【作者】 詹祖锋；

【导师】 曲巍；

【作者基本信息】 大连医科大学 ， 骨外科学， 2010， 硕士

【摘要】 目的：1通过观察利用负压封闭引流技术治疗复杂创伤性下肢皮肤软组织缺损所形成的陈旧性创面,报道负压封闭引流技术在骨外科应用的临床效果。2分析负压封闭引流的优缺点。3探讨负压封闭引流技术的手术要点及注意事项。方法：1病例选择方法：1.1选择标准：1.1.1病例应在负压封闭引流技术之前,外伤后6-8小时内进行了急诊清创或者骨折固定手术,因Ⅰ期难以闭合或者Ⅰ期闭合术后下肢体皮肤软组织坏死所形成的创面。1.1.2创面的大小至少在5cm×5cm以上,从性价比考虑较小的创面即使无法Ⅰ期闭合,不宜使用在负压封闭引流技术。1.2病例资料：观察下肢皮肤软组织外伤后缺损形成慢性陈旧性创面的患者共9例,其中男7例,女2例,年龄在17-62岁之间。致伤原因：车祸伤6例,重物砸伤1例,烫伤1例,坠落伤1例。2、负压封闭引流的材料：负压封闭引流材料包括医用泡沫材料、多侧孔引流管、透性粘贴薄膜、负压引流瓶。设计原理[4]用医用泡沫材料包裹多侧孔引流管,医用泡沫置于被引流区,再利用透性粘贴薄膜封闭被引流区便与外界隔绝,引流管接高负压源,形成了一个高效引流系统。3、手术方法：对创面进行清创、止血,根据创面大小裁剪、拼接泡沫敷料,用泡沫敷料覆盖、填充整个创面,再用半透膜“叠瓦法”逐层逐片粘贴封用泡沫敷料覆盖、填充整个创面,再用半透膜“叠瓦法”逐层逐片粘贴封闭整个创面,硅胶管与负压吸引装置连接。术后根据引流管通畅情况决定是否冲管或者跟换负压引流装置。结果：去除负压引流装置后创面局部观察项目：①创面干燥、清洁、无坏死组织及渗液;②创面水肿消退；③创面肉芽组织新鲜,呈粉红色颗粒状,触之易出血；④创面能保证植皮或皮瓣转位成功。患者全身是否发热,疼痛能否耐受等情况。负压引流治疗后9例创面均不同程度的缩小,其肉芽组织新鲜,表面平坦,毛细血管丰富,组织无水肿、渗出,无死腔残留,感染均得以控制。但骨外露、肌腱外露处肉芽组织生长较少。2例因创面分泌物多更换负压引流材料,其中1例患术后引流管堵塞出现全身发热,3例创面较大的患者出现引流管堵塞,其中一例冲洗后不通畅,更换负压引流敷料。结论：负压封闭引流技术是一种新的处理陈旧性创面的方法,该技术操作简便,易于掌握,疗效明显。改变了传统创而治疗中频繁更换敷料的换药方法,减少了换药给患者带来的痛苦,有效地预防和限制感染的扩散、减轻局部水肿、改善局部血运、促进创面肉芽组织生长,对于有肌腱外露、骨外露的创面,负压封闭引流技术还能促进新鲜肉芽组织从周边部分覆盖,促进创面的修复,使创面缩小,给Ⅱ期手术植皮或者皮瓣转移带来便利。更多还原

【Abstract】 Objective:1 Report the clinical effects of treatment the complicated skin and soft tissue of traumatic lower limb defects with vacuum sealing drainage.2 Analyze advantages and disadvantages of vacuum sealing drainage.3 To investigate the points and notes for vacuum sealing drainage.Methods:1.1 Case Selection:1.1.1 Selection criteria:Before the vacuum sealing drainage,within 6-8 hours after injury the cases treatment by the emergency debridement surgery or fracture fixation operation.The formation of lower extremity wounds is due to the skin and soft tissue necrosis after emergency surgery or that it is difficult to suture the wound during the emergency surgery.1.1.2 Wounds should be at least 5cm×5cm.From cost considerations, even if can not be closed during the emergency surgery the wound should not be too small to use the vacuum sealing drainage.1.2 Case Information:Choose skin and soft tissue defect of lower limb 9 patients,in January 2009 to January 2010 period by Taihe Hospital of Shiyan City in Hubei province.Include 7 males and 2 females,aged 17-62 years old.Injury reas-ons:traffic accident in 6 cases,1 case bruise, burn in 1 case,1 case of crash injury.Vacuum sealing drainage materials:including medical foam materials, multiside hole drainage, semipermeable membrane of paste,vacuum suction source.Design principles with the medical side of the foam wrap and more drainage holes, medical foam was placed in drainage area, and then paste the permeability of thin films using closed drainage area will be isolated, then the high negative pressure drainage tube source, forming a efficient drainage system. Surgical Methods:After debridement the wound and stop bleeding, foam dressing was cut and stitched according to wound size.The wound was covered with dressing, then closed the wound with semipermeable membrane, the material silicone tube with suction device is connected. Depending on whether drainage tube patency take appropriate measures, if necessary, replace the dressing.Results:Observation of the wound after dressing removal project:①wound dry, clean, non-necrotic tissue and exudate;②wound edema;③fresh granulation tissue, pink granular, easy to touch the bleeding;④wounds can be skin graft or flap transposition successfully.It should also pay attention to whether the fever, pain tolerance, et.After treatment by vacuum sealing drainage,9 cases were different degrees of reduced wound, granulation tissue was fresh with flat surface, capillary rich, tissue had no edema or exudate,infection was controlled. Less granulation tissue growth in bone exposure,the exposed tendon department.2 cases replaced dressing as more wound secretion,1 case of drain plug results in systemic fever.3 cases of wound drainage in patients larger the block, one case of smooth even after washing,dressing changeConclusion:Vacuum sealing drainage is a new method of wound treatment.The technology is simple, easy to master and curative effect. Improve the treatment of frequent replacement of the traditional wound dressings ways.Reduce the pain of patients by dressing.Dressing to reduce the pain of patients,prevent and limit the spread of infection,reduce local edema, improve local blood circulation and promotes the growth of granulation tissue.For those exposed and bone exposed wounds,vacuum sealing drainage also promote granulation tissue from the peripheral part of the coverage, promoting wound repair, so that the wounds became narrow bring convenience to the late skin graft or flap transposition.更多还原