Application effects of self-made simple vacuum sealing drainage device in postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle
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摘要: 目的 探讨自制简易负压封闭引流(VSD)装置在足踝部移植腓肠神经营养血管皮瓣术后治疗中的应用效果。 方法 2017年1月—2019年1月,新疆维吾尔自治区人民医院收治的36例足踝部皮肤缺损及骨外露患者符合入选标准,对其进行回顾性队列研究。根据采用的术区包扎方法,将患者分为简易负压组18例(男12例、女6例)和抗菌敷料组18例(男14例、女4例),其年龄分别为(41.6±2.8)、(42.3±2.6)岁。2组患者均行腓肠神经营养血管皮瓣移植术,术后抗菌敷料组患者采用纳米银抗菌敷料常规包扎术区及换药,每3天换药1次;简易负压组患者用由纱布、剪孔硅胶吸痰管和生物透性薄膜等材料自制而成的简易VSD装置封闭术区,接墙壁中心负压吸引系统行-40.0~-16.6 kPa持续VSD治疗,每5天更换1次负压材料。统计换药次数,每次换药时采用数字评分法评估的患者疼痛评分,换药费用,术后3、5 d评估的皮瓣肿胀程度;观察皮瓣成活情况。对数据行独立样本
t 检验、Wilcoxon秩和检验以及χ 2检验。 结果 简易负压组患者换药次数为(3.4±0.5)次,明显少于抗菌敷料组的(7.0±0.8)次(t =15.338,P <0.01)。简易负压组患者换药期间疼痛评分为(4.3±0.8)分,明显低于抗菌敷料组的(6.8±0.7)分(t =10.168,P <0.01)。2组患者换药费用相近。术后3、5 d,简易负压组患者皮瓣肿胀程度明显优于抗菌敷料组(Z =4.448、2.395,P <0.05或P <0.01)。简易负压组患者皮瓣成活情况明显优于抗菌敷料组(χ 2=4.500,P <0.05)。 结论 与传统敷料包扎比较,足踝部移植腓肠神经营养血管皮瓣术后应用自制简易VSD装置能够减少换药次数,减轻患者换药疼痛和皮瓣肿胀,促进皮瓣成活,值得在临床中推广应用。-
关键词:
- 负压伤口疗法 /
- 设备设计 /
- 伤口愈合 /
- 皮肤移植 /
- 腓肠神经营养血管皮瓣
Abstract: Objective To investigate the application effects of self-made simple vacuum sealing drainage (VSD) device in the postoperative treatment of sural neurocutaneous flap transplantation in the foot and ankle. Methods From January 2017 to January 2019, 36 patients with foot and ankle skin defects and bone exposure admitted to People′s Hospital of Xinjiang Uygur Autonomous Region met the inclusion criteria, and a retrospective cohort study was conducted. According to the bandaging method of the operative area, simple negative pressure group and antibacterial dressing group were both allocated with 18 patients, with 12 males and 6 females in the former group, 14 males and 4 females in the latter group, aged (41.6±2.8) and (42.3±2.6) years, respectively. Patients in the two groups all received sural neurocutaneous flap transplantation. Patients in antibacterial dressing group received nano silver antibacterial dressing change in the operative area, and the dressing was changed once every 3 days. In simple negative pressure group, the operative area was sealed with a simple VSD device made of gauze, silicone sputum suction tube with holes cut out, and biological permeable membrane, etc., which was connected with the wall central negative pressure suction system for continuous VSD treatment of -40.0 to -16.6 kPa. The negative pressure material was changed once every 5 days. The number of dressing change, the pain score evaluated by Numeric Rating Scale during each dressing change, the cost of dressing change, and the degree of flap swelling evaluated on the 3rd and 5th day after surgery were recorded, and the flap survival was observed. Data were statistically analyzed with independent samplet test, Wilcoxon rank sum test, and chi-square test. Results The number of dressing change of patients in simple negative pressure group was (3.4±0.5) times, which was significantly less than (7.0±0.8) times in antibacterial dressing group (t =15.338,P <0.01). The pain score during dressing change of patients in simple negative pressure group was (4.3±0.8) points, which was significantly lower than (6.8±0.7) points in antibacterial dressing group (t =10.168,P <0.01). The cost of dressing change of patients was similar between the two groups. On the 3rd and 5th day after surgery, the degrees of flap swelling of patients in simple negative pressure group were significantly superior to those in antibacterial dressing group (Z =4.448, 2.395,P <0.05 orP <0.01). The flap survival of patients in simple negative pressure group was significantly superior to that in antibacterial dressing group (χ 2=4.500,P <0.05). Conclusions Compared with the traditional dressing bandage, the self-made simple VSD device used after sural neurocutaneous flap transplantation can reduce the frequency of dressing change, relieve the pain of dressing change and the swelling of flap, and promote the flap survival, which is worth popularizing and applying in clinic.
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