负压封闭引流术联合皮肤牵张术治疗外科手术后慢性创面的疗效观察  

Therapeutic effect of negative pressure wound therapy combined with skin stretching on postoperative chronic wounds

作　　者：刘迪 张浩[2] 潘振宇[2] 周敏[2] 喻爱喜[2] 漆白文[2] LIU Di;ZHANG Hao;PAN Zhenyu;ZHOU Min;YU Aixi;QI Baiwen(Interventional Diagnostic and Therapeutic Center,Zhongnan Hospital of Wuhan University,Wuhan,Hubei 43007l,China;Department of Trauma and Microorthopedics,Zhongnan Hospital of Wuhan University,Wuhan,Hubei 430071,China)

机构地区：[1]武汉大学中南医院介入诊疗中心,湖北武汉430071 [2]武汉大学中南医院创伤与显微骨科,湖北武汉430071

出　　处：《中华实用诊断与治疗杂志》2023年第11期1148-1151,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：湖北省自然科学基金面上项目(2020CFB662)。

摘　　要：目的观察负压封闭引流术联合皮肤牵张术治疗合并感染的术后慢性创面愈合情况,探讨其疗效。方法2019年7月—2021年10月武汉大学中南医院诊治外科术后合并感染的慢性创面患者24例,主要表现为软组织缺损、窦道形成、慢性滑囊炎大量渗液。彻底清除滑囊和死腔,缝合创面为圆形或椭圆形规则缺损创面后沿创面长轴于两侧切口边缘穿入2枚克氏针,克氏针上安置皮肤牵张器牵拉切口皮肤,创面空腔内放置引流管,负压泡沫敷料覆盖创面缺损部位,引流管接负压吸引后贴半透膜,设置负压80~100mmHg。治疗5~7d更换负压泡沫敷料时根据创面愈合及感染情况再次清创后移除负压引流,继续皮肤牵张器牵拉切口皮肤常规换药至创面切口闭合,拆除牵张器缝合创面。治疗同期根据创面分泌物细菌培养结果静脉滴注敏感抗生素。记录治疗后创面感染控制、肉芽组织生长、创缘张力下降、创面直接闭合、伤口愈合情况等。结果治疗7d,24例患者创面感染均明显控制,肉芽组织生长良好,创缘张力下降。治疗14d,20例患者创面愈合,伤口闭合良好,渗液消失,另4例患者创面新鲜肉芽呈鲜红色颗粒状,创缘张力显著下降,创面面积缩小,经换药和持续皮肤牵张治疗,创面于治疗16~23d后愈合。24例患者创面愈合时间为(16.4±3.5)d。结论负压封闭引流术联合皮肤牵张术治疗外科术后合并感染的慢性创面可彻底清除创面滑囊和死腔,有效控制感染,降低创面张力,促进创面闭合。Objective To observe the healing of postoperative chronic infected wounds after negative pressure combined with skin stretching,and to investigate its therapeutic effect.Methods Twenty-four patients with postoperative chronic infected wounds were treated in Zhongnan Hospital of Wuhan University from July 2019 to October 2021.The main manifestations included soft tissue defects,fistula formation,and chronic synovitis with massive exudate.After thorough debridement of the synovial bursa and dead space,the wound was closed with circular or elliptical regular defects.Two Kirschner wires were inserted on either side of the wound along the long axis,and a skin stretching device was placed on the Kirschner wires to stretch the skin of the wound.A drainage tube was placed inside the wound cavity,and negative pressure foam dressings were used to cover the wound defect area.A semi-permeable film was sticked after connecting negative pressure to the drainage tube,with a negative pressure setting of 80-100 mmHg.The negative pressure foam dressings were changed every 5 to 7 d.The removal of negative pressure drainage was performed based on wound healing and infection conditions after re-debridement.Skin stretching and routine dressing changes were continued until wound closure,and the skin stretching device was removed,followed by wound closure.During the treatment,sensitive antibiotics were administered intravenously based on bacterial culture results of wound secretions.Records were kept on wound infection control,granulation tissue growth,reduction of wound edge tension,direct wound closure,and wound healing progress.Results After 7-d treatment,the infection of all wounds was obviously controlled in 24 patients,the granulation tissue grew well,and the tension of wound edge decreased.After 14-d treatment,the wounds were directly closed,the wounds healed well,and the exudate disappeared in 20 patients,while the fresh granulation of the other 4patients showed bright red granules,the tension of the wound edge decreased signifi

关 键 词：外科手术后慢性创面 负压封闭引流术 皮肤牵张术 滑囊炎 

分 类 号：R61[医药卫生—外科学]