Conquest Anne M, Garofalo James H, Maziarz David M, Mendelson Kim G, Su Sun You, Wooden William A, Meadows William M, Nifong Wiley, Chitwood W Randolph
East Carolina University, Greenville, North Carolina 27858, USA.
J Surg Res. 2003 Dec;115(2):209-13. doi: 10.1016/s0022-4804(03)00331-7.
Application of the Vacuum-Assisted Closure device (VAC) to open sternal wounds has negative hemodynamic effects. We hypothesized that the interposition of a muscle flap attenuates these negative hemodynamic effects.
After institutional approval, monitoring lines were placed in anesthetized, ventilated pigs. Through a median sternotomy, sonometric crystals were strategically positioned around the left ventricle. A rectus flap was rotated over the mediastinal wound, and the VAC was placed over the flap. After baseline measurements, a vacuum of 125 mmHg [Group (GP) 1, n = 5] or 50 mmHg (GP2, n = 6) was initiated. Hemodynamics were recorded every 15 min for 1.5 h, and 15 min after cessation of the vacuum therapy. GP3 (n = 6) underwent intermittent VAC cycling (on 5 min/off 2 min). Significance determined by t test.
While non-flapped animals had significant detriment in both left ventricular filling volume and cardiac output, flapped animals had insignificant depression of both parameters.
Application of muscle flaps to sternal wounds prior to VAC therapy significantly attenuates the negative hemodynamic effects seen when the VAC is used alone.
将负压封闭引流装置（VAC）应用于开放性胸骨伤口会产生负面的血流动力学效应。我们推测植入肌瓣可减轻这些负面的血流动力学效应。
经机构批准后，在麻醉通气的猪身上放置监测线。通过正中胸骨切开术，将超声晶体有策略地放置在左心室周围。将腹直肌瓣旋转覆盖在纵隔伤口上，并将VAC置于该肌瓣上方。在进行基线测量后，开始施加125 mmHg的负压（第1组，n = 5）或50 mmHg的负压（第2组，n = 6）。每15分钟记录一次血流动力学数据，持续1.5小时，并在负压治疗停止后15分钟记录。第3组（n = 6）进行间歇性VAC循环（开启5分钟/关闭2分钟）。通过t检验确定显著性。
未植入肌瓣的动物左心室充盈量和心输出量均有显著损害，而植入肌瓣的动物这两个参数的降低不显著。
在VAC治疗前将肌瓣应用于胸骨伤口可显著减轻单独使用VAC时出现的负面血流动力学效应。
