生物材料及封闭式负压引流技术修复潜行死腔的大面积皮肤软组织缺损  

Biomaterials and vacuum sealing drainage technique to repair a large area of skin and soft tissue defects with stealth dead space

作　　者：邝炯祥[1] 康国锋[1] 张光明[1] 杨运发[1] 肖学军[1] 

机构地区：[1]广州医学院附属广州市第一人民医院创伤骨科,广东省广州市510180

出　　处：《中国组织工程研究与临床康复》2010年第34期6433-6436,共4页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:大面积皮肤缺损其创面难以修复,深部死腔常合并坏死感染,修复难度大,治疗时间长,费用昂贵。目前临床已开始广泛应用封闭式负压引流技术修复各种创面。目的:评价生物材料及封闭式负压引流技术在合并潜行死腔的大面积皮肤软组织缺损创面中的应用价值。方法:选择广州医学院附属广州市第一人民医院创伤外科2007-01/2008-12收治的合并潜行死腔的大面积皮肤软组织缺损患者32例,全部实施封闭式负压引流术修复创面,封闭式负压引流负压引流材料为高分子泡沫材料制成,负压值维持在20～60kPa,一次负压密封引流可维持有效引流7～14d。观察死腔闭合时间、伤口感染消除时间、新鲜肉芽生长及并发症发生情况。结果与结论:32例患者均获得随访。经平均2周的封闭式负压引流技术治疗后,22例死腔自行封闭,经植皮基本成活。6例合并深层死腔的病例,再次施行封闭式负压引流术后死腔完全封闭。4例皮肤软组织大面积缺损至骨外露并感染的患者多次清创,行临近肌瓣转位修复术修复创面。除1例患者小腿植皮边缘再次感染渗液外,未见骨髓炎发生,创面修复良好;无其他合并症发生,治疗后创面修复率为96.8%,人体与材料之间无组织不相容现象。BACKGROUND：The wounds of large-area skin defect are difficult to repair,deep dead space is often associated with necrosis infection,thus the repair is difficult,the treatment is long and expensive.Vacuum sealing drainage technique has been widely used in clinic to repair all kinds of wounds.OBJECTIVE：To evaluate the application of biomaterials and vacuum sealing drainage technique in a large area of skin and soft tissue defects combined with stealth dead space.METHODS：A total of 32 patients with stealth dead space combined a large area of skin and soft tissue defects,who admitted to Department of Traumatic Orthopaedics,Guangzhou First People＇s Hospital,Guangzhou Medical College from January 2007 to December 2008.They were all treated with vacuum sealing drainage technique to repair the wounds using high polymer foam materials.the negative pressure maintained at 20-60 kPa,and one time of vacuum sealing drainage could effectively drain 7-14 days.The dead space closure time,the time of eliminating wound infection,fresh granulation growth and complications were analyzed.RESULTS AND CONCLUSION：Totally 32 cases were involved in the follow-up.Following average two weeks of vacuum sealing drainage treatment,dead space was closed in 22 cases and basically survived after skin grafting.Six patients accompanied with deep dead space,which was completely closed after the implementation of secondary vacuum sealing drainage.Four cases of large-area skin and soft tissue defects with exposed bone and infection underwent multiple debridement,the wounds were repaired using peripheral muscle flap translocation;except one case was re-infected with skin graft edge effusion,no one case appeared osteomyelitis with good wound healing;no other complications occurred,and postoperative wound healing rate was 96.8%,there was no incompatibility between human body and the materials.

关 键 词：封闭式负压引流 生物材料 皮肤软组织缺损 大面积 潜行死腔 修复 

分 类 号：R318[医药卫生—生物医学工程]