负压创面治疗技术对皮肤移植成活的临床观察及实验研究

目的：采用负压固定移植皮片方法，观察负压创面治疗技术（negative-pressure wound therapy，NPWT）对游离皮片成活的影响，初步探讨微血管形成与皮肤成活之间的关系。方法：采用回顾性研究的方法，对65例皮肤缺损的患者，根据皮肤移植术后皮片固定方法的不同，分为两组，其中Ⅰ组为NPWT治疗组，有35例患者，刃厚游离皮片移植术后行创面负压吸引治疗；Ⅱ组为常规治疗组。有30例患者，刃厚游离皮片移植术后用打包或加压包扎的方式固定。Balb／c小鼠20只，按皮片移植后不同固定加压方式，分为实验组：负压创面治疗技术使用组（10只），对照组：打包加压组（10只），于皮片移植术后第5天，大体观察移植皮片颜色、有无水疱、有无皮下积液及质地，计算并比较皮片成活率，以免疫组化染色标记毛细血管内皮，检测皮片中微血管情况。结果：临床观察表明：Ⅰ组术后皮片成活时间平均较Ⅱ组缩短，有统计学差异（P〈0．01），Ⅰ组术后住院治疗时间平均较Ⅱ组缩短5天，有统计学差异（P〈0．01），Ⅰ组术后抗生素费用、换药次数及换药费用较Ⅱ组减少，有统计学差异（P〈0．01）。动物实验结果表明：术后第5天，实验组小鼠移植皮片中微血管增生较对照组明显增多（P〈0．05）。结论：与常规打包或加压包扎固定皮片的方式相比，负压创面治疗技术的应用可以缩短皮片成活时间，缩短患者住院治疗时间，减少抗生素的使用及换药次数，促进移植皮片中毛细血管增生，提高皮片成活率。

The clinical observation and experimental study of negative pressure wound therapy on the survival of skin grafts

Objective： To observe the clinical effects of negative-pressure wound therapy （NPWT） on skin grafts after blade-thickness free skin graRing, investigate the affect and mechanism of NPWT on the survival of skin. Methods： Sixty-five patients with injuries of skin, which were divided into NPWT group （group Ⅰ, n=35） and conventional treatment （CT） group （group Ⅱ, n=30） according to the different postoperative treatment. Free skins of patients in group Ⅰ were fixed with continuous suction after skin grafting, and patients in group Ⅱ were fixed with tieover bolster dressing. Twenty mice were divided into NPWT group （experimental group, n=10） and conventional treatment group （control group, n=10） according to the different postoperative treatment. Free skins of mice in experimental group were fixed with continuous suction after skin grafting, and mice in control group were fixed with tie-over bolster dressing. Mice were sacrificed on postoperative days 5, harvested tissues were observed in general and processed for immunohistochemical staining based on vessel density （CD31）. Results ：The time for skin grafts to survival in group Ⅰ was shorter than that of group Ⅱ （P 〈0.01）, the duration of postoperative period of patients in group I were obviously less than those of group Ⅱ （P 〈0.01）, and the costs of antibiotics and dressings in group Ⅰ were less than those of group Ⅱ （P〈0.01）. The number of capillaries in experimental group was much more than that of control group （P〈0.05）. Conolusions： Compared with tie-over bolster dressing, negative pressure wound theprapy can shorten the survival duration of skin grafts, lessen the duration of hospitalization, reduce the use of antibiotics and dressings, promote the proliferation of capillaries and enhance the survival ratio of skin grains.