摘要
目的 探讨负压封闭引流技术（vacuum sealing drainage,VSD）联合刃厚皮片植皮治疗下肢静脉性溃疡的临床效果。方法 选择2013年1月—2014年4月蚌埠医学院第一附属血管外科收治的40例下肢静脉性溃疡的患者,包括单纯性静脉曲张合并溃疡14例,Cockett综合征合并溃疡12例,布加综合征合并溃疡8例,下肢深静脉血栓后综合征合并溃疡6例,在处理原发病的基础上,采用刃厚皮片植皮联合VSD持续负压吸引治疗。所有患者给予常规换药、对症处理,以做到创面较清洁,创面取分泌物培养,有指征者应给予敏感抗生素治疗,溃疡时间较长、创面较大应取活检,排除恶变可能。单纯性静脉曲张合并溃疡同期手术;Cockett综合征、布加综合征、血栓后综合征均先开通闭塞的血管,解除下肢静脉回流障碍,3-7 d后再行进一步手术治疗。在处理原发病的基础上,采用刃厚皮片植皮治疗,同时采用VSD持续吸引,观察其治疗效果。结果 40例患者平均使用VSD 6 d,32例全部成活,6例皮片成活92%,2例成活60%,创面经常规换药愈合。无再次手术病例。结论 刃厚皮片植皮联合VSD持续吸引治疗下肢静脉性溃疡疗效明确。VSD能够减少组织水肿,提高局部微循环,加速新鲜肉芽组织生长,同时VSD能更好地进行创面引流,控制感染,促进创面贴附,有利于植皮片存活。
Objective To study the clinical effect of vacuum sealing drainage （VSD） combined with split-thickness skin graft in the treatment of venous ulcer of lower extremity. Methods Total 40 cases of venous ulcer of lower extremity ,included 14 cases of simple varicose vein combined with ulcer, 12 cases of Cockett syndrome combined with ulcer,8 cases of Budd Chiari syndrome with ulcer, and 6 cases of lower extremity deep vein thrombosis associated with ulcer, were recruited in our hospital between January 2013 and April 2014. All patients were given conventional dressing and symptomatic treatmerit in order to achieve wound cleaner. The wound culture was performed and antibiotics were given on the basis of indications. Biopsy was performed for the larger ulcer wound to exclude the possibility of malignancy. For the patients with simple varicose vein combined with ulcer the split-thickness skin graft were performedsimultaneously;for the patients with Cockett syndrome, Budd Chiari syndrome or post thrombotic syndrome, the recanalization were performed and the splitthickness skin graft followed 3 -7 days later. VSD was conducted for all patients. Results Forty patients were treat with VSD on average of 6 days. The skin grafts were all survived in 32 cases, survived 92% in 6 cases, and survived 60% in 2 cases, all wound were healed after dressing change. No case needs the second operation. Conclusion Effect of VSD combined with split thickness skin graft for venous ulcer were clear. VSD can reduce the tissue edema, improve local microcirculation, accelerate the fresh granulation tissue growth. At the same time, VSD with advantage of better wound drainage, control infection, promote wound attached, is conducive to the graft survival.
出处
《中华全科医学》
2016年第2期209-211,共3页
Chinese Journal of General Practice
关键词
下肢静脉性溃疡
负压封闭引流
刃厚皮片
游离植皮
Venous ulcer of lower extremity
Vacuum sealing drainage
Split-thickness skin graft
Free skin grafting
