Study On The Effect Of The Survival Of Postoperative Flaps By The Application Of Vacuum Sealing Drainage

Objective: To investigate the efficacy and mechanism of VSD after transposition of skin flap.Providing a new method for clinical promote flap survival.Methed:1 Animal experiment:40 New Zealand rabbits(at a weight of 2980 g to 3020g)were divided into 5 groups in random.A flap was designed and put on either side of a rat’s back,and altogether 80 flaps were created.The flap was squareness and the width and the length of the flap were 2.5cm and 7.5cm.And the flaps on one side of the rabbits’ backs were randomly arranged into control side,and the flaps on the other side served as the experiment side.The 5 groups divided at first were named respectively after the time of the experiment: the four-hour group,the one-day group,the three-day group,the five-day group,and the seven-day group.The experiment side connected the VSD device on negative pressure initiatively and alternatively from-50 mm Hg(2 hours)to 0mm Hg(2 hours),while,the control side flap given sterile Vaseline gauze and sterile cotton pad cover flap.The congestion area and necrotic area,and the expressions of flap histology and CD34 and VEGF were observed mainly through HE dyeing and immunohistochemistry and ELISA.The statistical data were treated to figure out the flap survival rate and determine whether statistical differences lie in the CD34 and VEGF and MVD.2.Clinical application: Analyze the patients received the VSD of postoperative flaps in our department from Jan 2015.Retrospective analysis the patients received the VSD of postoperative flaps from Jan 2015 to Jan 2016 with the patients received the traditional aseptic dressing from Jan 2014 to Jan 2015Result: 1.Congestion incidence,average area,average congestion flap flap necrosis area of the VSD sides on every time point were less than the control side except the 4hours group.2.The degree of tissue edema,microvascular thrombosis and angiogenesis of the VSD sides on every time point were better than the control side except the 4hours group 3.The expression of VEGF and CD34 of the VSD side were better than the control side on every time point except the 4 hours group.,4.The positive rate of pathogenic microorganisms under skin flaps of VSD side were lower than the control side.2.Clinical application: Distal end of flap was dead on five patients of fifty-four patients with VSD after the flap operation from January 2015 to January 2016.Four were dead of the flap blood stasis,and the other one was dead of flap necrosis of flap infection.The remaining 49 cases survived completely,the flap survival rate was 90.7%;the patients flaps average hospitalization was 15.91±7.38 days.Distal end of flap was dead on ten patients of sixty-four patients with The traditional aseptic dressing after the flap operation from January 2014 to December 2014.Seven were dead of the flap blood stasis,and the other two were dead of flap necrosis of flap infection.The remaining 54 cases survived completely,the flap survival rate was 84.3%;the patients flaps average hospitalization was 19.31±9.16 days.Conclusion: Based on our data,it appears that the application of VSD early could diminish the flap venous stasis,tissue edema,and the flap infection,which results in alleviating the adverse effects on the survival of skin flap.Furthermore,VSD provides benefits to the improvement of microcirculation homeostasis,the occurrence of new blood vessels in flap tissues.To sum up,the treatment of VSD has a higher first wound healing rate,shorter hospital stay,which is worthy of extensive clinical application.