封闭式负压引流【封闭式负压引流技术应用于Ⅲ度烧伤保留脂肪组织削痂植皮创面的临床研究】

　　[摘要] 目的 观察封闭式负压引流技术（VSD）应用于四肢Ⅲ度烧伤保留健康脂肪组织削痂植皮创面的临床疗效。 方法 选取2008年1月～2011年12月收治的四肢小面积浅Ⅲ度烧伤43例患者行保留脂肪组织削痂植皮应用封闭式负压引流技术治疗（A组）；2003年1月～2007年12月收治的四肢小面积浅Ⅲ度烧伤46例患者行Ⅲ度创面切痂至深筋膜植皮治疗（B组）。观察两组术中失血量、植皮成活率及并发症、创面愈合时间，以及创面愈合后肢体外形、对称性和功能恢复的差异。 结果 A组创面愈合后肢体外观、对称性和功能较好，自身对照上下肢周径，差异无统计学意义（P﹥0.05）。B组创面愈合后肢体明显缩小，左右明显不对称，功能较差，自身对照上下肢周径，差异具有统计学意义（P < 0.05）。两组术中失血量比较，差异无统计学意义（P﹥0.05）。A组与B组比较，皮片成活率高（P < 0.05）、创面愈合时间短（P < 0.05）、创面感染等并发症发生少（P < 0.01）、外形与功能优良满意（P < 0.01）。 结论 VSD技术应用于四肢Ⅲ度烧伤保留健康脂肪组织削痂植皮创面，可有效促进烧伤创面的愈合，缩短疗程，减轻换药痛苦，能更好维护肢体的外观，有助于肢体活动功能的康复。VSD技术是一种较理想的植皮后的固定方法，值得临床推广应用。[关键词] Ⅲ度烧伤；封闭式负压引流；削痂术；皮肤移植；脂肪组织
　　[中图分类号] R644 [文献标识码] A [文章编号] 1673-7210（2012）08（b）-0035-03
　　Clinical research on treatment of tangential excision for full thickness burns with adipose tissue reserved by vacuum sealing drainage
　　ZHANG Zheng ZHANG Rumin
　　Department of Plastic and Cosmetic Surgery, the Central Hospital of Zibo City, Shandong Province, Zibo 255036, China
　　[Abstract] Objective To study on the clinical efficacy of treatment of tangential excision for full thickness burns of limbs with adipose tissue reserved by vacuum sealing drainage and auto-skin grafting． Methods 43 burn patients collected from January 2008 to December 2011 with superficial full thickness burn of limbs were grouped for A, which were treated by vacuum sealing drainage combined with tangential excision with adipose tissue reserved and auto-skin grafting. 46 burn patients collected from January 2003 to December 2007 with superficial full thickness burn of limbs were grouped for B to contrast, which were treated by tangential excision with deep fascia reserved and auto-skin grafting. Therapeutic efficacy between the two groups were compared with the intra-operative blood loss, the survival rate and complications of the skin graft, the healing time of wounds, the figure and function of healed limbs. Results The profile, the symmetry, the function of the limbs of group A were obviously better than that group B; the upper limb and lower limb compared with own of group A, there was no statistical significance (P﹥0.05). However the upper limb and lower limb compared with own of group B, the difference was statically significant (P﹤0.05). Between the two groups in intra-operative blood loss was not noticeable (P﹥0.05).While between the two groups in survival rate of the skin graft and the healing time there was significant difference (P < 0.05), and so was there in the complications, the figure and functions of healed limbs (P < 0.01). Conclusion The vacuum sealing drainage technology combined with tangential excision with adipose tissue reserved and auto-skin grafting can efficiently heal the wound, short the therapeutic time, alleviate the pain, preserve the figure and conduce to the recovery of the limbs function. The VSD (vacuum sealing drainage) technique is an ideal anchored method which is deserved to get a widely clinical use.