The Clinical Application Study Of Vacuum-assisted Closure On Chronic Wound

[Objective] To investigate the effects of vacuum-assisted closure for different types of chronic wound treatment and analysis of the factors that affect wound healing time during VAC therapy and observe the influence of vacuum-assisted closure that different wound filler dressing application on the blood vessel formation and cell proliferation, so as to achieve the best effective interventions, to support clinical evidence.[Method]①Research objects:to the nanjing General Hospital of Nanjing Military Command outpatient wound care center clinic of 53 cases of chronic complex wound patients, met inclusion criteria, patients were informed consent and sign informed consent form (see the appendix 1) researchers as the research objects.②Methods:choose outpatient treatment, treatment for 4 hours per day, provisions for 3 weeks. according to "ten-step" operation procedure (see the appendix 2) VAC therapy.53 cases implementation VAC therapy, observe the effects of VAC therapy to the treatment of chronic wounds and influencing factors; another randomized controlled study of 20 cases, used clinical randomized controlled trials, divided the patients into foam group (foam filling) and gauze group (gauze filling), each group has 10 patients,surveyed the effect of 2 international standards dressing on blood vessels of tissue, so as to select the optimum treatment method.③Objectives:The primary objective of this study includes the time of the wound bed granulation tissue growth of 76-100%(assess the wound as a clock, face with the 12 o'clock position in the direction of the patients head, on the contrary direction set to 6 o'clock, connecting two points, do a vertical line horizontal split this line, the wound will be cut into four pieces, each part as 25%),the rate of wound healing (the number of wound healing/total wound×100%),the wound area or volume reduction rate and immunohistochemical staging System based on blood vessel density (CD34+) and cell proliferation (PCNA). During applyied VAC therapy, measured and calculated the rate of wound size (including size, depth, volume) reduction [an area of reduced rate%=(the original wound area-wound area was measured)/original wound area×100%; volume reduced rate%=(the original wound volume-wound volume was measured)/original wound size×100%]. Secondary objective consists of the wound temperature, PH value, Pressure Ulcer Scale for Healing (PUSH). ④Data management and statistical analysis:appointed special persons for the observation record and recorded data to ensure timely, complete, accurate and true. After the instructors review, establish the statistical database under the guidance of established professionals. Using double entry method, conducted of cross-validation trial to found and corrected errors.If in doubt, fill in the question form, amend the date after the researchers affirmed, the data manager has no right to modify the original data. After a unified data auditing, reported the data management process,the general situation and the completion of cases into the research (including loss cases),the items which involved in statistical analysis and the problems that need to discuss and solve (selected/excluded standard inspection, integrity checking, logical consistency checks, outlier checks, et al), confirmed by the instructors and researchers. Using statistical software SPSS18.0 analyze the database. We analysed the distribution of values by variable using a Shapiro-Wilk test. If that did not have normal distributions, we used a non-parametric procedure to compare the baseline values. The Kaplan-Meier estimator was used to determine the median days to 100% closure and 76-100% wound bed granulation over all indications and separately for each indication.A Wilcoxon signed-rank test was conducted to determine whether the median percentage reduction in wound volume, area and depth was significantly different from zero.factors that affect of wound healing time was assessed with a Cox Regression model. Apply infrared thermometer (model CEMDT-8811, No.03000166 Guangdong system) to measure the wound and surrounding skin temperature, measured at the center of the wound as the wound temperature, at 2.5cm from the wound edge, measured at 4 points, take the mean value as the skin temperature;before and after each VAC treatment,using B-wide strips (Shanghai Third Reagent Factory) dipped into the wound exudate, color post card with instructions to compare the value, as the wound exudate pH value); histopathological and immunohistochemical measurement:Patients enrolled in this study were undergoing an approved care pathway, and signed consent before VAC therapy, under the control of pain, before VAC therapy and after 7d,14d,21d, through the sharp debridement,draw a small size of wound tissue in the same wound bed area,formaldehyde fixed, delivered to Pathology timely, choose the formation of blood vessels (CD34+) levels and tissue activity(PCNA) indicators of immunity, comparing the effect of two different wound filling dressing to vascular proliferation.[Results] (1)The observational study of VAC therapy in different types of chronic wounds showed that:ulcerative wounds group,dehisced surgical wounds and surgical incision wounds and trauma groups reduced the wound area was 42.48%,58.37%,50.00%,resepectively, volume reduction rate was 70.55%,78.90%,77.22%, but each between has not statistically significant (P >0.05).VAC therapy can shorten wound healing time and enhancing healing rate, total healing rate 60.38%, the average healing time was 80.75±36.42 days, there was no statistically significant difference in each group (P> 0.05). VAC therapy can accelerate wound bed granulation tissue growth, wound bed 76%-100% granulation tissue growth average time for 22 days, ulcer wounds group of time longer than the average time, but each group was not statistically significant (P> 0.05). The wound healing has significance relevant between patient age, wound volume and wound PH value (PH) before VAC treatment.(2) Compared VAC therapy of two kinds of filling dressing results show that:gauze and foam has the same in neovascularization (CD34+) and cell proliferation (PCNA)(P>0.05),so both could be used as the VAC filling dressings, All patients with different time compare CD34+ and PCNA, all there was no statistically significant difference. Each week comparison, one week after VAC treatment,PCNA increased significantly,during VAC therapy 2-3 weeks, there was no statistically significant (P> 0.05),.other time had statistically significant.one week after VAC treatment compared with before treatment, CD34+ increased statistically significant, other time also had statistically significant.20 times a microscope found one week after VAC treatment by compressed into lumen of circular, endothelial cell populations, microvascular counting increased obviously.[Conclusion] VAC technology have good effect on all kinds of chronic wounds. And age, wound volume,area and PH before VAC treatment are important influence factors at wound concrescence. Two kinds of materials (gauze and foam) can be the NPWT filling dressings, one week after VAC treatment, CD34+ increase most significant. However, the cost of two kinds of dressing, the price of single foam dressing was 100 times more than medical gauze, which indicated that the current use of medical gauze VAC therapy is the best option.