• 中南大學(xué)湘雅醫(yī)院骨科（長(zhǎng)沙，410008）;

目的 對(duì)比觀察封閉式負(fù)壓引流技術(shù)（vacuum sealing drainage，VSD）聯(lián)合反取皮和直接反取皮治療開放性創(chuàng)傷截肢創(chuàng)面的療效。 方法 2005 年3 月－ 2010 年6 月，應(yīng)用隨機(jī)單盲法對(duì)收治的60 例四肢開放性骨折截肢患者分別采用一期VSD 聯(lián)合反取中厚皮片植皮（試驗(yàn)組，30 例）與一期單純反取中厚皮片植皮覆蓋截肢創(chuàng)面（對(duì)照組，30例）治療。兩組患者性別、年齡、致傷原因、截肢部位、皮膚缺損面積、術(shù)前白蛋白指數(shù)及受傷至就診時(shí)間等一般資料比較差異均無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。試驗(yàn)組截肢后剪除多余殘肢皮膚應(yīng)用皮鼓取皮制成中厚交錯(cuò)篩網(wǎng)狀皮片，植于截肢創(chuàng)面，表面用VSD 覆蓋，24 h 不間斷吸引持續(xù)7 ～ 10 d；對(duì)照組截肢后直接行反取中厚皮片覆蓋創(chuàng)面，術(shù)后常規(guī)換藥。 結(jié)果 試驗(yàn)組患者于術(shù)后平均8 d 去除VSD 裝置。試驗(yàn)組皮片存活率（90.0%）、創(chuàng)面感染率（3.3%）及再截肢率（0）、換藥次數(shù)[（2.0 ± 0.5）次]、住院時(shí)間[（12.0 ± 2.6）d]，均顯著優(yōu)于對(duì)照組[ 分別為63.3%、20.0%、13.3%、（8.0 ± 1.5）次、（18.0 ± 3.2）d]，比較差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。兩組患者均獲隨訪，隨訪時(shí)間1 ～ 3 年，平均2 年。末次隨訪時(shí)，試驗(yàn)組瘢痕面積、瘢痕分級(jí)及創(chuàng)面兩點(diǎn)辨別覺(jué)均優(yōu)于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。兩組患者殘肢均未見明顯腫脹；術(shù)后試驗(yàn)組患肢疼痛發(fā)生率、殘肢長(zhǎng)度均優(yōu)于對(duì)照組（P  lt; 0.05），而患肢殘端形狀比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。兩組殘肢與健側(cè)相比較，均存在肌肉廢用性萎縮、肌力下降，各組健側(cè)與患側(cè)肌力比較差異均有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05），但兩組患側(cè)間比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P  gt; 0.05）。 結(jié)論 與單純反取中厚皮片比較，VSD 聯(lián)合反取中厚皮片能夠一期關(guān)閉截肢創(chuàng)面并對(duì)創(chuàng)面進(jìn)行引流，降低感染發(fā)生，促進(jìn)皮片與創(chuàng)面良好貼附，提高了皮片存活率，降低了截肢平面，利于假肢佩戴，是一期處理截肢創(chuàng)面的理想方法之一。

引用本文： 廖前德,許鑒,翁曉軍,鐘達(dá),劉志勤,王成功. 封閉式負(fù)壓引流聯(lián)合反植皮一期閉合開放性創(chuàng)傷截肢創(chuàng)面的臨床分析. 中國(guó)修復(fù)重建外科雜志, 2012, 26(5): 558-562. doi: 復(fù)制

1. Braakenburg A, Obdeijn MC, Feitz R, et al. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg, 2006, 118(2): 390-397.
2. Gregory RT, Gould RJ, Peclet M, et al. The mangled extremity syndrome (M. E. S.): a severity grading system for multisystem injury of the extremity. J Trauma, 1985, 25(12): 1147-1150.
3. 陳曉棟. 一種新的瘢痕疙瘩臨床分級(jí)標(biāo)準(zhǔn). 中華醫(yī)學(xué)會(huì)第14次全國(guó)皮膚性病學(xué)術(shù)年會(huì)論文匯編, 2008.
4. 王少新, 李彬, 陳建超, 等. 胸大肌肌皮瓣與中厚皮片修復(fù)頸部咽瘺. 中華整形外科雜志, 2007, 23(1): 10-12.
5. Parrett BM, Matros E, Pribaz JJ, et al. Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plast Reconstr Surg, 2006, 117(4): 1315-1324.
6. Hou Z, Irgit K, Strohecker KA, et al. Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture. J Trauma, 2011, 71(6): 1705-1708.
7. Stansby G, Wealleans V, Wilson L, et al. Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds. J Wound Care, 2010, 19(11): 496, 498-502.
8. Müllner T, Mrkonjic L, Kwasny O, et al. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg, 1997, 50(3): 194-199.
9. Scherer SS, Pietramaggiori G, Mathews JC, et al. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg, 2008, 122(3): 786-797.
10. Vuerstaek JD, Vainas T, Wuite J, et al. State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V. A. C.) with modern wound dressings. J Vasc Surg, 2006, 44(5): 1029-1038.
11. Powell ET 4th. The role of negative pressure wound therapy with reticulated open cell foam in the treatment of war wounds. J Orthop Trauma, 2008, 22(10 Suppl): S138-141.
12. Babiak I, Zakiewicz W, Luterek M. Application of negative-pressure wound therapy in complex therapy of open tibia fractures IIIB and IIIC with massive soft tissue loss. Chir Narzadow Ruchu Ortop Pol, 2011, 76(3): 154-160.
13. Blume PA, Walters J, Payne W, et al. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care, 2008, 31(4): 631-636.
14. Smith N. The benefits of VAC therapy in the management of pressure ulcers. Br J Nurs, 2004, 13(22): 1359-1365.
15. Zuhaili B, Aflaki P, Koyama T, et al. Meshed skin grafts placed upside down can take if desiccation is prevented. Plast Reconstr Surg, 2010, 125(3): 855-865.
16. 張建超, 沈國(guó)良, 趙小瑜等. 網(wǎng)狀中厚皮片移植聯(lián)合負(fù)壓封閉引流修復(fù)皮膚軟組織缺損. 中國(guó)誤診學(xué)雜志, 2009, 9(34): 8317-8319.
17. Dini M, Quercioli F, Mori A, et al. Vacuum-assisted closure, dermal regeneration template and degloved cryopreserved skin as useful tools in subtotal degloving of the lower limb. Injury, 2011. [Epub ahead of print].
18. Goldstein JA, Iorio ML, Brown B, et al. The use of negative pressure wound therapy for random local flaps at the ankle region. J Foot Ankle Surg, 2010, 49(6): 513-516.
19. Argenta LC, Morykwas MJ, Marks MW, et al. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg, 2006, 117(7 Suppl): 127-142.
20. Flack S, Apelqvist J, Keith M, et al. An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers. J Wound Care, 2008, 17(2): 71-78.
21. Kaplan M, Daly D, Stemkowski S. Early intervention of negative pressure wound therapy using Vacuum-Assisted Closure in trauma patients: impact on hospital length of stay and cost. Adv Skin Wound Care, 2009, 22(3): 128-132.
  1. 1. Braakenburg A, Obdeijn MC, Feitz R, et al. The clinical efficacy and cost effectiveness of the vacuum-assisted closure technique in the management of acute and chronic wounds: a randomized controlled trial. Plast Reconstr Surg, 2006, 118(2): 390-397.
  2. 2. Gregory RT, Gould RJ, Peclet M, et al. The mangled extremity syndrome (M. E. S.): a severity grading system for multisystem injury of the extremity. J Trauma, 1985, 25(12): 1147-1150.
  3. 3. 陳曉棟. 一種新的瘢痕疙瘩臨床分級(jí)標(biāo)準(zhǔn). 中華醫(yī)學(xué)會(huì)第14次全國(guó)皮膚性病學(xué)術(shù)年會(huì)論文匯編, 2008.
  4. 4. 王少新, 李彬, 陳建超, 等. 胸大肌肌皮瓣與中厚皮片修復(fù)頸部咽瘺. 中華整形外科雜志, 2007, 23(1): 10-12.
  5. 5. Parrett BM, Matros E, Pribaz JJ, et al. Lower extremity trauma: trends in the management of soft-tissue reconstruction of open tibia-fibula fractures. Plast Reconstr Surg, 2006, 117(4): 1315-1324.
  6. 6. Hou Z, Irgit K, Strohecker KA, et al. Delayed flap reconstruction with vacuum-assisted closure management of the open IIIB tibial fracture. J Trauma, 2011, 71(6): 1705-1708.
  7. 7. Stansby G, Wealleans V, Wilson L, et al. Clinical experience of a new NPWT system in diabetic foot ulcers and post-amputation wounds. J Wound Care, 2010, 19(11): 496, 498-502.
  8. 8. Müllner T, Mrkonjic L, Kwasny O, et al. The use of negative pressure to promote the healing of tissue defects: a clinical trial using the vacuum sealing technique. Br J Plast Surg, 1997, 50(3): 194-199.
  9. 9. Scherer SS, Pietramaggiori G, Mathews JC, et al. The mechanism of action of the vacuum-assisted closure device. Plast Reconstr Surg, 2008, 122(3): 786-797.
  10. 10. Vuerstaek JD, Vainas T, Wuite J, et al. State-of-the-art treatment of chronic leg ulcers: A randomized controlled trial comparing vacuum-assisted closure (V. A. C.) with modern wound dressings. J Vasc Surg, 2006, 44(5): 1029-1038.
  11. 11. Powell ET 4th. The role of negative pressure wound therapy with reticulated open cell foam in the treatment of war wounds. J Orthop Trauma, 2008, 22(10 Suppl): S138-141.
  12. 12. Babiak I, Zakiewicz W, Luterek M. Application of negative-pressure wound therapy in complex therapy of open tibia fractures IIIB and IIIC with massive soft tissue loss. Chir Narzadow Ruchu Ortop Pol, 2011, 76(3): 154-160.
  13. 13. Blume PA, Walters J, Payne W, et al. Comparison of negative pressure wound therapy using vacuum-assisted closure with advanced moist wound therapy in the treatment of diabetic foot ulcers: a multicenter randomized controlled trial. Diabetes Care, 2008, 31(4): 631-636.
  14. 14. Smith N. The benefits of VAC therapy in the management of pressure ulcers. Br J Nurs, 2004, 13(22): 1359-1365.
  15. 15. Zuhaili B, Aflaki P, Koyama T, et al. Meshed skin grafts placed upside down can take if desiccation is prevented. Plast Reconstr Surg, 2010, 125(3): 855-865.
  16. 16. 張建超, 沈國(guó)良, 趙小瑜等. 網(wǎng)狀中厚皮片移植聯(lián)合負(fù)壓封閉引流修復(fù)皮膚軟組織缺損. 中國(guó)誤診學(xué)雜志, 2009, 9(34): 8317-8319.
  17. 17. Dini M, Quercioli F, Mori A, et al. Vacuum-assisted closure, dermal regeneration template and degloved cryopreserved skin as useful tools in subtotal degloving of the lower limb. Injury, 2011. [Epub ahead of print].
  18. 18. Goldstein JA, Iorio ML, Brown B, et al. The use of negative pressure wound therapy for random local flaps at the ankle region. J Foot Ankle Surg, 2010, 49(6): 513-516.
  19. 19. Argenta LC, Morykwas MJ, Marks MW, et al. Vacuum-assisted closure: state of clinic art. Plast Reconstr Surg, 2006, 117(7 Suppl): 127-142.
  20. 20. Flack S, Apelqvist J, Keith M, et al. An economic evaluation of VAC therapy compared with wound dressings in the treatment of diabetic foot ulcers. J Wound Care, 2008, 17(2): 71-78.
  21. 21. Kaplan M, Daly D, Stemkowski S. Early intervention of negative pressure wound therapy using Vacuum-Assisted Closure in trauma patients: impact on hospital length of stay and cost. Adv Skin Wound Care, 2009, 22(3): 128-132.