负压封闭引流术在整形外科中的拓展性应用

目的 本研究探讨负压封闭引流技术（vacuum sealing drainage，VSD）在整形外科中多种复杂创面上的拓展性运用及辅助治疗效果，为临床上负压封闭引流技术在整形外科多种创面的治疗推广提供参考和依据。方法 通过回顾性分析负压封闭引流技术拓展性运用于笔者科室56例各种复杂创面的治疗，其中临近肌瓣修复胫骨外露创面17例，足部恶性黑色素瘤扩大切除加患侧腹股沟淋巴结清扫术后创面17例，感染清创术后创面12例，糖尿病足难愈性创面10例。根据具体病情特点，分别在肌瓣上一期植皮、腹股沟淋巴结清扫术后、感染创面清创后、糖尿病足清创后安置VSD，根据VSD冲洗或引流情况放置时间约7~14天后拆除，中间如有VSD堵管不畅，处理后负压不理想，可根据情况予以更换。结果 将VSD拓展于上述创面治疗后，均达到理想效果。结论 VSD能有效引流创面渗液，促进微循环、增加创面血流量，提供创面床准备、提高创面抗感染能力及刺激肉芽组织生长、封闭断端淋巴管；拓展性运用VSD于肌瓣修复创面一期植皮、腹股沟清扫预防淋巴漏、控制创面感染及糖尿病足，具有明显治疗效果；在整形外科中，VSD对复杂创面的拓展性应用具有临床推广价值。

Expanding Use of Vacuum Sealing Drainage in Plastic Surgery

Objective To investigate the expanding use,clinical analysis and the matters needing attention of vacuum sealing drainage(VSD) in plastic surgery for a variety of complex wound,(to provide the reference and basis for treatment of VSD in plastic surgery). Methods Through retrospective analysis of vacuum sealing drainage expansion of 56 cases with complex wound treatment in our department, the adjacent muscle flap to repair tibia exposed foot wounds in 17 cases, malignant melanoma excision combined with ipsilateral inguinal lymph node dissection in 17 cases, 12 cases of wound debridement, 10 cases diabetic foot wound. According to the specific characteristics, placement of VSD in a skin flap, inguinal lymph node dissection, after debridement of wound infection and diabetic foot debridement respectively, removed VSD about 7-14 days later. If the VSD''s negative pressure is not ideal,You can change it. Results After the treatment of VSD, the wounds recoverd abviously:high survival rates of skin graft and skin flap, no lymphatic leak, wound infection is in control. Conclusion The VSD can effective drainage of wound drainage, promote microcirculation, increase the flow of blood in the wound, increase the wound ability of anti-infection and stimulate the growth of granulation tissue. The effect of VSD expanding use in the first phase of muscle flap to repair the wound skin graft, sweeping groin lymphatic for leakage prevention, controling the wound infection and refractory wound treatment, etc. were obvious.In plastic surgery, the expanding application of VSD for complex wounds has clinical value.