摘要
目的探讨皮瓣修复褥疮术前术后应用封闭负压引流技术（VAC）的临床疗效及机制。方法对22例褥疮患者，按随机数字表法分为研究组和对照组，对照组术前应用VAC处理创面，持续负压约7—10d后行皮瓣修复褥疮手术，术后不应用VAC；研究组术前不应用VAC，皮瓣修复褥疮术后应用VAC，缝合皮瓣与褥疮创缘后，在皮瓣上应用封闭负压吸引，持续约7～10d后去除负压吸引装置。通过比较两组的大体外观、创面积血、积液、微血管计数及创面细菌培养检出率等指标，探讨两种治疗方法的临床效果并分析初步机制。结果对照组11例术前应用VAC处理创面后有少许肉芽组织生长，创面积血、积液少，微血管计数增加，细菌培养呈阴性，但皮瓣修复褥疮术后有4例出现死腔残留、创面积液、积血，细菌培养呈阳性，切口裂开延迟愈合4例。研究组皮瓣I期修复褥疮后应用VAC，皮瓣与基底接触紧密，皮瓣下方积血积液少，微血管计数增加，细菌培养呈阴性，1例皮瓣下出现小面积分离，经换药后皮瓣与皮下愈合，皮瓣成活良好，其余切口I期愈合。结论皮瓣修复褥疮术后应用VAC可减少手术次数，利于皮瓣成活。
Objective To investigate the clinical efficacy and mechanism of vacuum-assisted closure （VAC） in the preoperative and postoperative treatment of bedsore united with skin flap. Methods Twenty two cases with bedsore were randomly divided into experimental and control groups. In the control group, the surgery of flap was performed after the treatment of continuous negative pressure about 7 -10 days and the VAC was not applied after operation. While in the experimental group, VAC was not used be- fore operation. It was applied on flaps as soon as sutured the border of flap and decubitus ulcers and re- moved after 7 - 10 days. By comparing the general appearance of two groups, microvessel count and the de- tection rate of bacterial culture and other indicators, the clinical effects of two treatments were investigated and the preliminary mechanism was analyzed. Results After preoperative VAC treatment, 11 cases of con- trol group showed a little granulation tissue growth, less subcutaneous hematoma and wound effusion, in- creased microvessel count and negative bacterial culture. However, there were 4 cases of death cavity resid- ual, subcutaneous hematoma and wound effusion, positive bacterial culture and another 4 cases of delayed healing with skin flap repairing bedsore. The application of VAC in experimental group showed close contact of flap with the basement, less effusion, increased microvessel count and negative bacterial culture. One case of skin flap had a small area of separation, after the dressing of skin and the flap survived. The other wounds healed by first intention. Conclusions The use of VAC to repair bedsore can reduce the number of operation, and it is beneficial to the flap survival.
出处
《中国医师杂志》
CAS
2017年第5期644-646,649,共4页
Journal of Chinese Physician
