负压封闭引流（VSD）治疗下肢软组织创面的临床研究
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摘要
目的：
1通过观察利用负压封闭引流技术治疗复杂创伤性下肢皮肤软组织缺损所形成的陈旧性创面,报道负压封闭引流技术在骨外科应用的临床效果。
2分析负压封闭引流的优缺点。
3探讨负压封闭引流技术的手术要点及注意事项。
方法：
1病例选择方法：
1.1选择标准：
1.1.1病例应在负压封闭引流技术之前,外伤后6-8小时内进行了急诊清创或者骨折固定手术,因Ⅰ期难以闭合或者Ⅰ期闭合术后下肢体皮肤软组织坏死所形成的创面。
1.1.2创面的大小至少在5cm×5cm以上,从性价比考虑较小的创面即使无法Ⅰ期闭合,不宜使用在负压封闭引流技术。
1.2病例资料：观察下肢皮肤软组织外伤后缺损形成慢性陈旧性创面的患者共9例,其中男7例,女2例,年龄在17-62岁之间。致伤原因：车祸伤6例,重物砸伤1例,烫伤1例,坠落伤1例。
2、负压封闭引流的材料：负压封闭引流材料包括医用泡沫材料、多侧孔引流管、透性粘贴薄膜、负压引流瓶。设计原理[4]用医用泡沫材料包裹多侧孔引流管,医用泡沫置于被引流区,再利用透性粘贴薄膜封闭被引流区便与外界隔绝,引流管接高负压源,形成了一个高效引流系统。
3、手术方法：对创面进行清创、止血,根据创面大小裁剪、拼接泡沫敷料,用泡沫敷料覆盖、填充整个创面,再用半透膜“叠瓦法”逐层逐片粘贴封用泡沫敷料覆盖、填充整个创面,再用半透膜“叠瓦法”逐层逐片粘贴封闭整个创面,硅胶管与负压吸引装置连接。术后根据引流管通畅情况决定是否冲管或者跟换负压引流装置。
结果：
去除负压引流装置后创面局部观察项目：①创面干燥、清洁、无坏死组织及渗液;②创面水肿消退；③创面肉芽组织新鲜,呈粉红色颗粒状,触之易出血；④创面能保证植皮或皮瓣转位成功。患者全身是否发热,疼痛能否耐受等情况。负压引流治疗后9例创面均不同程度的缩小,其肉芽组织新鲜,表面平坦,毛细血管丰富,组织无水肿、渗出,无死腔残留,感染均得以控制。但骨外露、肌腱外露处肉芽组织生长较少。2例因创面分泌物多更换负压引流材料,其中1例患术后引流管堵塞出现全身发热,3例创面较大的患者出现引流管堵塞,其中一例冲洗后不通畅,更换负压引流敷料。
结论：
负压封闭引流技术是一种新的处理陈旧性创面的方法,该技术操作简便,易于掌握,疗效明显。改变了传统创而治疗中频繁更换敷料的换药方法,减少了换药给患者带来的痛苦,有效地预防和限制感染的扩散、减轻局部水肿、改善局部血运、促进创面肉芽组织生长,对于有肌腱外露、骨外露的创面,负压封闭引流技术还能促进新鲜肉芽组织从周边部分覆盖,促进创面的修复,使创面缩小,给Ⅱ期手术植皮或者皮瓣转移带来便利。
Objective:
1 Report the clinical effects of treatment the complicated skin and soft tissue of traumatic lower limb defects with vacuum sealing drainage.
2 Analyze advantages and disadvantages of vacuum sealing drainage.
3 To investigate the points and notes for vacuum sealing drainage.
Methods:
1.1 Case Selection:
1.1.1 Selection criteria:Before the vacuum sealing drainage,within 6-8 hours after injury the cases treatment by the emergency debridement surgery or fracture fixation operation.The formation of lower extremity wounds is due to the skin and soft tissue necrosis after emergency surgery or that it is difficult to suture the wound during the emergency surgery.
1.1.2 Wounds should be at least 5cm×5cm.From cost considerations, even if can not be closed during the emergency surgery the wound should not be too small to use the vacuum sealing drainage.
1.2 Case Information:
Choose skin and soft tissue defect of lower limb 9 patients,in January 2009 to January 2010 period by Taihe Hospital of Shiyan City in Hubei province.Include 7 males and 2 females,aged 17-62 years old.Injury reas-ons:traffic accident in 6 cases,1 case bruise, burn in 1 case,1 case of crash injury.
Vacuum sealing drainage materials:including medical foam materials, multiside hole drainage, semipermeable membrane of paste,vacuum suction source.Design principles with the medical side of the foam wrap and more drainage holes, medical foam was placed in drainage area, and then paste the permeability of thin films using closed drainage area will be isolated, then the high negative pressure drainage tube source, forming a efficient drainage system. Surgical Methods:After debridement the wound and stop bleeding, foam dressing was cut and stitched according to wound size.The wound was covered with dressing, then closed the wound with semipermeable membrane, the material silicone tube with suction device is connected. Depending on whether drainage tube patency take appropriate measures, if necessary, replace the dressing.
Results:Observation of the wound after dressing removal project:①wound dry, clean, non-necrotic tissue and exudate;②wound edema;③fresh granulation tissue, pink granular, easy to touch the bleeding;④wounds can be skin graft or flap transposition successfully.It should also pay attention to whether the fever, pain tolerance, et.
After treatment by vacuum sealing drainage,9 cases were different degrees of reduced wound, granulation tissue was fresh with flat surface, capillary rich, tissue had no edema or exudate,infection was controlled. Less granulation tissue growth in bone exposure,the exposed tendon department.2 cases replaced dressing as more wound secretion,1 case of drain plug results in systemic fever.3 cases of wound drainage in patients larger the block, one case of smooth even after washing,dressing change
Conclusion:Vacuum sealing drainage is a new method of wound treatment.The technology is simple, easy to master and curative effect. Improve the treatment of frequent replacement of the traditional wound dressings ways.Reduce the pain of patients by dressing.Dressing to reduce the pain of patients,prevent and limit the spread of infection,reduce local edema, improve local blood circulation and promotes the growth of granulation tissue.For those exposed and bone exposed wounds,vacuum sealing drainage also promote granulation tissue from the peripheral part of the coverage, promoting wound repair, so that the wounds became narrow bring convenience to the late skin graft or flap transposition.
1通过观察利用负压封闭引流技术治疗复杂创伤性下肢皮肤软组织缺损所形成的陈旧性创面,报道负压封闭引流技术在骨外科应用的临床效果。
2分析负压封闭引流的优缺点。
3探讨负压封闭引流技术的手术要点及注意事项。
方法：
1病例选择方法：
1.1选择标准：
1.1.1病例应在负压封闭引流技术之前,外伤后6-8小时内进行了急诊清创或者骨折固定手术,因Ⅰ期难以闭合或者Ⅰ期闭合术后下肢体皮肤软组织坏死所形成的创面。
1.1.2创面的大小至少在5cm×5cm以上,从性价比考虑较小的创面即使无法Ⅰ期闭合,不宜使用在负压封闭引流技术。
1.2病例资料：观察下肢皮肤软组织外伤后缺损形成慢性陈旧性创面的患者共9例,其中男7例,女2例,年龄在17-62岁之间。致伤原因：车祸伤6例,重物砸伤1例,烫伤1例,坠落伤1例。
2、负压封闭引流的材料：负压封闭引流材料包括医用泡沫材料、多侧孔引流管、透性粘贴薄膜、负压引流瓶。设计原理[4]用医用泡沫材料包裹多侧孔引流管,医用泡沫置于被引流区,再利用透性粘贴薄膜封闭被引流区便与外界隔绝,引流管接高负压源,形成了一个高效引流系统。
3、手术方法：对创面进行清创、止血,根据创面大小裁剪、拼接泡沫敷料,用泡沫敷料覆盖、填充整个创面,再用半透膜“叠瓦法”逐层逐片粘贴封用泡沫敷料覆盖、填充整个创面,再用半透膜“叠瓦法”逐层逐片粘贴封闭整个创面,硅胶管与负压吸引装置连接。术后根据引流管通畅情况决定是否冲管或者跟换负压引流装置。
结果：
去除负压引流装置后创面局部观察项目：①创面干燥、清洁、无坏死组织及渗液;②创面水肿消退；③创面肉芽组织新鲜,呈粉红色颗粒状,触之易出血；④创面能保证植皮或皮瓣转位成功。患者全身是否发热,疼痛能否耐受等情况。负压引流治疗后9例创面均不同程度的缩小,其肉芽组织新鲜,表面平坦,毛细血管丰富,组织无水肿、渗出,无死腔残留,感染均得以控制。但骨外露、肌腱外露处肉芽组织生长较少。2例因创面分泌物多更换负压引流材料,其中1例患术后引流管堵塞出现全身发热,3例创面较大的患者出现引流管堵塞,其中一例冲洗后不通畅,更换负压引流敷料。
结论：
负压封闭引流技术是一种新的处理陈旧性创面的方法,该技术操作简便,易于掌握,疗效明显。改变了传统创而治疗中频繁更换敷料的换药方法,减少了换药给患者带来的痛苦,有效地预防和限制感染的扩散、减轻局部水肿、改善局部血运、促进创面肉芽组织生长,对于有肌腱外露、骨外露的创面,负压封闭引流技术还能促进新鲜肉芽组织从周边部分覆盖,促进创面的修复,使创面缩小,给Ⅱ期手术植皮或者皮瓣转移带来便利。
Objective:
1 Report the clinical effects of treatment the complicated skin and soft tissue of traumatic lower limb defects with vacuum sealing drainage.
2 Analyze advantages and disadvantages of vacuum sealing drainage.
3 To investigate the points and notes for vacuum sealing drainage.
Methods:
1.1 Case Selection:
1.1.1 Selection criteria:Before the vacuum sealing drainage,within 6-8 hours after injury the cases treatment by the emergency debridement surgery or fracture fixation operation.The formation of lower extremity wounds is due to the skin and soft tissue necrosis after emergency surgery or that it is difficult to suture the wound during the emergency surgery.
1.1.2 Wounds should be at least 5cm×5cm.From cost considerations, even if can not be closed during the emergency surgery the wound should not be too small to use the vacuum sealing drainage.
1.2 Case Information:
Choose skin and soft tissue defect of lower limb 9 patients,in January 2009 to January 2010 period by Taihe Hospital of Shiyan City in Hubei province.Include 7 males and 2 females,aged 17-62 years old.Injury reas-ons:traffic accident in 6 cases,1 case bruise, burn in 1 case,1 case of crash injury.
Vacuum sealing drainage materials:including medical foam materials, multiside hole drainage, semipermeable membrane of paste,vacuum suction source.Design principles with the medical side of the foam wrap and more drainage holes, medical foam was placed in drainage area, and then paste the permeability of thin films using closed drainage area will be isolated, then the high negative pressure drainage tube source, forming a efficient drainage system. Surgical Methods:After debridement the wound and stop bleeding, foam dressing was cut and stitched according to wound size.The wound was covered with dressing, then closed the wound with semipermeable membrane, the material silicone tube with suction device is connected. Depending on whether drainage tube patency take appropriate measures, if necessary, replace the dressing.
Results:Observation of the wound after dressing removal project:①wound dry, clean, non-necrotic tissue and exudate;②wound edema;③fresh granulation tissue, pink granular, easy to touch the bleeding;④wounds can be skin graft or flap transposition successfully.It should also pay attention to whether the fever, pain tolerance, et.
After treatment by vacuum sealing drainage,9 cases were different degrees of reduced wound, granulation tissue was fresh with flat surface, capillary rich, tissue had no edema or exudate,infection was controlled. Less granulation tissue growth in bone exposure,the exposed tendon department.2 cases replaced dressing as more wound secretion,1 case of drain plug results in systemic fever.3 cases of wound drainage in patients larger the block, one case of smooth even after washing,dressing change
Conclusion:Vacuum sealing drainage is a new method of wound treatment.The technology is simple, easy to master and curative effect. Improve the treatment of frequent replacement of the traditional wound dressings ways.Reduce the pain of patients by dressing.Dressing to reduce the pain of patients,prevent and limit the spread of infection,reduce local edema, improve local blood circulation and promotes the growth of granulation tissue.For those exposed and bone exposed wounds,vacuum sealing drainage also promote granulation tissue from the peripheral part of the coverage, promoting wound repair, so that the wounds became narrow bring convenience to the late skin graft or flap transposition.
引文
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1. Stannard JP,Robinson JT,Anderson ER,et al.Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma[J].J Trauma,2006,6(60):1301-1306.
2. 庄永青,傅小宽,杜冬,等.游离组织瓣移植与外固定器固定对创伤性下肢组织缺损的修复.中华显微外科杂志.2004,27：161-163.
3. Fleisehmann W,Strecker W,Bombelli M,et al.Vacuum sealing as treatment of soft tissue damage in open fractures [J]. Unfallchirurg,1993,96(3):488-492.
4. Argenta LC,Morykwas MJ. Vacuum-assisted closure a new method for wound control and treament clinical experience.Ann Piast surg,1997,38(6):563-578.
5. Neumaier J.Innovative herapeutic measures in problem wounds:autologous skin and vacuum sealing.MMW Fortsehr Med,2004,146(17):14.
6. Polykandriotis E,Kneser U,Kopp J,et al.Modified gloving technique for Vacuum therapy in the hand.Zentralbl Chir,2006,131(Suppl 1):36-39.
7. 裘华德.负压封闭引流技术[M].北京：人民卫生出版杜,2003：32-82.
8. Kilpadi DV,Bower CE,Reade CC,et al.Effect of vacuum assisted closure therapy on early systemic cytokine levels in a swine model[J].Wound Repair and Regerneration,2006,14(2):210-215.
9. Doss M,Martells S,wood JP,et al.Vacuum-assisted suction drainage versus conventional treatment in the management of post sternotomy [J]. Eur J Cardio-thorac surg,2002,22(6):934-938.
10. Cedidi Cberger A,Ingianni G.The two-stage concept with temporary subcutaneous implantation of a vacuum sealing system:An alternative surgical appproach in infected partial abdominal defects after lapratomy or abdomi-noplaty [J].Eur J Med Res,2002,7(9):399-403.
11. Petzina R,Gustafsson L,Mokhtari A,et al.Effect of vacuum-assisted closure on blood flow in the peristernal thoracic wall after internal mammary artery harvesting[J].Eur J Cardiothorac Surg,2006,30(1):85-89.
12. Venturi ML,Attinger CE,Mesbahi AN,et al.Mechanisms and clinical applications of the vacuum-assisted closure(VAC)device:a review[J].Am J Clin Dermat-ol,2005,6(3):185-194
13. Kelenerman L.The evolution of the compartment syndrome since 1948 as recorded in the JBJs(B)EJ].J Bone Joint Surg Br,2007,89(10):1280.
14. Duby, Hofman J,Cameron D,etal.A randomized trial in the treatment of venous leg ulcer comparing short stretch bandages, four layer bandage system and long stretch-paste bandage system wounds[J].1993,5(6):276-279.
15. Conquest AM,Garofalo JH,Maziarz DM,et al.Hemodynamic effects of the vacuum-assisted closure device on open Mediastinal wounds[J].J Surg Res, 2003,115(2):209-213.
16.汤苏阳,徐获荣,齐连军等.封闭式负压引流技术对失神经支配创面愈合过程中血管生成的影响[J].中国临床康复,2005,9(46)：91-93.
17. Weed T,Ratiff C,Drake DB.Quantifying bacterial bioburden during negative pressure wound therapy does the wound VAC enhances bacterial clearance.Ann Plast Surg,2004,52(3):276-280.
18. Skimkawa w, zsseroff RR, Topical negative pressure devices use for enhanc-ement of healing chronic wounds. Arch Rematol.2005,141(11):1449-1453
19. Chen S, Li J, Li XY, et al. Effects Of vacuum-assisted cloure on wound microci-rculation:an experimental study[J]. Asian J Stag,2005,28(3):211-217.
20. Squier CA. The effect of stretching on formation of myofibroblagts in mouse skin[J]. Cell TiBsue Res,1981,220(2):325-335.
21. Takei T, Mills I. Arai K, etal. Moleclar for tissue expansion:clinical implic-ations for the surgeon[J]. Plast Reconstr Surg,1998,102(1):247-258.
22. Andersson N, da Sousa CP, Paredes S. Social cost of land mines in four countries: Afghanistan, Bosnia, Cambodia, and Mozambique [J]. BMJ,1995,311 (7007):718-721.
23. Phillips PG,Birnby LM,Narendran A.hypoxia induces capillary network forma-tion in cultured bovine pulmonary microesssel endothelial cells[J].Am J Physiol,1995,268(S):L789-800.
24. Debus ES,Schmidt K,ziegler UE,et al.The role of growth factors in wound healing[J].Zentralbl Chir,2000,125(S1):49-55
25. Moran SG,Windham ST,Cross JM,et al.Vacuum-assisted complex wound closure with elastic vessel loop augmentation:a novel technique[J].J Wound Care,2003, 12(6):212-213.
26.陈绍宗,曹大勇,李金清,等.封闭负压引流技术对创面愈合过程中原癌基因表达的影响[J].中华整形外科杂志,2005,21(3)：197-200.
27.汤苏阳,陈绍宗,胡昭华.封闭式负压引流技术对大鼠创面愈合过程中VEGF和BCL-2的影响[J].中国美容医学,2003,12(2)：134-135
28.石冰,陈绍宗.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[J].实用美容整形外科杂志,2002,13(6)：330-332.
29. Miller Q,Bird E,Bird K,et al.Effect of subatmospheric pressure on the acute healing wound[J].Curr Surg,2004,61(2):205-208.
30. Meara JG,Guo L,Smith JD,et al.Vacuum-assisted closure in the treatment of degloving injuries.Ann Plast Surg,1999,42:589-594.
31. DeFranzo AJ,Marks MW,Argenta LC,et al.Vacuum-assisted closure for the treatment of degloving injuries.Plast Beconstr Surg,1999,104:2145-2148.
32. DeFranzo AJ,Argenta LC,Marks MW,et al.The use of vacuum-assisteted closure therapy for the treatment of lower-extremity wounds with exposed bone[J]; Plast Reconstr Surg,2001,108(5):1184-1189.
33. Avery C,Pereira J,Moody A,et al.Negative pressure wound dressing of the radial forearm donor site.Int J Oral Maxillofac Surg.2000,29:198-200.
34.[34]喻爱喜,余国荣,邓凯,等.封闭负压吸引联合组织瓣移植治疗严重感染性骨外露[J].中华显微外科杂志,2006,29(3)：219-220.
35. [35]Blume PA,Walters J,Payne W,et al.Comparison of negative pressure wound therapy using Vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers:a muiticenter randomized controlled trial [J].Diabetes Care,2008,31(4):631-636.
36. [36]Korber A,Franekson T,Grabbe S,et al.Vacuum assisted closure device improves the take of mesh grafts in chronic leg ulcer patients.Dermatology, 2008,216:250-256.
37. [37]Gouttefangeas C,Eberle M,Ruck P,et al.Functional T lymphocytes infiltrate implanted polyvinyl alcohol foams during surgical wound closure therapy[J].Cli Exp Immunol,2001,124(3):398-405.
38. [38]Webb LX.New techniques in wound management:vacuum-assisted wound closure.J Am Acad Orthop Surg,2002,10:303-311.
39. [39] Labler L,Trentz O.The use of vacuum assisted closure(VAC)in soft tissue injuries after high energy pelvic trauma.Langenbecks Arch Surg,2007, 392:601-609.
40. [40]Siwach R,Singh R,Arya S,et al.Treatment of 78 type Ⅱ and type ⅢA open fractures by primary closure on suction drain:a prospective study.J Orthop Trauma,2007,8:173-176.
2. Argenta LC,Morykwas MJ. Vacuum-assisted closure a new method for wound control and treatment clinical experience.Ann Piast surg,1997,38(6):563-578.
3. 裘华德,负压封闭引流技术[M].北京：人民卫生出版杜,2003：32-82.
4. 刘飞,罗晴瑜,梁智.封闭式负压引流技术的原理与创面修复[J].中华损伤与修复杂志,2008,3(4)：49-51.
5. 王彦峰,裘华德.负压封闭引流治疗严重急性软组织损伤合并感染创面.中华创伤杂志,1998,14(4)：25.
1、 Fleischmann Wstrecker w,Bombelli M.Vacuum sealing as treatment of soft damage in open fractures.Unfallchirurg,1993.96(9):488-492.
2、 Argenta LC,Morykwas MJ.Vacuum-assisted closure a new method for wound control and treatment clinical experience.Ann Piast surg,1997,38(6):563-578.
3、 Siwach R,Singh R,Arya S, et al. Treatment of 78 type Ⅱ and type ⅢA open fractures by primary closure on suction drain:a prospective study.J Orthop Trauma,2007,8:173-176.
4、 冯骏.负压封闭引流技术治疗软组织创伤29例临床观察.新医学,2009,40(5)：307-309.
5、 姚元章,黄显凯,麻晓林,等.负压封闭技术治疗创伤后软组织缺损[J].创伤外科杂志,2002,4(1)：9-12.
6、Neumaier J.Innovative therapeutic measures in problem wounds:autologous skin and vacuum sealing[J].MMW Fonschr Med,2004,146(17):14.
7、 Polykandriotis E,Kneser U,Kopp J,et al.Modified gloving technique for vacuum therapy in the hand[J].Zentralbl chir,2006,131(s1):S36-39.
8、 吴在德.外科学.第五版.人民卫生出版社.2002：198.
9、 Petzina R,Gustafsson L,Mokhtari A,et al.Effect of vacuum-assisted closure on blood flow in the peristernal thoracic wall after internal mammary artery harvesting[J].Eur J Cardiothorac Surg,2006,30(1):85-89.
10、 Venturi ML,Attinger CE,Mesbahi AN,et al.Mechanisms and clinical applications of the vacuum-assisted closure(VAC)device:a review[J].Am J Clin Dermatol,2005,6(3):185-194.
11、 Kelenerman L.The evolution of the compartment syndrome since 1948 as recorded in the JBJs(B)EJ].J Bone Joint Surg Br,2007,89(10):1280.
12、 Duby, Hofman J,Cameron D,etal.A randomized trial in the treatment of venous leg ulcer comparing short stretch bandages, four layer bandage system and long stretch-paste bandage system wounds[J].1993,5(6)::276-79.
13、 Conquest A M,Garofalo J H,Maziarz DM,et al.Hemodynamic effects of the vacuum-assisted closure device on open Mediastinal wounds[J].J Surg Res,2003,115(2):209-213.
14、 Weed T,Ratiff C,Drake DB.Quantifying bacterial bioburden during negative pressure wound therapy does the wound VAC enhances bacterial cle- arance.Ann Plast Surg,2004,52(3):276-280.
15、Skimkawa W,zsseroff RR, Topical negative pressure devices use for enhancement of healing chronic wounds,Arch Rematol,2005,141(11):1449-1453.
16、 Chen S,Li J,Li XY,et al. Effects Of vacuum-assisted cloure on wound microcirculation:an experimental study[J].Asian J Stag,2005,28(3):211-217.
17、 汤苏阳,徐获荣,齐连军等.封闭式负压引流技术对失神经支配创面愈合过程中血管生成的影响[J].中国临床康复,2005,9(46)：91-93
18、 李靖,陈绍宗,许龙顺.封闭负压引流技术对兔耳创面毛细血管及创面愈合的影响[J].中国临床康复,2004,8(5)：904-905.
19、 吕小星,陈绍宗,李学拥.封闭负压引流技术对创周组织水肿及血管通透性的影响[J].中国临床康复,2003,7(8)：1244-1245
20、 Squier CA.The effect of stretching on formation of myofibroblagts in mouse skin[J]. Cell TiBsue Res,1981,220(2):325-335.
21、 舒茂国,郭树忠,韩岩,等.机械应力对培养人皮肤成纤维细胞增殖细胞核抗原的表达的影响.中国美容医学,2003,12(2)：120-122.
22、 Takei T,Mills I,Arai K,etal.Moleclar for tissue expansion:clinical implicat-ions for the surgeon[J].Plast Reconstr Surg,1998,102(1):247-258.
23、 Amstrong DG,Lavery LA.Negative pressure wound therapyfter partial diabetic foot amputation:multicentre, andomised controlled trial.Lancet,2005, 366(9498):1704-1710.
24、 PhillipsPG,Birnby LM,Narendran A.hypoxia induces capillary network formation in cultured bovine pulmonary microesssel endothelial cells[J].Am J Physiol,1995,268(S):L789-800.
25、 Debus ES,Schmidt K,ziegler UE,et al.The role of growth factors in wound ealing[J].Zentralbl Chir,2000,125(S1):49-55.
26、 Moran SG,Windham ST,Cross JM,et al.Vacuum-assisted complex wound closure with elastic vessel loop augmentation:a novel technique[J].J Wound Care,2003,12(6):212-213.
27、 汤苏阳,李春伶,董继红等.封闭负压引流对创伤愈合中周围神经末梢分泌的P物质及表皮生长因子表达的影响[J].中国临床康复,2004,8(32)：7171-7173.
28、 陈绍宗,曹大勇,李金清,等,封闭负压引流技术对创面愈合过程中原癌基因表达的影响[J].中华整形外科杂志,2005,21(3)：197-200.
29、 汤苏阳,陈绍宗,胡昭华.封闭式负压引流技术对大鼠创面愈合过程中VEGF 和BCL-2的影响[J].中国美容医学,2003,12(2)：134-135
30、 石冰,陈绍宗.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[J].实用美容整形外科杂志,2002,13(6)：330-332.
31、 Miller Q, Bird E, Bird K, et al. Effect of subatmospheric pressure on the acute healing wound[J]. Curr Surg,2004,61(2):205-208
32、 石冰,陈绍宗.封闭负压引流技术对人肉芽创面中MMP-1、 MMP-2、 MMP-13 mRNA表达的影响[J].中华整形外科杂志,2003,19(4)：379-381.
33、 石冰,张萍,李望舟,等.封闭负压引流技术对人慢性创面中胶原酶活性的影响.中华整形外科杂志,2006,22(6)：465-467.
34、 李跃军,曹大勇,陈绍宗.封闭负压引流技术对创面愈合过程纤溶酶原激活剂级联表达的影响.中华整形外科杂志,2006年,22(4)：306-309.
35、 汤苏阳,李春伶,董继红等.封闭负压引流对创伤愈合中周围神经末梢分泌的P物质及表皮生长因子表达的影响[J].中国临床康复,2004,8(32)：7171-7173.
1. Stannard JP,Robinson JT,Anderson ER,et al.Negative pressure wound therapy to treat hematomas and surgical incisions following high-energy trauma[J].J Trauma,2006,6(60):1301-1306.
2. 庄永青,傅小宽,杜冬,等.游离组织瓣移植与外固定器固定对创伤性下肢组织缺损的修复.中华显微外科杂志.2004,27：161-163.
3. Fleisehmann W,Strecker W,Bombelli M,et al.Vacuum sealing as treatment of soft tissue damage in open fractures [J]. Unfallchirurg,1993,96(3):488-492.
4. Argenta LC,Morykwas MJ. Vacuum-assisted closure a new method for wound control and treament clinical experience.Ann Piast surg,1997,38(6):563-578.
5. Neumaier J.Innovative herapeutic measures in problem wounds:autologous skin and vacuum sealing.MMW Fortsehr Med,2004,146(17):14.
6. Polykandriotis E,Kneser U,Kopp J,et al.Modified gloving technique for Vacuum therapy in the hand.Zentralbl Chir,2006,131(Suppl 1):36-39.
7. 裘华德.负压封闭引流技术[M].北京：人民卫生出版杜,2003：32-82.
8. Kilpadi DV,Bower CE,Reade CC,et al.Effect of vacuum assisted closure therapy on early systemic cytokine levels in a swine model[J].Wound Repair and Regerneration,2006,14(2):210-215.
9. Doss M,Martells S,wood JP,et al.Vacuum-assisted suction drainage versus conventional treatment in the management of post sternotomy [J]. Eur J Cardio-thorac surg,2002,22(6):934-938.
10. Cedidi Cberger A,Ingianni G.The two-stage concept with temporary subcutaneous implantation of a vacuum sealing system:An alternative surgical appproach in infected partial abdominal defects after lapratomy or abdomi-noplaty [J].Eur J Med Res,2002,7(9):399-403.
11. Petzina R,Gustafsson L,Mokhtari A,et al.Effect of vacuum-assisted closure on blood flow in the peristernal thoracic wall after internal mammary artery harvesting[J].Eur J Cardiothorac Surg,2006,30(1):85-89.
12. Venturi ML,Attinger CE,Mesbahi AN,et al.Mechanisms and clinical applications of the vacuum-assisted closure(VAC)device:a review[J].Am J Clin Dermat-ol,2005,6(3):185-194
13. Kelenerman L.The evolution of the compartment syndrome since 1948 as recorded in the JBJs(B)EJ].J Bone Joint Surg Br,2007,89(10):1280.
14. Duby, Hofman J,Cameron D,etal.A randomized trial in the treatment of venous leg ulcer comparing short stretch bandages, four layer bandage system and long stretch-paste bandage system wounds[J].1993,5(6):276-279.
15. Conquest AM,Garofalo JH,Maziarz DM,et al.Hemodynamic effects of the vacuum-assisted closure device on open Mediastinal wounds[J].J Surg Res, 2003,115(2):209-213.
16.汤苏阳,徐获荣,齐连军等.封闭式负压引流技术对失神经支配创面愈合过程中血管生成的影响[J].中国临床康复,2005,9(46)：91-93.
17. Weed T,Ratiff C,Drake DB.Quantifying bacterial bioburden during negative pressure wound therapy does the wound VAC enhances bacterial clearance.Ann Plast Surg,2004,52(3):276-280.
18. Skimkawa w, zsseroff RR, Topical negative pressure devices use for enhanc-ement of healing chronic wounds. Arch Rematol.2005,141(11):1449-1453
19. Chen S, Li J, Li XY, et al. Effects Of vacuum-assisted cloure on wound microci-rculation:an experimental study[J]. Asian J Stag,2005,28(3):211-217.
20. Squier CA. The effect of stretching on formation of myofibroblagts in mouse skin[J]. Cell TiBsue Res,1981,220(2):325-335.
21. Takei T, Mills I. Arai K, etal. Moleclar for tissue expansion:clinical implic-ations for the surgeon[J]. Plast Reconstr Surg,1998,102(1):247-258.
22. Andersson N, da Sousa CP, Paredes S. Social cost of land mines in four countries: Afghanistan, Bosnia, Cambodia, and Mozambique [J]. BMJ,1995,311 (7007):718-721.
23. Phillips PG,Birnby LM,Narendran A.hypoxia induces capillary network forma-tion in cultured bovine pulmonary microesssel endothelial cells[J].Am J Physiol,1995,268(S):L789-800.
24. Debus ES,Schmidt K,ziegler UE,et al.The role of growth factors in wound healing[J].Zentralbl Chir,2000,125(S1):49-55
25. Moran SG,Windham ST,Cross JM,et al.Vacuum-assisted complex wound closure with elastic vessel loop augmentation:a novel technique[J].J Wound Care,2003, 12(6):212-213.
26.陈绍宗,曹大勇,李金清,等.封闭负压引流技术对创面愈合过程中原癌基因表达的影响[J].中华整形外科杂志,2005,21(3)：197-200.
27.汤苏阳,陈绍宗,胡昭华.封闭式负压引流技术对大鼠创面愈合过程中VEGF和BCL-2的影响[J].中国美容医学,2003,12(2)：134-135
28.石冰,陈绍宗.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[J].实用美容整形外科杂志,2002,13(6)：330-332.
29. Miller Q,Bird E,Bird K,et al.Effect of subatmospheric pressure on the acute healing wound[J].Curr Surg,2004,61(2):205-208.
30. Meara JG,Guo L,Smith JD,et al.Vacuum-assisted closure in the treatment of degloving injuries.Ann Plast Surg,1999,42:589-594.
31. DeFranzo AJ,Marks MW,Argenta LC,et al.Vacuum-assisted closure for the treatment of degloving injuries.Plast Beconstr Surg,1999,104:2145-2148.
32. DeFranzo AJ,Argenta LC,Marks MW,et al.The use of vacuum-assisteted closure therapy for the treatment of lower-extremity wounds with exposed bone[J]; Plast Reconstr Surg,2001,108(5):1184-1189.
33. Avery C,Pereira J,Moody A,et al.Negative pressure wound dressing of the radial forearm donor site.Int J Oral Maxillofac Surg.2000,29:198-200.
34.[34]喻爱喜,余国荣,邓凯,等.封闭负压吸引联合组织瓣移植治疗严重感染性骨外露[J].中华显微外科杂志,2006,29(3)：219-220.
35. [35]Blume PA,Walters J,Payne W,et al.Comparison of negative pressure wound therapy using Vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers:a muiticenter randomized controlled trial [J].Diabetes Care,2008,31(4):631-636.
36. [36]Korber A,Franekson T,Grabbe S,et al.Vacuum assisted closure device improves the take of mesh grafts in chronic leg ulcer patients.Dermatology, 2008,216:250-256.
37. [37]Gouttefangeas C,Eberle M,Ruck P,et al.Functional T lymphocytes infiltrate implanted polyvinyl alcohol foams during surgical wound closure therapy[J].Cli Exp Immunol,2001,124(3):398-405.
38. [38]Webb LX.New techniques in wound management:vacuum-assisted wound closure.J Am Acad Orthop Surg,2002,10:303-311.
39. [39] Labler L,Trentz O.The use of vacuum assisted closure(VAC)in soft tissue injuries after high energy pelvic trauma.Langenbecks Arch Surg,2007, 392:601-609.
40. [40]Siwach R,Singh R,Arya S,et al.Treatment of 78 type Ⅱ and type ⅢA open fractures by primary closure on suction drain:a prospective study.J Orthop Trauma,2007,8:173-176.
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