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目的总结封闭式负压引流(VAC)技术治疗各种创面的效果,进一探讨该技术的适应证与禁忌证。方法 2004年1月至2015年8月,笔者应用VAC治疗各种创面357例,其中创伤后皮肤软组织缺损113例、糖尿病溃疡和足趾坏疽74例,骨髓炎创面14例、术后伤口愈合不良22例、压力性溃疡37例、跟腱术后外露18例、窦道11例、Ⅲ度烧伤伴脓肿和慢性溃疡形成15例,Ⅲ度电击伤8例、供皮区5例、血管渗漏组织坏死2例、贯通伤1例,植皮区12例,下肢静脉性溃疡7例,骨筋膜室综合征5例,热压伤5例,痛风性溃疡2例,外周动脉性溃疡5例,不明原因慢性溃疡1例。积极全身支持治疗,及时手术扩创,行VAC治疗,术后3~7 d更换负压装置。结果经过VAC治疗后,植皮区皮片全部存活;余创面中,除供皮区、动脉疾病性溃疡外,其他创面肉芽组织生长迅速,全部或部分覆盖深部组织,创面缩小。自行愈合6例,直接扩创缝合34例,自体皮片移植修复167例,皮瓣修复128例,人工真皮联合自体皮片复合移植修复19例,3例创面缩小后改传统换药治疗。患者随访6个月~3年,除3例糖尿病治愈患者同部位再次出现创面外,其他无复发,3例仍有残余创面,总治愈率为98.3%。结论 VAC适应证较广,对多数复杂难愈创面有显著效果,能明显缩短疗程,提高治愈率,但供皮区等创面效果不佳。
Objective To summarize the effect of closed negative pressure drainage (VAC) technique on various wounds and to explore the indications and contraindications of this technique. Methods From January 2004 to August 2015, the author applied VAC to treat 357 cases of various wounds, including 113 cases of skin and soft tissue defects after wounding, 74 cases of diabetic ulcer and toe gangrene, 14 cases of osteomyelitis wounds, and poor postoperative wound healing 22 cases, pressure ulcer in 37 cases, Achilles tendon exposure in 18 cases, sinus in 11 cases, Ⅲ degree burns with abscess and chronic ulcer in 15 cases, Ⅲ degree electric shock in 8 cases, donor area in 5 cases, vascular leakage 2 cases of tissue necrosis, 1 case of penetrating injury, skin graft in 12 cases, venous leg ulcer in 7 cases, osteofascial compartment syndrome in 5 cases, hot crushing in 5 cases, gout ulcer in 2 cases, peripheral arterial ulcer in 5 cases, One case of chronic ulcer of unknown cause. Positive body supportive treatment, timely surgical expansion, line VAC treatment, 3 to 7 days after the replacement of negative pressure device. Results After VAC treatment, skin grafts all survived. Except wound donor area and arterial ulcer, wound granulation tissue grew rapidly and all or part of the wound surface covered the deep wounds. Six cases were cured by themselves, 34 cases were directly expanded and sutured, 167 cases were repaired with autologous skin grafts, 128 cases were repaired with skin flap, 19 cases were repaired with artificial dermis combined with autologous skin graft, and 3 cases were treated with traditional dressing change after the wound was reduced. The patients were followed up for 6 months to 3 years. Except for the wounds reappeared in the same site in 3 patients with diabetes mellitus, no recurrence was found in 3 cases, and residual wounds were found in 3 cases. The total cure rate was 98.3%. Conclusion The VAC has a wide range of indications, which has a significant effect on most complex and refractory wounds. It can significantly shorten the course of treatment and improve the cure rate. However, the wounds such as donor area are not effective.