封闭负压引流技术对人慢性创面中透明质酸含量的影响

目的研究人慢性创面在经封闭负压引流治疗前后,创面渗出液中透明质酸含量的变化,部分阐明封闭负压引流促进慢性创面愈合的机理.方法取8例乳癌术后第1、2、3、4天急性创面的引流液,同时收集11例慢性创面(5例压力性溃疡,6例静脉性溃疡)于封闭负压引流治疗前以及治疗后第1、3、5、7、9天的渗出液,利用放射免疫测定的方法分别测定其中透明质酸的含量,并进行动态的观察与比较.结果急性创面引流液中随时间延长透明质酸含量逐渐增高,各时间点的差异有显著意义(P＜0.05).压力性溃疡中,封闭负压引流治疗前渗出液中透明质酸含量较低,引流后随治疗时间的延长透明质酸水平升高(第1、3、5、7天差异有显著意义P＜0.05),至第9天有下降趋势;而静脉性溃疡中,封闭负压引流治疗前透明质酸水平极高,治疗后透明质酸含量随时间延长呈现极明显的波动,但于第7天后呈下降趋势.结论封闭负压引流通过平衡透明质酸的代谢从而促进慢性创面的愈合,这可能是封闭负压引流促进慢性创面愈合的一个重要机制.     

封闭负压引流技术对人慢性创面中胶原酶活性的影响

目的研究人慢性创面经封闭负压引流（vacuum—assisted closure，VAC）治疗前后，创面渗出液中胶原酶活性的变化，以部分阐明VAC促进慢性创面愈合的机理。方法取4例急性创面在术后1、2、3d的创面引流液（乳癌术后），同时收集6例慢性创面（4例静脉性溃疡，2例压力性溃疡）在VAC治疗前以及治疗后2、4、6d的创面渗出液，利用酶谱分析的方法，观察各时间点的渗出液对可溶性Ⅲ型胶原的降解情况，同时应用强力霉素抑制实验来分析渗出液中胶原酶的类型。结果急性创面引流液可以部分降解Ⅲ型胶原，随时间推移变化较小，慢性创面渗出液中的胶原酶活性较高，VAC治疗前基本将Ⅲ型胶原全部降解，随时间推移、降解减少，胶原酶活性下降，强力霉素抑制实验证明在100μmol／L浓度时无抑制，在600μmol／L浓度时出现部分抑制。结论在慢性创面渗出液中胶原酶活性增高，VAC的应用可以降低胶原酶的活性，阻止胶原蛋白大量降解，利于创面愈合，在慢性创面渗出液中胶原酶应主要是MMP-1型（成纤维细胞型）。     

封闭负压引流技术对人慢性创面创缘组织中c-fos表达的影响

目的研究人慢性创面在封闭负压引流治疗前后,创缘组织中原癌基因c-fos表达的变化,从而进一步阐明封闭负压引流促进慢性创面愈合的机制以及慢性创面的成因.方法对5例慢性创面患者给予封闭负压引流治疗(-120?mmHg压力),分别于吸引前以及吸引后1,4,7天切取创缘组织,固定、包埋、切片后,应用免疫组织化学方法观察c-fos蛋白表达的动态变化.结果负压吸引前,c-fos阳性细胞表达较多,主要分布在表皮基底以及真皮浅层中的成纤维细胞及炎性细胞的胞核中,少部分胞浆中亦存在.随负压时间的延长,c-fos阳性细胞渐少,主要分布在真皮层的成纤维细胞胞核中,至第7天已罕见c-fos蛋白的表达.结论 c-fos在封闭负压引流促进慢性创面愈合的过程中,可能起着重要作用,也反向证实c-fos的大量表达,是慢性创面形成的一个重要因素.     

封闭负压引流技术对人慢性创面创缘组织中c-fos表达的影响

目的　研究人慢性创面在封闭负压引流治疗前后 ,创缘组织中原癌基因c -fos表达的变化 ,从而进一步阐明封闭负压引流促进慢性创面愈合的机制以及慢性创面的成因。方法　对 5例慢性创面患者给予封闭负压引流治疗 ( - 12 0mmHg压力 ) ,分别于吸引前以及吸引后 1,4,7天切取创缘组织 ,固定、包埋、切片后 ,应用免疫组织化学方法观察c -fos蛋白表达的动态变化。结果　负压吸引前 ,c-fos阳性细胞表达较多 ,主要分布在表皮基底以及真皮浅层中的成纤维细胞及炎性细胞的胞核中 ,少部分胞浆中亦存在。随负压时间的延长 ,c-fos阳性细胞渐少 ,主要分布在真皮层的成纤维细胞胞核中 ,至第 7天已罕见c-fos蛋白的表达。结论　c -fos在封闭负压引流促进慢性创面愈合的过程中 ,可能起着重要作用 ,也反向证实c -fos的大量表达 ,是慢性创面形成的一个重要因素     

封闭负压引流对人慢性创面中基质金属蛋白酶的影响

目的：研究人慢性创面在经封闭负压引流（Vacuum-assisted-closure V.A.C)治疗前后，创面肉芽组织中基质金属蛋白酶（metalloproteinase,MMp)MMP1,MMP2,MMP13，以及金属蛋白酶组织抑制剂（tissue inhibitor of melalloproteinase,TIMP)TIMP-1,TIMP-2 mRNA的变化。方法：对9例慢性创面患者给予V.A.C治疗（－120mmHg压力），分别于治疗前和治疗后1，4，7天切取创面中央肉芽组织，提取总RNA，利用RT－PCR方法测定MMP－1，MMP－2，13和TIMP－1，TIKMP－2mRNA的表达情况，并对其定量结果进行统计学分析。结果；MMP－1，13mRNA在V.A.C治疗后表达下降，以MMP－13下降趋势尤为明显。MMP－2mRNA表达呈现波动，但总体为下降趋势，在V．A．C治疗前，检测不到TIMP－1，2mRNA的表达，应用V．A．C后，出现了两者的表达，而且随时间的延长，TIMKP－1，2mRNA的表达呈现明显的上升趋势。结论：V．A．C通过抑制MMP－1，2，13mRNA的表达，促进TIMP－1，2mRNA的表达，使更多的MMP与TIMP形成复合物进而抑制胶原和明胶的降解，促进慢性创面的愈合，同时也反向证明慢性创面形成过程中，MMP－1，2，13mRNA的表达增加以及TIMP－1，2，mRNA表达下降是重要因素。     

封闭负压引流技术对人慢性创面创缘组织中c—fos表达的影响

目的：研究人慢性创面在封闭负压引流治疗前后，创缘组织中原癌基因c-fos表达的变化，从而进一步阐明封闭负压引流促进慢性创面愈合的机制以及慢性创面的成因。方法：对5例慢性创面患者给予封闭负压引流治疗（-120mmHg压力），分别于吸引前以及吸引后1，4，7天切取创缘组织，固定、包理、切片后，应用免疫组织化学方法观察c-fos蛋白表达的动态变化。结果：负压吸引前，c-fos阳性细胞表达较多，主要分布在表皮基底以及真皮浅层中的成纤维细胞及炎性细胞的胞核中，少部分胞浆中亦存在。随负压时间的延长，c-fos阳性细胞渐少，主要分布在真皮层的成纤维细胞胞核中，至第7天已罕见c-fos蛋白的表达。结论：c-fos在封闭负压引流促进慢性创面愈合的过程中，可能起着重要作用，也反向证实c-fos的大量表达，是慢性创面形成的一个重要因素。     

封闭负压引流技术对创面血管化的影响

目的 观察封闭负压引流技术对创面血管化的影响.方法 制作幼猪肌腱外露创面模型2×12个,设为封闭负压引流组(VSD组)和对照组,对表达CD31的新生血管、表达α-平滑肌肌动蛋白(α-SMA)的成熟血管和表达血管内皮生长因子(VEGF)的细胞数进行统计学比较.结果 第7天,VSD组CD31阳性新生血管数为(19.90±1.36)个,α-SMA阳性成熟血管数为(11.90±1.32)个,VEGF阳性新生血管数为(69.90±1.27)个,CD31 mRNA表达量为(1.543±0.072);对照组分别为(13.20±1.02)、(8.20±1.05)、(44.20 ±0.72)个以及(0.988 ±0.031),差异有统计学意义(P＜0.05).结论 封闭负压引流能加速创面血管化,肉芽覆盖肌腱,促进创面愈合.     

负压封闭引流治疗高位肛周脓肿的临床研究

探讨负压封闭引流治疗高位肛周脓肿的疗效。94例高位肛周脓肿患者按数字随机表法分为两组,每组47例。治疗组给予负压封闭引流治疗,对照组给予低位切开引流治疗,比较两组手术时间、住院时间、创面愈合时间、住院费用;比较两组术后第2日疼痛视觉模拟评分(VAS)和Wexner肛门失禁评分;比较两组术前及术后7 d血清肿瘤坏死因子-α(TNF-α)和表皮生长因子(EGF)水平;术后4周比较两组治愈率。治疗组术后住院时间、创面愈合时间及住院费用均少于对照组(P<0.01);术后第2日治疗组VAS评分、Wexner评分均低于对照组(P<0.01);术后7 d治疗组血清TNF-α水平低于对照组(P<0.01),EGF水平高于对照组(P<0.01),术后4周治疗组治愈率高于对照组(P<0.05),差异均有统计学意义。负压封闭引流术治疗高位肛周脓肿可有效保护肛门功能,缓解术后疼痛,减少创面愈合时间和住院时间,提高治愈率。     

封闭负压引流对创面微循环超微结构影响的实验研究

目的研究封闭负压引流(VAC)对创面微循环超微结构的影响。方法以兔耳背全层皮肤缺损创面为模型,左耳创面为治疗组,给予VAC治疗;右耳创面为对照组,给予油纱敷料包扎。于各时间点切取创缘皮肤含皮下组织,制成超薄切片,在透射电镜下观察毛细血管和内皮细胞形态改变。结果VAC组:治疗10min,毛细血管腔明显扩张,2h扩张最为显著;30min可见血管出芽增生,2h见内皮细胞间隙缩小,第3天血管出芽和内皮细胞增生仍显著,内皮细胞连接紧密,血管基膜完整。对照组:治疗前后毛细血管形态无明显改变,术后第3天见血管出芽增生,而内皮细胞间隙较大,血管基膜不完整。结论VAC能扩张毛细血管,促进血管出芽增生,并加强内皮细胞间的连接,促进血管基膜恢复完整,从而改善创面微循环,有利于创面愈合。     

封闭负压引流技术对猪皮肤软组织爆炸伤感染创面的疗效

目的 了解封闭负压引流(VAC)技术对猪皮肤软组织爆炸伤感染创面的疗效. 方法 用电雷管在4只小白家猪双侧肩胛及双侧臀部共造成16个爆炸伤创面,将创面分为对照组和负压治疗组.2组创面伤后前2 d不作任何处理任其感染;第3天起,对照组创面用油纱换药,负压治疗组创面行VAC治疗.于治疗前(伤后第3天)及开始治疗后1、3、6、9、14、19、24 d测量并计算创面的面积、深度;取创面组织进行病理形态学观察,检测细胞增殖指数、血管内皮细胞数、髓过氧化物酶(MPO)活性和细菌计数.记录创面愈合时间. 结果 开始治疗后第1、3天,负压治疗组创面面积和创面深度不再扩大和加深,创面内炎性细胞、血管内皮细胞和增殖细胞数目均增多,MPO活性明显增高,细菌数明显减少;此期间对照组各指标变化情况与该组相反.治疗后1～19 d,2组创面的面积、深度、血管内皮细胞数以及细菌数比较,差异有统计学意义(P＜0.01);治疗后1～9 d,2组创面细胞增殖指数差异有统计学意义(P＜0.01);治疗后3、6 d,2组创面MPO活性比较,差异有统计学意义(P＜0.01).对照组创面愈合时间为(32.8±1.6)d,明显长于负压治疗组的(25.8±1.0)d(P＜0.01).结论与常规换药相比,VAC能明显减少猪皮肤软组织爆炸伤感染创面的细菌数量,减轻继发性坏死,促进炎性反应,快速启动肉芽组织生成,缩短创面愈合时间.     

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。     

Successful management of abdominal wound dehiscence using a vacuum assisted closure system combined with mesh-mediated medial traction

Management of the open abdomen has advanced significantly in recent years with the increasing use of vacuum assisted closure (VAC) techniques leading to increased rates of fascial closure. We present the case of a patient who suffered two complete abdominal wall dehiscences after an elective laparotomy, meaning primary closure was no longer possible. She was treated successfully with a VAC system combined with continuous medial traction using a Prolene^® mesh. This technique has not been described before in the management of patients following wound dehiscence.     

The management of deep sternal wound infections using vacuum assisted closure (V.A.C.) therapy

A group of international experts met in May 2006 to develop clinical guidelines on the practical application of vacuum assisted closure (V.A.C.)+ therapy in deep sternal wound infections. Group discussion and an anonymous interactive voting system were used to develop content. The recommendations are based on current evidence or, where this was not available, the majority consensus of the international group. The principles of treatment for deep sternal wound infections include early recognition and treatment of infection. V.A.C. therapy should be instigated early, following thorough wound irrigation and surgical debridement. V.A.C. therapy in deep sternal wound infections requires specialist surgical supervision and should only be undertaken by clinicians with adequate experience and training in the use of the technique.     

Management of abdominal wound dehiscence using vacuum assisted closure in patients with compromised healing

BACKGROUND: Restoration of the abdominal wall's integrity after postoperative wound dehiscence is frequently performed in a delayed fashion, necessitating a temporary dressing of the dehisced wound. METHODS: The Vacuum Assisted Closure (VAC) system (Kinetic Concepts, Inc., San Antonio, TX) was used in 21 patients with postoperative abdominal wound dehiscences that could not be closed immediately and who were at high risk for healing complications. The VAC device was used in conjunction with sharp debridement and it was maintained on a continuous mode with a negative pressure of -75 to -125 mm Hg. The dressing was changed every 2 days. VAC therapy was continued until the integrity of the abdominal wall was reestablished by surgical procedures or secondary healing. RESULTS: Thirteen patients had fascial dehiscence, and 9 of them had frank bowel exposure. Definitive fascial closure was performed in 9 of 13 patients with fascial dehiscence. Stable cutaneous coverage was subsequently achieved in all patients by local abdominal skin flap advancement (6), skin grafting (9), or secondary intention healing (6). Seven patients had part of their VAC therapy as outpatients. The complications included a low-output small bowel enterocutaneous fistula in 2 patients and partial skin graft loss in 1 patient. The fistulae resolved after operative treatment (1) or conservative treatment (1). CONCLUSION: Integration of the VAC system in the management of post-laparotomy wound dehiscence in patients with compromised wound healing appears to be successful and should be considered in such patients to provide a stable, healed wound.     

透明质酸含量在兔正常皮肤及皮肤创伤愈合过程的变化

目的　分析透明质酸在创伤愈合过程中的含量变化以及胎儿型愈合和成人型愈合的机理。方法　通过胎兔创伤模型及皮肤均化的方法，提取游离及结合的透明质酸（ＨＡ） ，应用透明质酸结合蛋白（ ＨＡＢＰ） 技术，对胚胎兔、成年兔皮肤在正常及创伤愈合过程中用放射免疫法测定游离、结合及ＨＡ 的总量。结果　⑴不同孕期正常胎兔皮肤的游离ＨＡ 及ＨＡ 总量的差异均无显著意义，结合ＨＡ 有显著的波动，而且均比正常成兔增高（ Ｐ＜ ０ ．０１） ；⑵胎兔皮肤创伤后不同愈合时间的游离ＨＡ 及ＨＡ 总量的差异均无显著意义，结合ＨＡ 的组成亦有显著变化；⑶创伤胎兔与正常胎兔相比，各组分ＨＡ 均增高（ Ｐ＜ ０ ．０５） ；⑷创伤成年兔游离ＨＡ 及ＨＡ 总量均比正常成年兔显著增高（ Ｐ＜ ０ ．０１） ，而在创伤成年兔内部游离ＨＡ 及ＨＡ 总量呈“山峰型”变化；⑸胎兔、成年兔皮肤创伤后对应比较发现，ＨＡ 总量均为胎兔高（ Ｐ＜ ０ ．０１） ，而游离ＨＡ 则第２ 、３ 天差异无显著意义。结论　ＨＡ 的增高是胎儿型愈合不可缺少的内部机制，其中游离ＨＡ 起主导作用，但结合ＨＡ 随孕期的延长以及在创伤后不同愈合时间所发生的显著变化，对于临床控制瘢痕形成具有很重要的意义     

The effect of regional block over pain levels during vacuum‐assisted wound closure

Despite being a wound treatment method with a broad spectrum of indications, vacuum‐assisted wound closure (VAWC) can be a painful treatment modality which may even result with patient unwillingness for the continuation of treatment. A prospective study was undertaken to determine the effect of regional pain blocks (RPB) for patients who wanted to abandon treatment due to pain after the first application. Patients were asked to score their pain using a visual analogue scale for two different time frames (i) during dressing changes and (ii) while daytime treatment. This evaluation was carried out for conventional wound dressings, VAWC before RPB and finally for VAWC after RPB. The pain experienced with blocks was significantly lesser than conventional and VAWC dressing changes that were applied without pain blocks. Also, the pain was significantly lesser under pain blocks for daytime treatment. For patients with refractory pain where VAWC would prove to be of most benefit, RPB can be discussed with the patient and used. This study has shown that effective pain control can be obtained through regional blocks for patients with excruciating pain undergoing VAWC treatment.     

Evaluation of vacuum‐assisted closure in patients with wound complications following tumour surgery

Covering the reconstructed area with a healthy soft‐tissue envelope is a major challenge after limb‐sparing surgery in patients with malignant bone and soft‐tissue tumours. Negative pressure wound therapy (NPWT) of open wounds hastens healing and minimises the requirement for complex reconstructive soft‐tissue surgery. The aim of this study was to investigate the effectiveness and safety of NPWT in bone and soft‐tissue malignant tumour patients with postoperative wound complications. Between January 2006 and November 2009, at a single institution, 13 patients with malignant bone and soft‐tissue tumours who had undergone wide resection were retrospectively analysed. NPWT was performed in all patients to temporarily close the soft‐tissue defects. After obtaining the culture negativity and normal infection markers, definitive soft‐tissue reconstruction was performed to close the wound with primary suturisation in two patients, split thickness grafts in four patients, full thickness grafts in two patients, rotational flaps in three patients and free flaps in two patients. Mean duration of hospitalisation was 20 (range 8–48) days and mean follow‐up period was 57·3 (range 50–74) months. There was no tumour recurrence or skip metastasis in the follow‐up period. In addition, there was no periprosthetic infection or complication associated with NPWT. In conclusion, NPWT therapy seems to be a safe and effective option in the management of local wound problems and secondary surgical site infections after musculoskeletal tumour surgery.