封闭式负压引流技术在各种复杂创面治疗中的应用

目的 总结封闭式负压引流(VAC)技术治疗各种创面的效果,进一探讨该技术的适应证与禁忌证.方法 2004年1月至2015年8月,笔者应用VAC治疗各种创面357例,其中创伤后皮肤软组织缺损113例、糖尿病溃疡和足趾坏疽74例,骨髓炎创面14例、术后伤口愈合不良22例、压力性溃疡37例、跟腱术后外露18例、窦道11例、Ⅲ度烧伤伴脓肿和慢性溃疡形成15例,Ⅲ度电击伤8例、供皮区5例、血管渗漏组织坏死2例、贯通伤1例,植皮区12例,下肢静脉性溃疡7例,骨筋膜室综合征5例,热压伤5例,痛风性溃疡2例,外周动脉性溃疡5例,不明原因慢性溃疡1例.积极全身支持治疗,及时手术扩创,行VAC治疗,术后3~7 d更换负压装置.结果 经过VAC治疗后,植皮区皮片全部存活;余创面中,除供皮区、动脉疾病性溃疡外,其他创面肉芽组织生长迅速,全部或部分覆盖深部组织,创面缩小.自行愈合6例,直接扩创缝合34例,自体皮片移植修复167例,皮瓣修复128例,人工真皮联合自体皮片复合移植修复19例,3例创面缩小后改传统换药治疗.患者随访6个月~3年,除3例糖尿病治愈患者同部位再次出现创面外,其他无复发,3例仍有残余创面,总治愈率为98.3%.结论 VAC适应证较广,对多数复杂难愈创面有显著效果,能明显缩短疗程,提高治愈率,但供皮区等创面效果不佳.

Application of vacuum-assisted closure in the treatment of various complex wounds

Objective To summarize the effect of surgical vacuum-assisted closure (VAC) in the treatment of vasious complex wounds, and to discuss the indications and contraindications of the technology. Methods A total of 357 patients with complex wounds, hospitalized from January 2004 to August 2015, were treated with VAC. There were 113 cases of post-traumatic soft tissue defects, 74 cases of diabetic foot ulcer and gangrene, 14 cases of osteomyelitis, 22 cases of postoprative poor wound healing, 37 cases of pressure ulcers, 18 cases of exposed Achilles tendon after opera-tion, 11 cases of sious, 15 cases ofⅢdegree burn with abscess and chronic ulcer formation, 8 cases ofⅢdegree electri-cal injury, 5 cases of donor site wounds, 2 cases of deep tissue necrosis after vascular leakage, 1 case of penetrationg wound, 2 cases of skin graft wounds, 7 cases of lower limb venous ulcers, 5 cases of osteofascial compartment syn-drome, 5 cases of hot crush injury, 2 cases of gouty ulcer, 5 cases of peripheral arterial ulcers, and 1 case of unexplained chronic ulcer. All the patients were given sysetemic supporting treatment in perioperative period and debridement, VAC treatment, with the fresh dressing for wounds changed 3~5 days after operation. Results After VAC treatment, the skin grafts all survived, and the wounds healed up nicely except for donor site wounds and arterial ulcers. The fresh granula-tion tissues were formed rapidly and had covered the deep tissue partially or totally, with the wounds shrinked. The pa-tients suffered self-healing (6 cases), direct debidement (34 cases), autologous skin grafting (167 cases), skin flap trans-plantation (128 cases), artificial dermis combined with autologous skin grafting (19 cases), and conventional dressing change after wound shrinking (3 cases). During the follow-up of 6 months to 3 years, no other case of relapse was found-ed except that 3 cases of diabetic foot showed wound in the same parts. Three patients still had residual wounds. The to-tal healing rate was 98.3%. Conclusion VAC has wide indications and shows significant effects on most complex wounds. It can shorten the course of treatment and improve the healing rate, but the effect is poor for donor site wounds.