封闭式负压引流技术在儿童感染创面修复中的应用
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摘要
目的:探讨封闭式负压引流技术(Vacuum sealing drainage,VSD)治疗儿童感染创面的临床疗效。方法:2008年7月-2010年3月,收治15例感染创面患儿,其中地震伤3例,交通事故伤10例,重物压砸伤2例。均为下肢损伤共15例共35处创面。创面皮肤软组织均有不同程度坏死,伴肌腱外露11例,骨外露7例,骨筋膜室综合征2例,骨折内固定10例。彻底清创后,采用VSD材料覆盖创面,维持压力于0.04 MPa,持续引流7~10 d。结果:除1例未完成VSD治疗外,其余患儿经治疗后创面均明显缩小,肉芽组织生长良好,采用皮片(13例)或皮瓣(1例)游离移植修复创面,皮片及皮瓣均一期愈合,皮片及皮瓣外形、质地、颜色等传统方法比较无差异。结论:VSD治疗儿童感染创面时创面肉芽培养在10~20 d左右,而传统方法等待创面坏死皮肤自溶脱落及更换敷料培养肉芽常需1~2月时间,故能明显缩短病程,减轻患儿痛苦及家属心理负担,有效控制创面感染,促进肉芽组织生长,从而取得显著的治疗效果。
Objective:To investigate the curative effect of vacuum sealing drainage(VSD)in children with infected wounds.Methods:From July 2008 to March 2010,15 children with infected wounds were treated,including earthquake damage in 3 cases,traffic accident in 10 cases,and heavy crush injury in 2 cases.All the 15 patients with injuries had 35 wounds in the lower limbs;the wounds had varying degrees of skin and soft tissue necrosis,with 11 cases of tendon exposure,7 cases of bone exposure,2 cases with bone compartment syndrome,and 10 cases of fracture fixation.After the debridement,the VSD material covered the wound to maintain the pressure at the 0.04 MPa,and kept continuous drainage 7~10 d.Results:Except for one child who gave up,all the wounds were narrowed obviously;granulation tissue grew well.In wound repair using skin grafts(13 patients)or flap(1 patient)graft,skin graft and flap graft were the first stage healing.The shape,texture,and color showed no difference compared with other traditional methods.Conclusion:For the VSD treatment of children with infected wounds,the culture of granulation tissue needs about 10 days to 20 days,while the traditional method needs about 1 to 2 months before the autolysis and necrotic skin off and replacement of the dressing.Therefore,the VSD treatment can significantly shorten the course,reduce the psychological burden of children and economic burden of their families,effectively control the wound infection,promote the growth of granulation tissue,and thus obtain a significant therapeutic effect.
Objective:To investigate the curative effect of vacuum sealing drainage(VSD)in children with infected wounds.Methods:From July 2008 to March 2010,15 children with infected wounds were treated,including earthquake damage in 3 cases,traffic accident in 10 cases,and heavy crush injury in 2 cases.All the 15 patients with injuries had 35 wounds in the lower limbs;the wounds had varying degrees of skin and soft tissue necrosis,with 11 cases of tendon exposure,7 cases of bone exposure,2 cases with bone compartment syndrome,and 10 cases of fracture fixation.After the debridement,the VSD material covered the wound to maintain the pressure at the 0.04 MPa,and kept continuous drainage 7~10 d.Results:Except for one child who gave up,all the wounds were narrowed obviously;granulation tissue grew well.In wound repair using skin grafts(13 patients)or flap(1 patient)graft,skin graft and flap graft were the first stage healing.The shape,texture,and color showed no difference compared with other traditional methods.Conclusion:For the VSD treatment of children with infected wounds,the culture of granulation tissue needs about 10 days to 20 days,while the traditional method needs about 1 to 2 months before the autolysis and necrotic skin off and replacement of the dressing.Therefore,the VSD treatment can significantly shorten the course,reduce the psychological burden of children and economic burden of their families,effectively control the wound infection,promote the growth of granulation tissue,and thus obtain a significant therapeutic effect.
引文
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[7]刘三风,刘志豪,戴志波.负压封闭引流技术(VSD)对各种复杂创面修复的临床研究[J].当代医学,2009,15(6):66-68.
[8]李永忠,李云飞,陈莉,等.封闭式持续负压吸引技术在地震伤创面感染治疗中的应用[J].创伤外科杂志,2008,10(5):407.
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[10]黄显凯,姚元章,王韬,等.负压封闭引流在严重多发伤创面治疗中的作用[J].创伤外科杂志,2008,10(5):437-439.
[11]赵杰,辛杰,初涛,等.持续封闭负压引流技术治疗复杂创伤性皮肤软组织缺损的临床疗效观察[J].成都医学院学报,2009,4(1):39-40.
[12]朱如里,马永平,郑闽前,等.封闭负压引流治疗腕部开放性骨折合并软组织缺损[J].创伤外科杂志,2010,12(3):218-220.
[13]蒙家辉,黄家基,施伟业,等.负压引流专用敷料治疗皮肤软组织缺损并骨外露[J].微创医学,2010,5(2):143-144.
[14]苏开新.VSD负压封闭引流术在整形外科的应用[J].中国中医院资讯,2010,2(11):73.
[15]吴宇,刘世清,赵训明,等.负压封闭引流技术治疗软组织缺损36例分析[J].中国误诊学杂志,2010,10(4):940-941.
[16]廖华,邓玉兰.负压引流技术治疗胫骨慢性骨髓炎的临床疗效观察[J].西南军医,2010,12(2):257-258.
[17]林秀丽,杨浩瑾,周雷,等.真空负压封闭技术在糖尿病足治疗中的应用[J].实用医学杂志,2010,26(7):1243-1244.
[18]贝朝涌,王锐英,李强,等.封闭式压引流联合植皮术治疗四肢皮肤软组织感染性缺损[J].山东医药,2010,50(4):11-12.
[19]蔡泽贤,林少弟,周明.负压封闭引流术在肢体严重热钢贯穿伤中的应用[J].航空航天医药,2010,21(5):693.
[20]唐延军,刘建锋,王宪俊,等.负压封闭引流技术、万古霉素珠链填充治疗慢性创伤性骨髓炎[J].中国临床研究,2010,23(1):42-43.
[2]Morykwas M J,Argenta L C,Shelton Brown E I,et al.Vacuum-as-sisted closure:a new method for wound control and treatment:animalstudies and basic foundation[J].Ann Plast Surg,1997,38(6):563-576.
[3]Whelan C,Stewart J,Schwartz B F.Mechanics of wound healing andim portance of vacuum assisted closure in urology[J].J Urol,2005,173(5):1463-1470.
[4]Venturi M L,Attinger C E,Mesbahi A N,et al.Mechanisms andclinical applications of the vacuum assisted cloure(VAC)device:a re-view[J].Am J Clin Dermatol,2005,6(3):185-194.
[5]Stechmiller J K,Kilpadi D V,Childress B,et al.Effect of vacuum-assisted closure therapy on the expression of cytokines and proteases inwound fluid of adults with pressure ulcers[J].Wound Repair Regen,2006,14(3):371-374.
[6]马丹,刘敏.VSD在5.12地震伤员下肢挤压伤后骨筋膜间隙综合征中的应用[J].重庆医学,2009,38(2):140-150.
[7]刘三风,刘志豪,戴志波.负压封闭引流技术(VSD)对各种复杂创面修复的临床研究[J].当代医学,2009,15(6):66-68.
[8]李永忠,李云飞,陈莉,等.封闭式持续负压吸引技术在地震伤创面感染治疗中的应用[J].创伤外科杂志,2008,10(5):407.
[9]刘红旗,张海生,段献荣,等.负压引流封闭治疗小腿外伤性软组织缺损伴骨外露[J].中国骨与关节损伤杂志,2007,22(11):940-941.
[10]黄显凯,姚元章,王韬,等.负压封闭引流在严重多发伤创面治疗中的作用[J].创伤外科杂志,2008,10(5):437-439.
[11]赵杰,辛杰,初涛,等.持续封闭负压引流技术治疗复杂创伤性皮肤软组织缺损的临床疗效观察[J].成都医学院学报,2009,4(1):39-40.
[12]朱如里,马永平,郑闽前,等.封闭负压引流治疗腕部开放性骨折合并软组织缺损[J].创伤外科杂志,2010,12(3):218-220.
[13]蒙家辉,黄家基,施伟业,等.负压引流专用敷料治疗皮肤软组织缺损并骨外露[J].微创医学,2010,5(2):143-144.
[14]苏开新.VSD负压封闭引流术在整形外科的应用[J].中国中医院资讯,2010,2(11):73.
[15]吴宇,刘世清,赵训明,等.负压封闭引流技术治疗软组织缺损36例分析[J].中国误诊学杂志,2010,10(4):940-941.
[16]廖华,邓玉兰.负压引流技术治疗胫骨慢性骨髓炎的临床疗效观察[J].西南军医,2010,12(2):257-258.
[17]林秀丽,杨浩瑾,周雷,等.真空负压封闭技术在糖尿病足治疗中的应用[J].实用医学杂志,2010,26(7):1243-1244.
[18]贝朝涌,王锐英,李强,等.封闭式压引流联合植皮术治疗四肢皮肤软组织感染性缺损[J].山东医药,2010,50(4):11-12.
[19]蔡泽贤,林少弟,周明.负压封闭引流术在肢体严重热钢贯穿伤中的应用[J].航空航天医药,2010,21(5):693.
[20]唐延军,刘建锋,王宪俊,等.负压封闭引流技术、万古霉素珠链填充治疗慢性创伤性骨髓炎[J].中国临床研究,2010,23(1):42-43.
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