Vacuum therapy as an intermediate phase in wound closure: a clinical experience

For severely crushed, contaminated, infected or chronic wounds, vacuum therapy can act as an intermediate phase in wound closure. In this article, our clinical experience with the vacuum system is presented. The aim of this study is to evaluate vacuum therapy in wound healing in a clinical setting. From January 1997 until May 1998, we treated 26 wounds in 26 patients with a vacuum system. Eight acute, seven subacute and 11 chronic wounds were included. The wound cavity was filled with a polyurethane (PU) or a polyvinylalcohol (PVA) foam and vacuum sealed with a PU foil. A subatmospheric pressure of 125 mm mercury was maintained by a vacuum pump. Wounds were eligible for wound closure if the bacterial load score was one or less, ranging from zero to four. The median suction time was 17 days (6–55), while the median hospital stay was 49 days (9–92). Twelve wounds were closed with a split skin graft, six with a local or pedicled flap and seven with a free musculocutaneous flap. Vacuum therapy was discontinued in one patient, because of sepsis. Successful closure was achieved in 23 wounds. Vacuum therapy seems to be benificial in complicated wounds with impaired wound healing. A prospective randomized clinical trail, in which vacuum therapy is compared to conventional dressing, is in progress. Received: 31 January 2000 / Accepted: 14 February 2000     

Vacuum-assisted closure: indications and clinical experience

The use of subatmospheric pressure to promote wound healing has gradually found support in the past few years. The vacuum-assisted closure system uses a pump providing a continuous negative pressure of preferably 125 mmHg, which is distributed over the wound surface by an airtight covered foam. The exact mechanisms of vacuum therapy are not yet understood, but clinically soft tissue defects seem to heal faster when subatmospheric pressure is applied. Our experience with the first 100 patients with soft tissue defects of different origin that were treated with vacuum therapy is presented. In 29 patients, the wounds healed without further surgical intervention, 53 patients underwent secondary wound closure and 11 patients required more than one procedure. Seven patients died due to their underlying disease. Few complications were seen. Vacuum sealing is a new therapeutic concept in wound healing which can precede and sometimes replace surgical wound closure. Received: 18 January 2000 / Accepted: 9 February 2000     

The evaluation of subatmospheric pressure and hyperbaric oxygen in ischemic full-thickness wound healing

We evaluated the efficacy of subatmospheric pressure and hyperbaric oxygen (HBO) as adjuncts in the treatment of hypoxic full-thickness wounds in a rabbit model. We hypothesized that subatmospheric pressure and HBO independently are effective in improving wound healing in the ischemic wound model and that when they are used in combination there is an increased positive effect on wound healing. Using a standard ischemic wound model four full-thickness wounds were created on each ear of 41 male New Zealand white rabbits (N = 82 ears). On each rabbit one ear was dressed with the vacuum-assisted closure (VAC) device and connected to suction; the other was dressed identically without the suction and suction tubing. Twenty rabbits were treated with HBO daily for 10 days at 2.0 atmospheres absolute for 90 minutes plus descent and ascent times. Necropsy on all rabbits was performed on postoperative day 10. Four ischemic wound treatment groups were evaluated: Group 1 (N = 21) VAC dressing alone; Group 2 (N = 20) VAC dressing plus HBO; Group 3 (N = 21) VAC dressing to suction alone; and Group 4 (N = 20) VAC dressing to suction and HBO. Using light microscopy a veterinary pathologist blinded to treatment groups quantified peak granulation tissue, granulation tissue gap, and epithelialization tissue gap. Data were analyzed by analysis of variance with significance indicated by P < 0.05. Statistical significance was found in a comparison of VAC dressing to suction and VAC dressing alone for peak granulation tissue and granulation tissue gap both with and without use of HBO. VAC device use appears to increase the rate of healing in a rabbit ischemic wound model. HBO therapy did not significantly affect the rate of healing in this model.     

改良负压封闭引流技术治疗糖尿病足的疗效观察

目的:观察应用改良负压封闭引流(VSD)技术治疗糖尿病足的效果.方法:将糖尿病足40例患者随机分为对照组和治疗组.对照组应用传统VSD技术治疗,治疗组应用改良VSD技术治疗,即在VSD敷料中增加一根冲洗管,经冲洗管每日1次注入呋喃西林500 ml和表皮生长因子30 ml,30 min后关闭冲洗管,开启负压.于治疗10 ...     

负压封闭引流技术在小儿严重外伤创面修复中的应用

目的探讨负压封闭引流(Vacuum sealing drainage,VSD)技术在小儿严重外伤创面中的应用。方法2007年12月至2008年10月,对9例因外伤所致大面积皮肤软组织缺损的小儿患者应用VSD技术进行治疗,创面肉芽组织生长良好后,予以植皮修复。结果9例患儿分别使用VSD治疗1～3次后,创面肉芽组织均生长良好,植皮全部成活。结论VSD技术应用于小儿外伤创面修复,可以有效刺激创面肉芽组织快速生长,缩短病程,减少痛苦,不失为一种有效、省时、省力的好方法。     

负压封闭引流在骨科的应用（附79例报告）

目的介绍负压封闭引流在骨科的应用体会。方法对2007年7月至2009年1月我院使用负压封闭引流（vacuum sealing drainage,VSD）治疗的骨创伤79例进行回顾性分析。结果 4例骨髓炎经2～4次VSD治疗后,创面明显缩小,有新鲜的肉芽组织生长,经治疗后痊愈;骨折术后钢板外露6例,经2～4次VSD治疗,创面明显缩小,有新鲜的肉芽组织生长,且肉芽组织部分覆盖钢板,后经游离皮瓣及皮瓣转位修复创面;8例感染创面应用VSD后,配合敏感抗生素的使用,感染均得到控制,平均使用14 d;植皮10例使用VSD 1次全部存活;开放性骨折外固定支架固定18例,经1～3次VSD治疗后,创面无明显感染,明显有新鲜的肉芽组织生长,后期行皮瓣、植皮、内固定治疗或继续外固定支架治疗;16例新鲜的软组织缺损创面经1次VSD治疗后,均能一期缝合创面或植皮修复创面;8例脓肿切开引流后经1～2次VSD治疗后有肉芽组织生长,均能填平创面或直接缝合创面;褥疮3例经1～3次VSD治疗后,创面有新鲜的肉芽组织生长,无明显渗液后行皮瓣修复创面;8例皮肤脱套伤,经1～2次VSD治疗后植皮全部存活。所有病例均经5～20个月的随访,均未有慢性炎症的发生。结论负压封闭引流是非常有效的引流手段,促进创面的愈合,减少换药的次数,减轻患者的痛苦,减轻医护人员的工作量。     

负压封闭引流在感染创面的局部应用

目的:评估负压封闭引流术(VSD)在感染创面局部应用的效果.方法:挑选18名创面感染患者,平均年龄(45±10)岁,其中11名男性,7名女性,感染创面部位:手部8例,小腿5例,臀部3例,骶部2例,创面使用100～125mmHg负压持续吸引2天,然后间歇吸引,平均负压吸引时间为(9±2)天,测量VSD治疗前后创面大小,随访平均时间为(11±6)个月.结果:创面平均吸引出100±50ml液体,组织水肿及创面引流得到解决,创面清洁干燥,其中15例患者通过运用抗生素及负压吸引术,创面已达到临床愈合,细菌培养阴性,通过负压治疗创面大小从(28±9)cm2减少至(12±8)cm2(P<0.05),只有6例需要进一步外科干预达到闭合创面,2例患者使用负压吸引后感觉疼痛.结论:与传统治疗方法相比,除了VSD本身对创面快速愈合的优点外,还提供了一个快速、舒适的条件.     

Techniques for applying subatmospheric pressure dressing to wounds in difficult regions of anatomy.

Subatmospheric pressure dressing (SPD) has been commercially available in the United States since 1995 as the vacuum-assisted closure (VAC) device. SPD increases local blood flow, decreases edema and bacterial count, and promotes the formation of granulation tissue. Despite recent clinical successes with the use of SPD in a variety of wound types, problems may occur with application of VAC system in certain areas of the body. The main limitation occurs when attempting to maintain an airtight seal over irregular surfaces surrounding a wound. For example, application of the adhesive drape and creation of a seal are particularly difficulty in the hip and perineum. In addition, wounds of the lower extremity can occur in multiple sites, posing the problem of providing a vacuum dressing to more than one wound from one suction pump machine. To address these challenging clinical wounds, we have developed techniques to allow the successful application of SPD to sacral pressure ulcers near the anus, and to multiple large lower extremity ulcers.     

改良可灌洗式持续负压引流技术治疗难愈性创面的临床疗效观察

目的探讨改良可灌洗式持续负压引流技术治疗复杂难愈性创面的临床效果。方法11例难愈性创面．应用改良可灌洗式持续负压引流技术进行治疗,观察负压引流持续时间、更换次数、愈合方式以及应用游离皮片移植及皮瓣转移的愈合情况。结果单例患者敷料套件更换次数最少2次,最多6次,首次治疗后,创面肉芽组织不同程度增生10例;继续应用改良技术固定游离皮片移植愈合10例,皮瓣转移修复1例,11例难愈性创面全部愈合。结论改良可灌洗式持续负压引流技术可以有效地改善创面条件,确保皮片及皮移植瓣成功率,效果良好,值得推广。     

负压封闭引流在骨科复杂创面修复中的应用

目的探讨负压封闭引流（VSD）在骨科复杂创面修复的适应证与疗效。方法对52例软组织缺损患者应用VSD治疗,负压吸引直至创面新鲜后经直接缝合、植皮或转移皮瓣覆盖修复。结果 52例创面均愈合良好。并发症：引流通路堵塞6例,膜下积液4例。结论负压封闭引流技术处理复杂软组织缺损疗效显著,是显微皮瓣技术的辅助及有益补充。     

Exposure to amniotic fluid inhibits closure of open wounds in the fetal rabbit

In many species, open cutaneous fetal wounds do not heal in utero. Such open wounds have been shown to close only after their exclusion from amniotic fluid, thus leading to the hypothesis that amniotic fluid inhibits open wound healing. Therefore the effect of amniotic fluid exposure on the healing of open fetal skin wounds was studied. Fetuses of New Zealand White rabbits received a full-thickness circular 4 mm diameter skin punch biopsy wound. Wounds were left uncovered, covered with a latex patch, or covered with a latex patch with a central hole (doughnut). This third group provided for wound exposure to amniotic fluid while controlling for any wound splinting effect of the patch. Wounds were harvested after 5 days, the wound area was determined planimetrically, and wound edges were examined by means of light microscopy. Analysis of glycosaminoglycans in the wound extra-cellular matrix was performed on a separate group of wounds treated similarly. Uncovered wounds enlarged by an average of 60%, whereas wounds covered with the doughnut patch enlarged by an average of 24%. In contrast, the wounds in the patch-covered group decreased in size by an average of 84%. Histologically all groups contained proliferating fibroblasts and epithelial migration at the wound edge but also an absence of granulation tissue. The patch-covered wounds, which had decreased wound area, were significantly enriched in hyaluronic acid. These results suggest that the healing of the patch-covered wounds occurs without the formation of granulation tissue, presumably through a process of cellular migration and proliferation and that healing was inhibited by exposure to amniotic fluid. Hyaluronic acid has been shown to be permissive of cellular migration and to play a key role in tissue regeneration. Therefore, we speculate that direct exposure of open wounds to amniotic fluid during the late stages of fetal development in the rabbit prevents hyaluronic acid deposition, which in turn may alter wound closure.     

持续负压封闭引流-冲洗技术在治疗感染创面中的应用

目的:本文通过介绍持续负压封闭引流-冲洗技术的有效结合及临床应用、效果分析和注意事项,为复杂感染创面的治疗寻求简单、快速、有效的方法。方法:通过回顾性分析我科22例复杂感染创面的治疗,总结持续负压封闭引流-冲洗技术在感染伴软组织缺损修复与重建的临床特点。结果:22例治疗取得了与传统方法及单纯负压引流技术治疗复杂感染创面无法达到的优良效果。结论:持续负压封闭引流-冲洗技术的改进,能够彻底去除腔隙或创面分泌物和坏死组织,有效控制感染,促进创面愈合,该技术操作简便,易于掌握,在感染复杂创面治疗中的疗效远优于单纯负压封闭引流技术治疗,有临床推广价值。     

Role of different negative pressure values in the process of infected wounds treated by vacuum‐assisted closure: an experimental study

Vacuum‐assisted closure (VAC) device is widely used to treat infected wounds in clinical work. Although the effect of VAC with different negative pressure values is well established, whether different negative pressures could result in varying modulation of wound relative cytokines was not clear. We hypothesise that instead of the highest negative pressure value the suitable value for VAC is the one which is the most effective on regulating wound relative cytokines. Infected wounds created on pigs' back were used to investigate the effects of varying negative pressure values of VAC devices. Wounds were treated with VAC of different negative pressure values or moist gauze, which was set as control. The VAC foam, semiocclusive dresses and moist gauze were changed on days 3, 5, 7 and 9 after wounds were created. When changing dressings, tissues from wounds were harvested for bacteria count and histology examination including Masson's trichrome stain and immunohistochemistry for microvessels. Western blot was carried out to test the expression of vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF). Results showed that on days 3 and 5 the number of bacteria in wounds treated by VAC with 75, 150, 225 and 300 mmHg was significantly decreased compared with that in wounds treated by gauze and 0 mmHg pressure value. However, there was no difference in wounds treated with negative pressure values of 75 , 150, 225 and 300 mmHg at any time spot. Immunohistochemistry showed that more microvessels were generated in wounds treated by VAC using 75 and 150 mmHg negative pressure comparing with that using 225 and 300 mmHg on days 3 and 5. However this difference vanished on days 7 and 9. Morphological evaluation by Masson's trichrome staining showed increased collagen deposition in VAC of 75 and 150 mmHg compared with that in VAC of 225 and 300 mmHg. Western blot showed that the expression of VEGF and bFGF significantly increased when the wounds treated with 75 and 150 mmHg negative pressure values compared with the wounds treated with 225 and 300 mmHg on day 5. Treatment using VAC with different negative pressure values more than 75 mmHg has similar efficiency on reducing bacteria in the infected wound. VAC with negative pressure values of 75 and 150 mmHg promote wound healing more quickly than other pressure values. Moreover, comparing with vigorous negative pressure, relatively moderate pressures contribute to wound healing via accelerated granulation growth, increased angiogenic factor production and improved collagen fibre deposition. Further study of this model may show other molecular mechanisms.     

外伤性皮肤窦道的整形修复及护理

目的:观察手术扩创+封闭负压引流+植皮术治疗长时间不愈合的外伤性皮肤窦道的临床疗效。方法:外伤性皮肤窦道在局麻、臂丛麻醉或硬膜外麻醉下行扩创手术,按创面大小和形状裁剪封闭负压引流(vacuum sealing drainage,VSD)材料覆盖伤口创面,持续引流,7天拆除,伤口为新鲜肉芽组织后行植皮术并行VSD负压引流,7～10天拆除VSD材料。结果:本组82例外伤性皮肤窦道手术扩创后经1～3次封闭负压引流,伤口创面肉芽组织新鲜,经植皮术后皮片成活良好,随访6个月,伤口处瘢痕不明显,部分局部稍凹陷。结论:手术扩创+VSD负压引流+植皮术治疗长时间不愈合的外伤性皮肤窦道,该方法操作简单,痛苦小,疗效肯定,值得临床应用。     

创伤性软组织缺损的负压封闭治疗

目的　探讨创伤致软组织缺损负压封闭 (VS)治疗的临床效果。　方法　 1 998年 8月～ 2 0 0 1年 1 2月 ,对 49例 55个大面积软组织缺损或 /和感染者 ,创面范围为 1 0 cm× 1 0 cm～ 30 cm× 30 cm;清创后将 Vacuseal材料覆盖在相应大小的创面上或填入创腔内 ,持续 50～ 60 k Pa负压引流 ,5～ 7天后二期缝合、植皮或皮瓣移位修复。1 2 6例采用传统换药或引流的患者为对照组。　结果　治疗组有 4例 (4个创面 )死亡未完成治疗 ,余 45例 51个创面治愈 ,无全身和局部并发症。在二期缝合时间、换药次数、创面缩小程度及总体治疗费用等方面 ,与对照组比较 ,均有统计学意义 (P<0 .0 1 )。创面或创腔直接通过 VS治愈 6个 ,采用游离皮瓣修复 4个 ,局部皮瓣移位修复 8个 ,植皮覆盖 2 7个 ,二期缝合 6个。　结论　 VS能充分引流和刺激创面肉芽组织快速生长 ,缩短治愈时间和消除感染。是治疗创伤后急、慢性软组织缺损的一种简便、有效方法     

负压封闭引流技术辅助组织瓣修复复杂或慢性创面

目的观察负压封闭引流技术应用于术前准备阶段协助组织瓣修复复杂或慢性创面的作用。方法回顾分析近2年来用此方案治疗的8例复杂或慢性创面患者．入院时均存在不同程度的创面血运差、骨或其他深部组织外露和顽固感染,一期先行清创手术后使用VSD持续负压吸引创面治疗,待创面新鲜无感染、肉芽丰富后,二期行组织瓣（包括带蒂组织瓣和游离组织瓣）移植覆盖创面。结果应用VSD技术可有效控制创面感染,促进肉芽组织生长。移植皮瓣全部成活,随访3-16个月,无慢性感染、溃疡和窦道存在,效果满意。结论术前正确应用VSD技术,可使创面准备相对简便和快捷．可有效地协助组织瓣修复复杂或慢性创面．值得临床推广和进一步深入研究。     

Evaluation of autologous bone marrow in wound healing in animal model: a possible application of autologous stem cells

A study was conducted to evaluate the potential of autologous bone marrow-derived cells in comparison with buffy coat of autologous blood for rapid cutaneous wound healing in rabbit model. Three square full-thickness skin excisional wounds were created in 15 selected experimental animals (rabbit) divided randomly into three groups. The wound was treated with autologous bone marrow cells in plasma (group 1), buffy coat of blood in plasma (group 2) and autologous plasma as control (group 3). Wounds were observed for 30 days for granulation tissue formation, biochemical, histomorphological and histochemical evaluation. In this study, granulation tissue appeared significantly lesser in wounds of group 3 animals followed by group 2 and 1 animals. Neovascularisation, granulation tissue formation, denser, thicker and better arranged collagen fibres, reticulin fibres and elastin fibres formation was more in group 1 as compared with other groups. It was concluded that the application of bone marrow-derived nucleated cells into the wound margins resulted in early and significantly faster rate of complete healing as compared with buffy coat of autologous blood and autologous plasma (control). This approach may be beneficial in various surface wounds that heal at a slower rate and recommended for healing of various complicated wound in future.     

Regenerative materials that facilitate wound healing

Wounds and damaged tissue become problematic when the tissue repair process does not proceed in a normal manner. Standard treatment of wounds entails topical dressings and devices in conjunction with good wound care practices. Good practices adequately support healing in most patients. Difficult, chronic, or recalcitrant wounds may require the use of more advanced technologies. Wounds that are full thickness or present with the absence of a matrix, may particularly benefit from regenerative materials. This article focuses on the use of cellular and acellular materials as well as chemical constructs to support granulation, tissue repair, and wound closure.     

封闭负压技术治疗各种术后伤口裂开

目的：观察封闭负压技术治疗外科手术后伤口裂开的临床效果及总结应用经验。方法：从2007年5月至2009年12月,采用封闭负压技术治疗各类外科术后伤口裂开患者17例,其中男10例,女7例,平均年龄41岁。创面面积为0.5cm×3.2cm～5.5cm×18.6cm,创面形成时间为8～94天,期间采用常规湿敷或中药换药治疗伤口未愈。给予-120mmHg～-150mmHg负压持续吸引,治疗时间为6～37天。结果：10例经封闭负压治疗后创面直接愈合,其余7例创面清洁,肉芽组织新鲜,伤口缩小,4例清创缝合,2例行局部皮瓣转移,1例行皮片移植修复,伤口均一期愈合。术后随访2～12个月,所有伤口愈合良好,无再次裂开。结论：封闭负压技术简便、无创,能有效促进伤口清洁,加快肉芽组织生长,缩短创面愈合时间,适合治疗各种外科术后伤口裂开,有较高的临床推广应用价值。     

A technique to visualize wound bed microcirculation and the acute effect of negative pressure

Although previous studies have proved that subatmospheric pressure in vacuum assisted closure therapy increased blood flow at the wound edge, no reports have presented data on blood flow in the wound bed. This study examined a technique that visualized microcirculation of the wound bed and estimated the acute effect of negative pressure. The superficial stratum of the mouse gluteal skin was microsurgically excised preserving the subdermal vascular plexus. The preserved vessels were visualized as the wound bed microcirculation using an intravital microscope–video–computer system. Three levels of negative pressure (?125 mmHg [n=12], ?500 mmHg [n=12], 0 mmHg [n=8]) were applied to the wound. Our experimental model successfully and quantitatively visualized wound bed microcirculation under negative pressure application. A negative pressure of ?125 mmHg significantly increased wound bed blood flow immediately after pressure application, maintained for 1 minute after pressure release, whereas in the ?500 mmHg group blood flow decreased with time and reached a statistically significant level 5 minutes after pressure application. These findings reinforce the hypothesis that enhanced blood flow in the wound bed as well as at the wound edge may contribute to the beneficial effects of certain levels of negative pressure therapy for wound perfusion.