Application Of Vacuum Sealing Drainage In Full-thickness Skin Grafts

Objective:Skin grafts is the most commonly used way of burns orthopedic surgery. At present, full-thickness skin graft is the best surgery way. Traditional surgical method is that the wound is to be packaged fixed with pressure after the operation. Although this approach can fix the skin well, for the irregular bed using packaged fixed often have dead space and skin grafts will be not fixed the exact situation. Moreover, packaged fixing easily leaves suture scar and it is a very long time we can not check the state if the skin survived. To solve this problem, the test of the New Zealand white rabbits about full-thickness skin graft applied simple suction device to explore the impact of different time of vacuum-assisted full-thickness skin survived.Methods:8 New Zealand white rabbits got full-Thickness skin graft on the back. They are randomly divided into Group A(wound with simple vacuum sealing drainage device), Group B (wound packaged fixed with pressure), Group C(wounds with simple packaged)。Wound healing time was recorded on 14th,21s day. Skin survival rates were evaluated。Wound speciments that were drawed on 3st,7th,14th day were examined histologically by optical microscopy and transmission electron microscopy。 Results:1. General observation Group A has good drainage and skin grafts attached to the bed closely. The tissue on the top of the drainage tube because the tube disrupt the adhered grafts. Necrosis occurred owing to long ischemic. Lateral skin grafts survival well. For Group B its have good drainage and adhesion. The wound of Group C does not drainage completely. There are some blood and fluid collection. The skin grafts can not adhere to the bed resulting in dot and dot necrosis of skin graft.2. Observation with ordinary optical microscope For Group A, the top and the side skin tissue do not show obvious changes when removed the drainage with structural integrity and the cells rules closely Later both the specimens from the top and the side show epithelial necrosis with eosinophilic staining. It shows pleomorphic cell layer thickening and base cells become round with separatism hyperplasia. The base tissue grow into deep tissue. Fibroblasts hyperplasia accompanied by amount of inflammatory cell. For Group B the skin tissue survive well with complete structure and clear layers. The proportion of the various cell layers has normal approximation. For Group C Structure is incomplete and layers are missed. Base cell hyperplasia and the layer become thicken. Fibroblasts and collagen fibers proliferation.Neutrophils and other inflammatory cells are distribution. Some tissue survives well with good structure and layer.3. Observation with transmission electron microscopy For Group A the cell on the top of the drainage tube early show ischemic changes. Later the top and side cell degeneration with spot necrosis. Cells markedly increased. Fibroblasts become obvious proliferation and base cells become longer and thinner. In cytoplasm mitochondrial and endoplasmic reticulum get obviously rich with basement membrane thickening. For Group B, in the early the cells show ischemic injury and some lipid droplets appear. Later the skin tissues become thicken and fibroblasts and base cell hyperplasia. For Group C the tissues show necrosis degeneration, cell ultrastructure showed unclear. Some tissue appropriate proportion of various cells. Fibroblast cells and basement membrane hyperplasia.4 The survival rate of skin graft with simple vacuum sealing drainage device was significantly shorter than that wound packaged fixed with pressure(P<0.05)。Histopathological results showed that in the early blood and fluid collection of the wound drain well. It would affect the survival of the skin grafts if removed the drainage vessel too late or too early。Conclusion:Morphology examination demonstrated that regional cuticular layer was necrotic in the vacuum sealing drainage group after early skin transplantation, while inflammatory cell infiltration, fibroblast degeneration, and mitochondrial swelling were also observed. At later skin transplantation, fibroblast and basal cell were proliferated, and function of mitochondria and plasmid was active. This suggested that vacuum sealing drainage promoted survival rate of skin graft.