封閉式負壓引流聯合反植皮一期閉合開放性創傷截肢創面的臨床分析_《中國修復重建外科雜志》

作者：

廖前德 , 許鑒 , 翁曉軍 , 鐘達 , 劉志勤 , 王成功

中南大學湘雅醫院骨科（長沙，410008）;

關鍵詞：

開放性創傷截肢創面反取皮植皮封閉式負壓引流技術

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目的對比觀察封閉式負壓引流技術（vacuum sealing drainage，VSD）聯合反取皮和直接反取皮治療開放性創傷截肢創面的療效。方法 2005 年3 月－ 2010 年6 月，應用隨機單盲法對收治的60 例四肢開放性骨折截肢患者分別采用一期VSD 聯合反取中厚皮片植皮（試驗組，30 例）與一期單純反取中厚皮片植皮覆蓋截肢創面（對照組，30例）治療。兩組患者性別、年齡、致傷原因、截肢部位、皮膚缺損面積、術前白蛋白指數及受傷至就診時間等一般資料比較差異均無統計學意義（P gt; 0.05）。試驗組截肢后剪除多余殘肢皮膚應用皮鼓取皮制成中厚交錯篩網狀皮片，植于截肢創面，表面用VSD 覆蓋，24 h 不間斷吸引持續7 ～ 10 d；對照組截肢后直接行反取中厚皮片覆蓋創面，術后常規換藥。結果試驗組患者于術后平均8 d 去除VSD 裝置。試驗組皮片存活率（90.0%）、創面感染率（3.3%）及再截肢率（0）、換藥次數[（2.0 ± 0.5）次]、住院時間[（12.0 ± 2.6）d]，均顯著優于對照組[ 分別為63.3%、20.0%、13.3%、（8.0 ± 1.5）次、（18.0 ± 3.2）d]，比較差異均有統計學意義（P lt; 0.05）。兩組患者均獲隨訪，隨訪時間1 ～ 3 年，平均2 年。末次隨訪時，試驗組瘢痕面積、瘢痕分級及創面兩點辨別覺均優于對照組，差異有統計學意義（P lt; 0.05）。兩組患者殘肢均未見明顯腫脹；術后試驗組患肢疼痛發生率、殘肢長度均優于對照組（P lt; 0.05），而患肢殘端形狀比較差異無統計學意義（P gt; 0.05）。兩組殘肢與健側相比較，均存在肌肉廢用性萎縮、肌力下降，各組健側與患側肌力比較差異均有統計學意義（P lt; 0.05），但兩組患側間比較差異無統計學意義（P gt; 0.05）。結論與單純反取中厚皮片比較，VSD 聯合反取中厚皮片能夠一期關閉截肢創面并對創面進行引流，降低感染發生，促進皮片與創面良好貼附，提高了皮片存活率，降低了截肢平面，利于假肢佩戴，是一期處理截肢創面的理想方法之一。

引用本文： 廖前德,許鑒,翁曉軍,鐘達,劉志勤,王成功. 封閉式負壓引流聯合反植皮一期閉合開放性創傷截肢創面的臨床分析. 中國修復重建外科雜志, 2012, 26(5): 558-562. doi: 復制

1.	Braakenburg A, Obdeijn MC, Feitz R, et al. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg, 2006, 118(2): 390-397.
2.	Gregory RT, Gould RJ, Peclet M, et al. The mangled extremity syndrome (M. E. S.): a severity grading system for multisystem injury of the extremity. J Trauma, 1985, 25(12): 1147-1150.
3.	陳曉棟. 一種新的瘢痕疙瘩臨床分級標準. 中華醫學會第14次全國皮膚性病學術年會論文匯編, 2008.
4.	王少新, 李彬, 陳建超, 等. 胸大肌肌皮瓣與中厚皮片修復頸部咽瘺. 中華整形外科雜志, 2007, 23(1): 10-12.
5.	Parrett BM, Matros E, Pribaz JJ, et al. Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plast Reconstr Surg, 2006, 117(4): 1315-1324.
6.	Hou Z, Irgit K, Strohecker KA, et al. Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture. J Trauma, 2011, 71(6): 1705-1708.
7.	Stansby G, Wealleans V, Wilson L, et al. Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds. J Wound Care, 2010, 19(11): 496, 498-502.
8.	Müllner T, Mrkonjic L, Kwasny O, et al. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg, 1997, 50(3): 194-199.
9.	Scherer SS, Pietramaggiori G, Mathews JC, et al. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg, 2008, 122(3): 786-797.
10.	Vuerstaek JD, Vainas T, Wuite J, et al. State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V. A. C.) with modern wound dressings. J Vasc Surg, 2006, 44(5): 1029-1038.
11.	Powell ET 4th. The role of negative pressure wound therapy with reticulated open cell foam in the treatment of war wounds. J Orthop Trauma, 2008, 22(10 Suppl): S138-141.
12.	Babiak I, Zakiewicz W, Luterek M. Application of negative-pressure wound therapy in complex therapy of open tibia fractures IIIB and IIIC with massive soft tissue loss. Chir Narzadow Ruchu Ortop Pol, 2011, 76(3): 154-160.
13.	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 multicenter randomized controlled trial. Diabetes Care, 2008, 31(4): 631-636.
14.	Smith N. The benefits of VAC therapy in the management of pressure ulcers. Br J Nurs, 2004, 13(22): 1359-1365.
15.	Zuhaili B, Aflaki P, Koyama T, et al. Meshed skin grafts placed upside down can take if desiccation is prevented. Plast Reconstr Surg, 2010, 125(3): 855-865.
16.	張建超, 沈國良, 趙小瑜等. 網狀中厚皮片移植聯合負壓封閉引流修復皮膚軟組織缺損. 中國誤診學雜志, 2009, 9(34): 8317-8319.
17.	Dini M, Quercioli F, Mori A, et al. Vacuum-assisted closure, dermal regeneration template and degloved cryopreserved skin as useful tools in subtotal degloving of the lower limb. Injury, 2011. [Epub ahead of print].
18.	Goldstein JA, Iorio ML, Brown B, et al. The use of negative pressure wound therapy for random local flaps at the ankle region. J Foot Ankle Surg, 2010, 49(6): 513-516.
19.	Argenta LC, Morykwas MJ, Marks MW, et al. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg, 2006, 117(7 Suppl): 127-142.
20.	Flack S, Apelqvist J, Keith M, et al. An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers. J Wound Care, 2008, 17(2): 71-78.
21.	Kaplan M, Daly D, Stemkowski S. Early intervention of negative pressure wound therapy using Vacuum-Assisted Closure in trauma patients: impact on hospital length of stay and cost. Adv Skin Wound Care, 2009, 22(3): 128-132.

1. Braakenburg A, Obdeijn MC, Feitz R, et al. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg, 2006, 118(2): 390-397.
2. Gregory RT, Gould RJ, Peclet M, et al. The mangled extremity syndrome (M. E. S.): a severity grading system for multisystem injury of the extremity. J Trauma, 1985, 25(12): 1147-1150.
3. 陳曉棟. 一種新的瘢痕疙瘩臨床分級標準. 中華醫學會第14次全國皮膚性病學術年會論文匯編, 2008.
4. 王少新, 李彬, 陳建超, 等. 胸大肌肌皮瓣與中厚皮片修復頸部咽瘺. 中華整形外科雜志, 2007, 23(1): 10-12.
5. Parrett BM, Matros E, Pribaz JJ, et al. Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plast Reconstr Surg, 2006, 117(4): 1315-1324.
6. Hou Z, Irgit K, Strohecker KA, et al. Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture. J Trauma, 2011, 71(6): 1705-1708.
7. Stansby G, Wealleans V, Wilson L, et al. Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds. J Wound Care, 2010, 19(11): 496, 498-502.
8. Müllner T, Mrkonjic L, Kwasny O, et al. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg, 1997, 50(3): 194-199.
9. Scherer SS, Pietramaggiori G, Mathews JC, et al. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg, 2008, 122(3): 786-797.
10. Vuerstaek JD, Vainas T, Wuite J, et al. State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V. A. C.) with modern wound dressings. J Vasc Surg, 2006, 44(5): 1029-1038.
11. Powell ET 4th. The role of negative pressure wound therapy with reticulated open cell foam in the treatment of war wounds. J Orthop Trauma, 2008, 22(10 Suppl): S138-141.
12. Babiak I, Zakiewicz W, Luterek M. Application of negative-pressure wound therapy in complex therapy of open tibia fractures IIIB and IIIC with massive soft tissue loss. Chir Narzadow Ruchu Ortop Pol, 2011, 76(3): 154-160.
13. 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 multicenter randomized controlled trial. Diabetes Care, 2008, 31(4): 631-636.
14. Smith N. The benefits of VAC therapy in the management of pressure ulcers. Br J Nurs, 2004, 13(22): 1359-1365.
15. Zuhaili B, Aflaki P, Koyama T, et al. Meshed skin grafts placed upside down can take if desiccation is prevented. Plast Reconstr Surg, 2010, 125(3): 855-865.
16. 張建超, 沈國良, 趙小瑜等. 網狀中厚皮片移植聯合負壓封閉引流修復皮膚軟組織缺損. 中國誤診學雜志, 2009, 9(34): 8317-8319.
17. Dini M, Quercioli F, Mori A, et al. Vacuum-assisted closure, dermal regeneration template and degloved cryopreserved skin as useful tools in subtotal degloving of the lower limb. Injury, 2011. [Epub ahead of print].
18. Goldstein JA, Iorio ML, Brown B, et al. The use of negative pressure wound therapy for random local flaps at the ankle region. J Foot Ankle Surg, 2010, 49(6): 513-516.
19. Argenta LC, Morykwas MJ, Marks MW, et al. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg, 2006, 117(7 Suppl): 127-142.
20. Flack S, Apelqvist J, Keith M, et al. An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers. J Wound Care, 2008, 17(2): 71-78.
21. Kaplan M, Daly D, Stemkowski S. Early intervention of negative pressure wound therapy using Vacuum-Assisted Closure in trauma patients: impact on hospital length of stay and cost. Adv Skin Wound Care, 2009, 22(3): 128-132.

《中國修復重建外科雜志》

封閉式負壓引流聯合反植皮一期閉合開放性創傷截肢創面的臨床分析

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《中國修復重建外科雜志》

封閉式負壓引流聯合反植皮一期閉合開放性創傷截肢創面的臨床分析

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

摘要全文圖表視頻參考文獻施引文獻補充材料