| Objective1 Through the contrast of the Skin defects by free skin graft wound after the combination of vacuum sealing drainage (vacuum sealing drainage, VSD) and oil sands broken gauze packing method,To investigate the treatment effects in the postoperative infection control, skin graft survival, length of hospital stay and hospital costs and other aspects.2 Through monitor the amount of protein expression changes of the two groups of animal models defect wound graft in local formation granulation tissue ascular endothelial growth factor (vascular endothelial factor, VEGF),so as to better explain the human skin graft wound after the skin defect with the application of VSD increased the survival rate of skin graft film mechanism , At the same time for the seal negative pressure drainage the clinical application of technology to provide theoretical and practical basis.Method1 Collection of clinical samples:Select two orthopedic of our hospital from February 2009 to October 2010 for medical treatment of 85 patients with refractory wounds. Single number of 42 patients admitted into the treatment group, two-numbers of the 34 patients admitted into the control group .Withdrawn from treatment in 9 cases. The people who with diabetes, cachexia, chronic infection exists elsewhere in the body or unwilling to enter and dropping out of the treatment group. Three months associated with damage to other parts of the body. Two weeks before injuries received the antimicrobial treatment in the research process excluded. Admission after the first treatment given to debridement. Into the treatment group, 42 patients with granulation tissue to be fresh from the body after the entire 0.1 ~ 0.2mm or more thickness skin graft for autologous skin grafting . After treatment with vacuum sealing drainage technology processing. Enter the control group of 34 patients. To be fresh wound granulation tissue after skin graft after the oil sands using traditional gauze packing method for treating broken. Their average length of stay, unpacking time, graft infection, skin graft healing rate, the incidence of subcutaneous hematoma, and skin graft after the dressing change frequency, and use of antibiotics and other costs and hospital costs were compared.2 The experimental application of VSD and gauze packing method of oil sands broken skin defects and skin graft in two groups of rabbits after treatment model. Western blot by protein imprinting method monitoring of two groups wound formed under the skin grafts piece by granulation tissue of the relative expression of VEGF protein quantity and the contrast, with millimeter graph paper method for calculation of two groups of wound healing rate.Results1 Application of VSD in the treatment of 42 patients,No systemic and local toxicity, allergic reactions. After unpacking the wound exudates obtained for bacterial culture, 3 cases of infection, accounting for 7.14%. 6 to 8 days after surgery to remove the skin graft was found VSD film dressing normal skin color, blood supply tablet supply. Only 4 cases of skin grafts some minor edge necrosis, dealing by dressing the wound healed all. 12～14 days after suture removal, the skin graft survived completely film, Limb motor function and appearance of a good recovery. After 3 to 12 months follow-up affected area with good function, satisfaction with the appearance of skin graft. The control group broken gauze packing method applied oil sand 34 patients treated,8 to 12 days after unpacking,Take wound exudates do the bacteria cultures. Results 23 cases infection, infection rates 67.65%, 3 cases of skin grafts leading to the eventual necrosis of subcutaneous purulent ; 4 cases of skin graft hematoma, resulting in skin graft necrosis in all, accounting for 11.76%;18 cases of partial skin graft survival of 68% to 82%. Compared with the control group, the average hospital stay, graft healing rate, the number of dressing changes and antibiotic costs were significant differences in terms of.2(1) With Western blot method to detect the experimental group, the control group and the blank control group wound granulation tissue in the relative expression level of VEGF protein (RI). VEGF protein in the experimental group and control group 1d, 3d, 5d, 7d, 10d, 14d in the wound granulation tissue relative expression levels were 0.37±0.03,0.85±0.07,1.03±0.13,1.12±0.21,0.96±0.36,0.77±0.25;0.32±0.03,0.43±0.22,0.58±0.18,0.65±0.20,0.74±0.14,0.73±0.11;Control group was 0.28±0.73.(2) Judging from the RI ratio, VSD group wound granulation tissue expression of VEGF protein in the first 3 days after injury showed a very significant increasing trend (P <0.05) . To peak on day 7, day 10 decreased, but still maintains a relatively high concentration. In the control group, wound granulation tissue of VEGF content with the passage of time also appears rising trend. But the overall level is relatively low compared with the VSD. From 10 days after injury to the change 14 days after injury showed a platform period, there were no significant changes.(3) In the experimental group after injury 3d, 5d, 7d, 10d four time points in wound tissue relative expression of VEGF protein were significantly higher (P <0.05) . And after the injury 1d, 14d experimental group and control group in the VEGF wound granulation tissue relative expression level of protein did not show significant differences (P> 0.05).(4) One day after injury, Granulation tissue in the experimental group, VEGF protein content with the control group (0.28±0.73) compared to that show a significant difference (P <0.05). Compared with the control group, the blank control group was not significant difference (P >0.05). After the injury 3d, 5d,7d, 10d, 14d, the experimental group and control group in the wound granulation tissue relative expression level of VEGF protein compared with the blank control were significantly increased. Showed significant statistical significance (P <0.05).3 Wound healing: Wound to form immediately and 3 days, 7 days . Two groups of wound area have no significant difference (P > 0.05). 5 days, 10 days and 14 days the wound area of the two groups were (11.33±0.28) cm2 and (12.03±0.43) cm2, (9.27±0.45) cm2and (8.97±0.59) cm2, (10.89±0.26) cm2and (10.43±0.36) cm2,the difference was statistically significant (P <0.05).Conclusion1 VSD after treatment with free skin grafting large skin defects of the body,can better drainage of the wound. To promote better adhesion of the graft pieces, reduce the incidence of hematoma and infection, conducive to the survival of skin grafts, the treatment of skin defects of the body is a very good method.2 After the large area of skin graft wound defect with VSD technology, can significantly improve the protein expression of the wound VEGF. After the oil sands than conventional skin grafting method of packing gauze pieces wound to the expression of VEGF protein significantly increased. And still can significantly reduce the area to promote wound. |
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