--were reviewed. Reductions in wound area and volume were compared to rates reported by Ferrell in 1993, and costs were analyzed. Ferrell reported trochanteric and trunk pressure ulcers averaging 4.3 cm2, treated with a low-air-loss surface and saline-soaked gauze closed at an average of 0.090 cm2 per day. For comparison to Ferrell's outcomes, we analyzed our Stage III and IV trochanteric and trunk wounds treated with low-air-loss and negative pressure wound therapy. Ours averaged 22.2 cm2 in area and closed at an average of 0.23 cm2 per day. The average 22.2 cm2 wound in our study, treated as described by Ferrell, would take 247 days to heal and cost $23,465. Using negative pressure wound therapy, the wound would heal in 97 days and cost $14,546. The study concluded that negative pressure wound therapy is an efficacious and economical treatment modality for a variety of chronic wounds.     

VSD技术应用于糖尿病足的护理探讨

目的探讨观察并分析负压封闭引流技术VSD治疗糖尿病足溃疡创面效果。方法该院2012年4月—2014年5月收治糖尿病足患者50例,VSD治疗组随机选取25例2型糖尿病足患者,使用VSD技术治疗创面,根据创面引流物多少及医用海绵清洁情况每3-7 d更换1次,25例常规换药组观察创面愈合时间、换药次数、治愈率等。结果 VSD组与常规换药组比较创面愈合时间[（16.8±5.5）d与（50.8±6.5）d]、换药次数[（7.9±3.5）次与（21.5±5.1）次,]、治愈率[96%与88%]。结论负压封闭引流技术VSD治疗糖尿病足可改善其局部血运,减轻局部水肿,利用负压引流将创面炎性渗出物和坏死组织吸出,加快糖尿病足溃疡面愈合速度,促进创面肉芽组织生长,缩短创面愈合时间[1]。