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目的:总结负压封闭引流技术(VSD)在四肢难治性创面治疗中的应用效果。方法:应用负压封闭引流技术(VSD)25例患者中手背、手掌、大腿皮肤撕脱伤3例,足背皮肤撕脱伤5例,慢性胫骨骨髓炎术后皮瓣坏死并骨外露3例,糖尿病足合并感染致皮肤坏死5例,合并慢性骨髓炎3例。胸腰椎骨折截瘫合并褥疮7例均先行去,清创然后应用负压封闭引流技术VSD。5-7天后,如果引流量仍然较多或引流管堵塞,则更换引流装置,VSD应用次数为1-3次。如果引流量小、创面炎症消退、体温正常、血常规、C反应蛋白和ESR等均恢复到正常水平,则再次手术清创封闭创面。结果:本组25例患者的皮肤创面缺损,经过彻底清创后应用负压封闭引流技术(VSD)5-7天后,发现创面水肿减轻,肉芽组织生长良好,血运丰富,直接缝合7例,植皮15例,随访1-2年无复发,无疼痛,感染有效控制。结论:负压封闭引流技术(VSD)改变了传统创面治疗中长期换药方法,免除患者在换药的疼痛痛苦,有效地控制感染,改善局部血运,减轻局部组织水肿,促进创面肉芽组织生长,有利于创面的修复。因此负压封闭引流技术(VSD)在四肢各类难治性创面皮肤缺损中的应用方法简单,缩短处理创面时间,减少并发症,有推广应用价值.
Objective: To summarize the application effect of negative pressure closed drainage (VSD) in the treatment of refractory wounds in the extremities. Methods: In the 25 cases of negative pressure closed drainage (VSD), avulsion of the back of the hand, palms and thighs in 3 cases, avulsion of the dorsum of the foot in 5 cases, flap necrosis of the tibia osteomyelitis in 3 cases , 5 cases of skin necrosis caused by diabetic foot infection and 3 cases of chronic osteomyelitis. Thoracolumbar fractures with paraplegia combined with bedsore in 7 cases go first, debridement and then use negative pressure closed drainage technology VSD. After 5-7 days, if the drainage volume is still high or the drainage tube is clogged, replace the drainage device, VSD applications for 1-3 times. If the drainage is small, the wound subsided inflammation, normal body temperature, blood, C-reactive protein and ESR were returned to normal levels, the reoperation debridement wounds closed. Results: The wounds of the 25 patients were found to have defects on the wound surface. After complete debridement, VSD was applied for 5-7 days. The edema on the wound surface was relieved, the granulation tissue grew well, blood vessels were abundant, and 7 cases were directly sutured. 15 cases of skin grafting, follow-up 1-2 years without recurrence, no pain, effective infection control. Conclusion: VSD can change the traditional wound dressing method in the medium and long term. It can relieve the patient pain during dressing change, effectively control the infection, improve the local blood circulation, reduce the local tissue edema, and promote the growth of wound granulation tissue , Is conducive to the repair of the wound. Therefore, negative pressure closed drainage technology (VSD) in the treatment of various types of refractory wound skin defects in the limbs is simple, shorten the treatment of wound time, reduce complications, and promote the use of value.