封闭负压引流技术结合邻近皮瓣转移修复难治性组织缺损

目的：探讨封闭负压引流技术（vacuum sealing drainage,VSD）结合邻近皮瓣转移在难治性组织缺损修复中的有效性和实用性。方法：自2010年3月,应用封闭负压引流技术结合邻近皮瓣转移修复不同原因造成的大面积深度组织缺损或骨外露患者16例,其中车祸伤后躯体大面积深度组织缺损伴感染创面2例、下肢骨折骨外露创面9例,小腿及足部的慢性溃疡3例,臀骶部褥疮2例。根据不同病情,辅助应用VSD于创面,视创面情况,在5～10天后去除或更换VSD装置,待创面缩小、感染控制、肉芽新鲜时应用邻近局部皮瓣或邻位皮瓣转移修复创面。结果：经持续负压引流并根据创面情况更换VSD敷料后,创面感染得到理想控制,创面明显缩小,结合应用邻近皮瓣转移修复,均达到理想效果。结论：持续负压封闭引流能及时清除引流区渗出物和坏死组织,改善局部微循环和促进组织炎症、水肿消退,刺激肉芽组织生长,加速创面愈合,缩小创面,只需结合相对简单易行的邻近皮瓣应用即可理想地修复多数难治性组织缺损创面。

The vacuum sealing drainage technique and adjacent skin flap to repair the refractory wounds

Objective To investigate the effectiveness and practicality of the combination of VSD and Adjacent Skin Flap in the repair of refractory issues defects.Methods Since March 2010,the combination of VSD and Adjacent Skin Flap has been applied in the treatment of 16 patients with large and deep tissue defects or bone exposure caused by various reasons.According to the actual condition,the VSD is applied and removed or renewed after 5 ～10 days.When the surface of wound is narrowed,infection controlled,and granulation refreshed,adjacent skin flap or local skin flap is applied to repair the wound.Results The wounds recovered satisfactorily after the application of VSD and Adjacent Skin Flap.Conclusions The Vacuum Sealing Drainage（VSD） can clear the necrosis tissue and effusion in the drain area in time,improve the local microcirculation,promote the extinction of inflammation and edema,stimulate the growth of granulation tissues,accelerate the wound healing and reduce the wound.Combined with the relatively easy adjacent skin flap,VSD can effectively repair the majority of refractory tissue defects.