Webb L X, Schmidt U
Department of Orthopaedic Surgery, Wake Forest University Medical Center, Winston-Salem, NC, USA.
Unfallchirurg. 2001 Oct;104(10):918-26. doi: 10.1007/pl00002776.
Vacuum assisted wound closure (VAC) is a closed system, which applies negative pressure to the wound tissues. Basic studies have shown beneficial effects on wound blood flow and proliferation of healing granulation tissue. Theoretically, the method acts by removal of excess tissue fluid from the extravascular space, which lowers capillary after-load and thereby promotes the microcirculation during the early stages of inflammation. Additionally, the mechanical effect of the vacuum on the tissue at the wound surface appears to have an "Ilizarovian" effect resulting in an exuberant proliferation of healing granulation tissue. This technique has been used in over 2560 patients at the author's institution over the past 10 years for an expanding list of wound applications in several surgical disciplines. Commonly used orthopedic indications include traumatic wounds following débridement, infection (following débridement), fasciotomy wounds for compartment syndrome, and as a dressing for anchoring an applied split thickness skin graft. The author's personal experience consists of 269 patients treated and has not been associated with any major complications. A low incidence (2.5%) of localized superficial skin irritation occurred when a portion of the vacuum sponge overlapped the affected area. This problem is avoided by carefully confining the sponge to the wound tissue and avoiding the overlap of normal skin. The technique is contraindicated in patients with an allergy to any of the components which contact the skin such as the polyurethane sponge, the adhesive, or the plastic film applied to seal the system to the skin around the wound. Patients whose skin is thin and easily damaged will not tolerate the pulling off of the adhesive film, which is done at the time of sponge removal/change. Also, patients who are fully anticoagulated or patients with large wound surface areas (e.g., burns) may need careful monitoring of electrolytes, hematocrit, and/or fluid balance in an intensive care or burn unit setting. The mainstay of wound care is débridement, and vacuum assisted wound closure is not a substitute for this. It is a novel and welcome addition to the methods available to surgeons charged with the management of challenging wounds, and its final role in the overall list of adjunctive wound treatment modalities is still seeking a final definition.
负压伤口治疗（VAC）是一种封闭系统，可对伤口组织施加负压。基础研究表明，其对伤口血流及愈合肉芽组织的增殖具有有益作用。从理论上讲，该方法通过清除血管外间隙中的多余组织液来发挥作用，这降低了毛细血管后负荷，从而在炎症早期促进微循环。此外，伤口表面组织上的负压机械效应似乎具有“伊里扎洛夫效应”，导致愈合肉芽组织过度增殖。在过去10年中，作者所在机构已将该技术应用于超过2560例患者，用于多个外科领域中越来越多的伤口应用。常用的骨科适应证包括清创后的创伤性伤口、感染（清创后）、骨筋膜室综合征的筋膜切开伤口，以及作为固定应用的中厚皮片的敷料。作者个人经验包括治疗269例患者，且未出现任何重大并发症。当部分负压海绵覆盖受影响区域时，局部浅表皮肤刺激的发生率较低（2.5%）。通过小心地将海绵局限于伤口组织并避免正常皮肤重叠，可避免此问题。对任何接触皮肤的组件（如聚氨酯海绵、粘合剂或用于将系统密封至伤口周围皮肤的塑料薄膜）过敏的患者禁用该技术。皮肤薄且易受损的患者无法耐受在去除/更换海绵时撕下粘附膜。此外，完全抗凝的患者或伤口表面积大的患者（如烧伤患者）可能需要在重症监护或烧伤病房环境中仔细监测电解质、血细胞比容和/或液体平衡。伤口护理的主要手段是清创，负压伤口治疗不能替代清创。它是负责处理具有挑战性伤口的外科医生可用方法中的一项新颖且受欢迎的补充，其在辅助伤口治疗方式总体列表中的最终作用仍有待最终确定。
