Clinical Research Of The Negative Pressure Drainage Treating Degloving Injury Of The Limbs

In clinical treatment,patients with traumatic fractures and large area skin avulsion injury cause the clinical medical workers to face huge pressure and heavy work,because of the difficulty is high,during the treatment of soft tissue repair clinical work;Using the closed negative pressure drainage(VSD vacuum sealing drainage)treatment of large area skin avulsion injury advantage is through the closed negative pressure drainage the local and surrounding tissues on the surface of the pressure difference,prompting wound perfusion increased capillary wall open,improve the oxygen supply for;Wound timely drainage,drainage to prevent bacterial infection,which is beneficial to all kinds of repair of cell proliferation and function,including promoting the growth of granulation tissue.Closed negative pressure drainage contrasts to the traditional method for the treatment of large area skin avulsion injury effect,on the surface of the skin graft in situ with closed negative pressure drainage ensures uniform pressure skin graft in the skin surface,and can ensure that increase the survival rate of skin graft;Closed negative pressure drainage can suck the necrotic tissue and adequate drainage and bacteria produce toxins,prevent or reduce the occurrence of systemic inflammatory response syndrome,especially to reduce the local inflammation reaction,and promote the growth of granulation tissue,help skin survival guarantee already so beautiful and can guarantee the thickness of the skin,the embodiment of the thicker skin protection,facilitate postoperative nursing at the same time,reduce the switching frequency significantly reduce the doctor workload.This subject adopts closed negative pressure drainage treatment limbs patients with large area of degloving injury can make the wound skin graft survival rate is high,the in situ wound ooze blood loss,clinical blood transfusion in patients with reduced and shorten the healing time.The closed negative pressure drainage treating large area degloving injury of limbs,7 ~ 10 days later again closed negative pressure drainage,a total of 3 or 4 times to replace the VSD,each part of skin necrosis after demolition of VSD patients,to remove dead skin tissue bank closed negativepressure drainage technology.Line found after closed drainage system can timely will ooze blood drainage,drainage and guaranteeing the survival rate of skin graft.Last closed negative pressure drainage can make the skin graft and wound is clingy,wound blood osmotic solutions significantly reduced,wound blood osmotic solutions less and blood volume loss,can reduce the clinical blood transfusion.37 cases of patients with closed negative pressure drainage technology is applied by the3-4 times wound limb skin graft in situ treatment,patients during treatment(RBC)transfusion total 2-6 U,an average of 3.5 U.Table can closed negative pressure drainage in situ graft ensures uniform pressure skin graft in the skin surface,and can increase the survival rate of skin graft.37 patients by 3-4 times closed negative pressure drainage technology treatment wound body in situ skin graft survival rate of 75-90%,average 85.1%.Large area skin avulsion injury wound through the closed negative pressure drainage can be fully drainage and can promote the growth of granulation tissue,conducive to the survival of the skin.For patients with large area skin stripped injury,closed negative pressure drainage technology not only shortens the period of treatment,high survival rate of skin graft in situ wound healing fast,in-hospital time significantly shortened.Incidence of hospital stay of 6-8 weeks,with an average of 6.95 weeks.The closed negative pressure drainage technology not only shortens the period of treatment,high survival rate of skin graft in situ wound healing fast,in-hospital time significantly shorten can cut down the cost of hospitalization.Incidence was in the hospital total cost 15.6-195000,an average of 172000.11 cases with large surface area of the skin avulsion wound off trauma patients only give treatment wound debridement in situ graft as control group,the body in situ skin graft survival rate of 45-55%,average 50.1%.During treatment(RBC)transfusion total 8-35 U,an average of 25.90 U;Length of hospital stay for 10 to 15 weeks,an average of 14.5 weeks;The hospital total cost is 20.3-307000,an average of 260300.And with the traditional method the treatment of wound debridement in situ graft study as control group.Two groups of cases of patients with wound skin graft survival rate and amount of blood transfusion treatment process,wound healing timeand cost of treatment.Using SPSS19.0 statistical analysis software package for t test and rank and inspection,P < 0.05,significant statistical difference;Using the closed negative pressure drainage treating large area skin avulsion injury patients,can significantly improve the limb salvage success,save the limb function to the greatest extent.Organizing cytology was studied for the damage to the wound,the VSD group and control group in 7 to 10 days after injury in wound granulation materials,HE staining and immunohistochemical staining,respectively connected by streptomycin avidin-peroxidase(SP).Vascular Endothelial Growth Factor VEGF(Vascular Endothelial Cell Growth Factor)in the VSD group and control group in granulation tissue of Vascular Endothelial Cell cytoplasm expression have obvious difference.VSD group less negative pressure controls vascular endothelial cells of VEGF expression positive cumulative scoring 87.3± 2.5 and 56.7±5.8.Specific effects on vascular endothelial cell growth factor VEGF in the role of angiogenesis in the process of wound healing,we detected using immunohistochemical SP method two kinds of cell growth factor expression in the avulsion injury of skin wound healing process,the results show that a high negative pressure less negative pressure groups VEGF content.VEGF levels increased,and then promote wound fibrous tissue,granulation tissue hyperplasia,promote the healing of the wound.This topic research found in the limbs closed negative pressure drainage treatment > 5% patients with large area of degloving injury can make the wound skin graft survival rate is high,the in situ wound ooze blood loss,clinical blood transfusion in patients with reduced and shorten the healing time.Degloving injury in limbs closed negative pressure drainage treatment and traditional wound skin graft in the comparative study on the survival rate,blood transfusion amount,healing time.Found the closed negative pressure drainage technology can promote the granulation tissue hyperplasia,promote the proliferation of collagen synthesis and repair period of shrinkage fiber synthesis,enhance the phagocytosis of white blood cell activity and quickly,reduce the number of bacteria and promote the healing of the wound,change the bandage daily and the technology to avoid the traditional operation,so that to reduce the patient's pain,shortens the time of patients in hospital and decreasethe medical costs.The correct use of closed negative pressure drainage,in patients with large area skin avulsion injury through closed negative pressure drainage technology,significantly improve limb-salvage successful treatment of maximum save patients with limb function,increase patients life confidence;Using negative pressure closed drainage treatment of serious large area skin avulsion injury really for good treatment of the wound.