封闭负压引流技术在整形外科中的应用(1)
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[摘要]目的:探讨封闭负压引流技术(vacuum sealing drainage, VSD)在整形外科多种常规手术中的辅助治疗效果。方法:自2009年10月,对36例整形外科患者术后部位应用VSD,其中瘢痕切除植皮术后15例,感染创面清创术后9例,轴型皮瓣移植术后8例,肢体脱套伤2例,压疮2例。根据病情特点,分别于皮片表面、皮瓣表面或皮瓣下及创腔内放置VSD,根据引流情况于3～5天后更换或撤除该装置。结果:经持续负压引流并根据创面情况更换VSD敷料后,伤口愈合均达到理想效果。结论:持续负压封闭引流不仅具有引流通畅、不易堵塞管腔的优点,而且还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水肿消退,刺激肉芽组织生长,加速创面愈合。
[关键词]封闭负压引流;整形外科;创伤愈合
[中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)07-0965-03
Use of vacuum sealing drainage in plastic surgery
ZHANG Pei-pei1,WU Yan-qiu1,YIN Xian-guang2,CHAI Jia-ke1
(1.Department of Burn and Plastic Surgery, First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China; 2. People's Hospital of Dehui City)
Abstract: ObjectiveTo investigate the auxiliary efficacy of Vacuum Sealing Drainage (VSD) in several ordinary plastic surgeries.Methods36 cases of plastic surgery patients after operations were treated with Vacuum Sealing Drainage since October 2009. Of them, 15 cases of skin grafting after scar resection; 9cases of post-debridement in infective wounds; 8 cases of axial pattern skin flap transplantation; 2 cases of limb degloving-injury, and 2 cases of pressure sore. VSD was applied correspondingly on the surface of skin grafts or skin flaps, under the flap and in the wound cavities. After 3 to 5 days, VSD was replaced or removed according to the drainage pattern.ResultsThe wounds recovered satisfactorily after continuous negative pressure grainage.ConclusionsThe Vacuum Sealing Drainage can not only keep drainage unobstructed but also clear the necrsis tissue and effusion in the drain area in time, improve the local microcirculation, promote the extinction of edema, stimulate the growth of granulation tissues and accelerate the wound healing.
Key words:vacuum sealing drainage(VSD);plastic surgery;wound healing
封闭负压引流(Vacuum Sealing Drainage,VSD)技术已广泛应用于骨科、普外科,对于开放性损伤、局部易形成血肿、积血积液等创伤部位可以起到良好的引流作用[1],从而促进伤口愈合。我科利用封闭负压引流技术这个优势,将其引入到整形外科常规手术中,取得良好效果,现报道如下。
1临床资料
1.1 VSD材料:聚乙烯酒精水化海藻盐泡沫:由武汉维斯第医用科技有限公司提供,其内置2根多侧孔硬质硅胶引流管,管径0.5cm;生物半透性粘贴薄膜:英国施乐辉公司生产;三通接头;负压吸引源:该组病例均应用院内中心负压吸引。
1.2 病例资料:本组共22例,男10例,女12例,年龄2～53岁。其中植皮术后用于植皮区14例,轴型皮瓣移植术后4例,感染创面清创术后2例,肢体脱套伤1例,压疮1例。
1.3 手术方法
1.3.1 植皮术中,植皮区彻底止血,皮片打孔后覆盖创面,数针固定皮片与创缘,皮片上覆盖一层大孔油纱后,将VSD材料修剪成相应形状覆盖于油纱上,并使该材料超出皮缘约1厘米,将生物半透薄膜封闭并固定整个术区,开放负压 ......
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