• 四川大學(xué)華西醫(yī)院燒傷整形科（成都，610041）;

【摘要】　目的　 探討封閉負(fù)壓引流（vacuum sealing drainage，VSD）裝置用于全厚皮移植術(shù)后加壓固定對全厚皮片移植成活的影響。　方法　 新西蘭大白兔24只，在脊柱兩側(cè)2個術(shù)區(qū)建立全厚皮片移植模型。每只兔2個術(shù)區(qū)分別采用VSD（A組）、傳統(tǒng)縫合打包加壓包扎（B組），做自身對照。第3、5、7天各隨機(jī)處死8只兔，觀察皮片成活情況，做移植皮片中央及邊緣（指打包固定的縫線處）的外觀質(zhì)量評價（由1名研究者做主觀評價），計(jì)算皮片成活率，并在移植皮片上取材，HE染色處理后，應(yīng)用光學(xué)顯微鏡觀察組織形態(tài)學(xué)特征。采用免疫組織化學(xué)檢測各組創(chuàng)面血管內(nèi)皮生長因子（vascular endothelial growth factor，VEGF）表達(dá)情況。　結(jié)果　 兩組比較，移植皮片邊緣的外觀質(zhì)量評價顯著提高（P lt;0.05），皮片中央差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）；皮片移植成活率差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。HE染色結(jié)果顯示，A組較B組皮片邊緣的細(xì)胞層次清晰、結(jié)構(gòu)完整，皮片中央無差異。免疫組織化學(xué)檢測顯示，A組皮片邊緣VEGF陽性染色部位的累積吸光度值顯著高于B組（P lt;0.05），皮片中央差異無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。　結(jié)論　 VSD用于全厚皮移植術(shù)后加壓固定可提高皮片邊緣的外觀質(zhì)量，促進(jìn)創(chuàng)面修復(fù)和血管生成，可能減輕邊緣瘢痕增生。
【Abstract】　Objective　 To explore the influence of vacuum sealing drainage (VSD) on compression bandage of full-thickness skin grafting.　Methods　 A model of full-thickness skin grafting in 2 operation zones was established in the two sides of spinal column of 24 New Zealand white rabbits. The wounds were deal with by VSD (group A) and conventional suture and compression bandage (group B) randomly. About 3, 5, and 7 days after operation, the assessment of the center and edge area (suture area) of skin grafting was performed by a single observer blinded to the randomization. The survival rate was calculated. Samples were selected from skin grafting and observed under a light microscope after HE staining. The expression of vascular endothelial growth factor (VEGF) was detected by immunohistochemistry method.　Results　 The assessment of the edge area of skin grafting in group A was significantly better than that in group B (P lt;0.05); the difference in the center area was not significant (P gt;0.05). HE staining showed that in the edge area of skin grafting, the cell layer and structure were better in group A than that in group B, the difference in the center area was not significant (P gt;0.05). Immunohistochemistry method showed that in the edge area of skin grafting, integrated optical density of VEGF was significantly higher in group A than in group B (P lt;0.05), it was not significantly in the center area (P gt;0.05).　Conclusions　 VSD utilized on compression bandage of full-thickness skin grafting can significantly improve the qualitative appearance of grafting, promote wound healing and vascularization. VSD may possibly reduce scar hyperplasia.

引用本文： 羅江蓉,劉勇,岑瑛. 負(fù)壓封閉引流裝置用于全厚皮移植術(shù)后加壓固定. 華西醫(yī)學(xué), 2011, 26(10): 1445-1448. doi: 復(fù)制

1. 　李清華, 李霞, 張健, 等. 負(fù)壓引流對全厚皮片移植成活的影響[J]. 中國燒傷創(chuàng)瘍雜志, 2009, 21(4): 310-314.
2. 　孫永華, 田孝臣, 曾丁, 等. 再談封閉負(fù)壓技術(shù)治療急慢性創(chuàng)面有關(guān)的幾個問題[J]. 中華損傷與修復(fù)雜志, 2010, 5(1): 6-8.
3. 　張建超, 沈國良, 趙小瑜, 等. 中厚皮片和真皮下血管網(wǎng)皮瓣聯(lián)合封閉式負(fù)壓引流技術(shù)修復(fù)四肢大面積皮膚撕脫傷[J]. 中國修復(fù)重建外科雜志, 2010, 24(3): 374-375.
4. 　黎曉華, 王惠東, 張長青, 等. 封閉式負(fù)壓引流技術(shù)聯(lián)合皮瓣修復(fù)下肢皮膚軟組織缺損[J]. 中國修復(fù)重建外科雜志, 2010, 24(6): 722-725.
5. 　段軍, 張遠(yuǎn)金. 封閉式負(fù)壓引流技術(shù)應(yīng)用于植皮術(shù)的臨床療效[J]. 中國修復(fù)重建外科雜志, 2011, 25(2): 251-252.
6. 　Moisidis E, Heath T, Boorer C, et al. A prospective, blinded, randomized, controlled clinical trial of topical negative pressure use in skin grafting[J]. Plast Reconstr Surg, 2004, 114(4): 917-922.
7. 　Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation[J]. Ann Plast Surg, 1997, 38(6): 553-562.
8. 　裘華德, 王彥峰, 李漢民. 負(fù)壓封閉引流技術(shù)[M]. 北京: 人民衛(wèi)生出社, 2003: 1-24.
9. 　Blackburn JH, Boemi L, Hall WW, et al. Negative-pressure dressings as a bolster for skin grafts[J]. Ann Plast Surg, 1998, 40(5): 453-457.
10. 　Sposato G, Molea G, Di Caprio G, et al. Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device[J]. Br J Plast Surg, 2001, 54(3): 235-237.
11. 　Molnar JA, De Franzo AJ, Marks MW. Single stage approach to skin grafting the exposed skull[J]. Plast Reconstr Surg, 2000, 105(1): 174-177.
12. 　Scherer LA, Shiver S, Chang M, et al. The vacuum assisted closure device: a method of securing skin grafts and improving graft survival[J]. Arch Surg, 2002, 137(8): 930-933.
13. 　Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience[J]. Ann Plast Surg, 1997, 38(6): 563-576.
  1. 1. 　李清華, 李霞, 張健, 等. 負(fù)壓引流對全厚皮片移植成活的影響[J]. 中國燒傷創(chuàng)瘍雜志, 2009, 21(4): 310-314.
  2. 2. 　孫永華, 田孝臣, 曾丁, 等. 再談封閉負(fù)壓技術(shù)治療急慢性創(chuàng)面有關(guān)的幾個問題[J]. 中華損傷與修復(fù)雜志, 2010, 5(1): 6-8.
  3. 3. 　張建超, 沈國良, 趙小瑜, 等. 中厚皮片和真皮下血管網(wǎng)皮瓣聯(lián)合封閉式負(fù)壓引流技術(shù)修復(fù)四肢大面積皮膚撕脫傷[J]. 中國修復(fù)重建外科雜志, 2010, 24(3): 374-375.
  4. 4. 　黎曉華, 王惠東, 張長青, 等. 封閉式負(fù)壓引流技術(shù)聯(lián)合皮瓣修復(fù)下肢皮膚軟組織缺損[J]. 中國修復(fù)重建外科雜志, 2010, 24(6): 722-725.
  5. 5. 　段軍, 張遠(yuǎn)金. 封閉式負(fù)壓引流技術(shù)應(yīng)用于植皮術(shù)的臨床療效[J]. 中國修復(fù)重建外科雜志, 2011, 25(2): 251-252.
  6. 6. 　Moisidis E, Heath T, Boorer C, et al. A prospective, blinded, randomized, controlled clinical trial of topical negative pressure use in skin grafting[J]. Plast Reconstr Surg, 2004, 114(4): 917-922.
  7. 7. 　Morykwas MJ, Argenta LC, Shelton-Brown EI, et al. Vacuum-assisted closure: a new method for wound control and treatment: animal studies and basic foundation[J]. Ann Plast Surg, 1997, 38(6): 553-562.
  8. 8. 　裘華德, 王彥峰, 李漢民. 負(fù)壓封閉引流技術(shù)[M]. 北京: 人民衛(wèi)生出社, 2003: 1-24.
  9. 9. 　Blackburn JH, Boemi L, Hall WW, et al. Negative-pressure dressings as a bolster for skin grafts[J]. Ann Plast Surg, 1998, 40(5): 453-457.
  10. 10. 　Sposato G, Molea G, Di Caprio G, et al. Ambulant vacuum-assisted closure of skin-graft dressing in the lower limbs using a portable mini-VAC device[J]. Br J Plast Surg, 2001, 54(3): 235-237.
  11. 11. 　Molnar JA, De Franzo AJ, Marks MW. Single stage approach to skin grafting the exposed skull[J]. Plast Reconstr Surg, 2000, 105(1): 174-177.
  12. 12. 　Scherer LA, Shiver S, Chang M, et al. The vacuum assisted closure device: a method of securing skin grafts and improving graft survival[J]. Arch Surg, 2002, 137(8): 930-933.
  13. 13. 　Argenta LC, Morykwas MJ. Vacuum-assisted closure: a new method for wound control and treatment: clinical experience[J]. Ann Plast Surg, 1997, 38(6): 563-576.