Clinical Study Of Platelet-rich Plasma Combined With Vacuum-assisted Closure In The Treatment Of Refractory Wounds

Objecttive:Comparative study of the clinical effects and characteristics of vacuum-assisted closure technology(VAC)combined with platelet-rich plasma(PRP)in the treatment of chronic refractory wounds.Methods:40 patients with chronic refractory wounds admitted to the Department of Burns?orthopedics and Plastic Surgery of the First Affiliated Hospital of Nanchang University from January 2018 to December 2019 were selected and divided into VAC group(20 cases)and VAC + PRP group(20 cases)according to the random number table method.Two groups of patients completed blood routine and blood biochemical examination after admission,including white blood cell count(WBC),red blood cell count(RBC),hemoglobin content(Hb),plasma albumin,C-reactive protein(CRP),and red blood cell sedimentation rate(ESR),Take the wound secretion and necrotic tissue for bacterial culture,and collect the age,duration of disease,positive results of bacterial culture,wound VAS score,and measurement of wound area.After the two groups of patients were contraindicated,VAC was used to treat wounds after debridement,and VAC was replaced every 7 days until the wounds reached the secondary repair standard and closed wounds were surgically repaired;VAC + PRP group was treated with PRP after debridement.After the wound injection treatment,the VAC closed wound treatment was repeated for 7 days,and the above treatment was repeated one cycle,and the second surgical closure or wound dressing change was performed depending on the wound condition.The VAS score and bacterial culture of the wounds were performed on the 7th and 14 th days after operation.Blood routine,blood biochemistry were reviewed,the area of the wound was reduced,and the VSS score and wound recurrence were followed up 2 months after discharge.Statistical analysis of the clinical efficacy of the two groups of patients.Results:The wound area reduction and wound healing rate of the VAC + PRP group on the 7th and 14 th days after operation were higher than those of the VAC group,and the differences were statistically significant(P <0.05).The time for complete wound healing and total hospital stay in the VAC + PRP group was lower than that in the VAC group,and the hospitalization cost was higher than that in the VAC group.The differences were statistically significant(P <0.05).The levels of infection indicators(WBC,CRP,ESR)and VAS scores of the two groups of patients showed a downward trend,and the differences were statistically significant(P <0.05);the levels of infection indicators on the 7th and 14 th days after surgery in the VAC + PRP group And the VAS scores were lower than those in the VAC group,and the difference was statistically significant(P <0.05).There was no significant change in Hb and RBC levels between the two groups of patients on the 7th and 14 th days after surgery,and the difference was not statistically significant(P> 0.05).However,the plasma albumin showed a downward trend,and the difference was statistically significant.P>0.05).There was no significant difference in Hb,RBC and plasma albumin between the two groups on the 7th and 14 th days after operation(P> 0.05).The bacteriostatic effect of the VAC + PRP group on the 7th day after surgery was not significantly different from that of the VAC group(P> 0.05);the bacterial inhibition effect of the VAC + PRP group on the 14 th day after operation was better than that of the VAC group,and the difference was statistically significant.(P <0.05).Two cases of recurrence in the VAC group were followed up two months after discharge.There was no recurrence in the VAC + PRP group.There was no significant difference in cure rate between the two groups(P> 0.05).The VSS score in the VAC + PRP group was lower than that in the VAC group,and the difference was statistically significant(P<0.05).Conclusions:Compared with VAC alone,VAC combined with PRP for chronic wounds can effectively accelerate wound healing,shorten wound healing time,hospital stay,control wound infection and inhibit bacteria,reduce wound pain and improve wound scars.However,the most suitable method of VAC combined with PRP treatment,theconcentration and preparation of PRP,and the choice of VAC mode are currently inconclusive.