【摘要】 目的 探讨大面积手部皮肤脱套伤并缺损的修复方式。 方法 2005年6月－2010年1月，应用腹部皮瓣包埋和游离中厚皮片植皮结合负压封闭引流（vacuum sealing drainage，VSD）技术治疗手部大面积皮肤脱套伤合并缺损12例，其中男8例，女4例；年龄21~56岁，平均34岁。机器绞伤9例，车祸伤3例。所有损伤均合并肌腱、关节或骨质外露；软组织缺损范围为9 cm×8 cm~25 cm×18 cm。受伤至手术时间4~17 h，平均6.5 h。手掌及手指缺损部位采用腹部带蒂皮瓣包埋；手掌及手指以外肌肉、筋膜完好的部位采用大腿游离中厚皮片植皮，再于植皮表面覆盖VSD敷料，接负压行持续吸引；所有患者均二期断蒂并进行分指或皮瓣成形手术。 结果 术后2例手指部分皮瓣或植皮坏死，2例小部分皮瓣及植皮边缘坏死，经单纯换药后逐渐愈合，1例缺损较大、较深，先行换药，待创面肉芽新鲜后行二期植皮手术，愈合良好 。其余皮瓣及植皮均成活，创面Ⅰ期愈合；供区植皮均成活，切口均Ⅰ期愈合。12例均获6~42个月随访，2例手指末节软组织缺损严重、血运差，术后7~10 d末节坏死后短缩；3例掌侧皮瓣移植后较臃肿；其余外观均较满意。所有患者创面愈合后1个月内深、浅感觉功能均稍差，3~6个月逐渐恢复，但手指精细感觉恢复差，两点辨别觉为6~13 mm，平均9.5 mm。所有患手平均掌指关节主动活动50°，指间关节20°。 结论 腹部皮瓣包埋和游离中厚皮片植皮结合VSD技术能较好地修复手部大面积皮肤脱套伤并缺损，是一种实用、安全且简便的手术方法。【Abstract】 Objective To investigate the ideal repair method for large-area hand avulsed wound and soft tissue defects. Methods From June 2005 to January 2010, 12 patients with large-area hand avulsed wound and soft tissue defects were repaired with abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique. The patients included 8 males and 4 females with their age ranged from 21 to 56 years averaging at 34 years. The causes of injury were machine twist injury in 9 cases and road accident injury in 3 cases. All the injuries combined with exposure of tendon, joint or bone. The area of defects ranged from 8 cm×9 cm to 18 cm×25 cm. The time between injury and operation was 4 to 17 hours averaging at 6.5 hours. The palm of hand and fingers were repaired by abdominal pedicle skin flaps, and the dorsum of hand and wrist were repaired by skin grafting combined with vacuum sealing drainage. About 3 weeks later, all pedicles of the abdominal flaps were cut off and flaps plasty were carried out. Results All patients were followed up from 6 to 42 months with an average period of 17 months. All of the flaps and skin grafts survived. Only 6 patients had distal edge partial necrosis, and all of them healed after a short time of dressing changes or second-stage skin grafting. All skin grafts of the donor sites survived and all the wounds healed by first intention. All the injured hands recovered well to their original shape and function except partial bad skin sensation. The sense of two-point discrimination was from 6 mm to 13 mm with an average distance of 9.5 mm. The active motion of metacarpophalangeal joints averaged at 60°, and the interphalangeal articulations averaged at 30°. Conclusion Abdominal skin flaps and skin grafting combined with vacuum sealing drainage technique can be used to repair large-area hand avulsed wound and soft tissue defects, and it is practical, safe and simple.
【摘要】 目的 探讨负压引流技术对不同部位、不同类型创面的方法和效果。 方法 回顾性分析2009年5月-2010年12月采用负压引流技术治疗85例创面的临床资料。其中男51例，女34例；年龄4~75岁，平均年龄48岁。 结果 79例创面行1次负压治疗后、6例创面连续行2次负压治疗后情况明显改善，二期行游离皮片移植术或皮瓣转移术修复创面，术后创面均Ⅰ期愈合，皮片或皮瓣存活良好。 结论 负压吸引治疗技术简便有效，可靠安全，能加速清除不同部位、不同类型创面的坏死组织，改善创面条件，缩短创面治疗时间。【Abstract】 Objective To explore the effects of negative pressure treatment on wound of different types at different parts. Methods The clinical data of 85 patients (51 males and 34 females; 4-75 years old) with wound who received negative pressure treatment between May 2009 and December 2010 were retrospectively analyzed. Results After receiving negative pressure treatment for once in 79 patients and twice in 6, the wound improved obviously. All cases received regular methods such as skin grafting or tissue flap transferring to reconstruct the wound. All of the 85 patients healed by first intention and the skin grafts or flaps survived well. Conclusion Negative pressure treatment is a simple, effective, stable and safe method for wound treatment, which can accelerate eliminating necrotic tissue of wound of different types at different parts, improve the wound condition and shorten the period of therapy.
ObjectiveTo discuss nursing measures and experiences for children with extensive skin avulsion injury of lower limbs treated by vacuum sealing drainage (VSD). MethodsWe reviewed the perioperative nursing data of 48 child patients with extensive skin avulsion injury in lower limbs who underwent VSD treatment between December 2010 to October 2012. And the data were compared with those for 56 children with the same disease and treatment between January 2007 and November 2010. ResultsIn these 48 children, 19 received once, 23 received twice, and 6 received 3 times of vacuum sealing drainage. During the treatment, 5 drainage tubes were blocked and were solved with normal saline, and 3 drainage tubes had leakage and two of them were reconnected and the other one became normal after changing the dressing. For VSD, the time between being wounded and skin-grafting was 13.6 days, and the average hospitalization time was 24.3 days. Compared with the traditional method group, children in the VSD group had fewer drug changes during hospitalization, lower infection rate, and shorter hospitalization stay, and the differences were significant (P<0.05). ConclusionKeeping drainage tube airtight, normal and effective is as important as nutrition and mental nursing in the treatment of children's extensive skin avulsion injury in lower limbs, which can decrease infection rate, reduce average hospitalization time, and increase operative efficacy.
ObjectiveTo explore the leakage management and skin care by improved homemade portable vacuum sealing drainage device used for enterocutaneous fistula, in order to solve such confusing problems as leakage collection and nursing for patients with inconvenient activity. MethodsThe homemade portable vacuum sealing drainage device was made by using hydrophilic fiber of silver ion antimicrobial dressings, leak-proof strings, skin protective film, transparent patches, sputum suction tube, bottle of portable infusion, and negative pressure drainage bottle. Between January 2011 and September 2013, patients with enterocutaneous fistula admitted into our hospital were divided into traditional treatment group and portable vacuum sealing treatment group according to the admission time, and traditional center negative pressure suction treatment and portable negative pressure drainage method were used respectively for the two groups of patients. We verified the effect of the mobile vacuum sealing drainage device through comparing these two groups in terms of wound healing time, redness, burst and impregnation of the skin. ResultsThe wound healing time was significantly shorter for patients in the portable vacuum sealing drainage treatment group (P<0.05), and patients in this group also had a lower occurrence of skin redness, impregnation and burst. ConclusionHomemade portable negative pressure drainage device for enterocutaneous fistula patients can reduce the incidence of skin complications such as redness, impregnation and burst, promote patients' activity, and reduce the patients' pain.
Objective To observe the clinical effect of vacuum sealing drainage (VSD) in the treatment of mesh infection following inguinal hernia repair. Methods A total of 24 patients who suffered form mesh infection following inguinal hernia repair and got treatment in our hospital from February 2012 to December 2015 were collected and divided into 2 groups according to the type of treatment, 12 patients (13 sides) of VSD group received treatment of VSD, and 12 patients (13 sides) of conventional group received conventional treatment. Comparison between the 2 groups in mesh retention rate, the wound healing time, hospitalization cost, and hospital stay was performed. Results There was significant difference in mesh retention rate〔76.9% (10/13)vs. 30.8% (4/13)〕, the wound healing time〔(20.5±4.4) dvs. (29.7± 6.7) d〕, hospitalization cost〔(18 430.1±7 180.2) RMBvs. (12 201.1±6 453.2) RMB〕, and hospital stay〔(23.5±4.1) dvs. (30.7±6.5) d〕between the VSD group and conventional group (P<0.050). Compared with conventional group, the mesh retention rate and hospitalization cost were higher, the wound healing time and hospital stay were shorter in VSD group. Conclusions VSD can effectively control the mesh infection following hernia repair, improve the mesh retention rate. The VSD can also promote growth of granulation tissue in cavity, shorten the wound healing time and hospital stay, but has a high hospitalization cost than conventional treatment.
Objective To evaluate the clinical effect of vacuum sealing drainage (VSD) technology in the treatment of high perianal abscess. Methods A total of 38 cases of high perianal abscess who underwent surgery in our hospital from May. 2014 to Feb. 2016 were randomly divided into 2 groups: the VSD group (n=19) and the control group (n=19). The cases of VSD group were performed with closure of internal orifice+VSD technique, and the cases of control group were treated with radical operation of perianal abscess (low incision combined with high thread operation). The following indexes of cases in 2 groups were compared and analyzed, including postoperative pain score, wound healing time, postoperative anal function score, and prognosis. Results There were significant differences in pain score (3.53±0.70vs. 5.11±0.74), postoperative anal function score (0vs. 1), and wound healing time〔(27.58±4.95) dvs. (44.68±6.53) d〕between VSD group and control group,P<0.05. Compared with the control group, the pain score and anal function score of the VSD group were both lower, and the wound healing time was shorter. However, there was no statistically significant difference in incidence of fistula between the two groups〔5.3% (1/19)vs. 15.8% (3/19),P=0.60〕. Conclusion In the treatment of high perianal abscess, VSD technology can relieve pain in patients, shorten the wound healing time, protect the anal function, and the prognosis is as well as low incision combined with high thread operation, so VSD is a better treatment method for high perianal abscess.