Petzina Rainer, Gustafsson Lotta, Mokhtari Arash, Ingemansson Richard, Malmsjö Malin
Department of Medicine, Lund University Hospital, Lund, Sweden.
Eur J Cardiothorac Surg. 2006 Jul;30(1):85-9. doi: 10.1016/j.ejcts.2006.04.009. Epub 2006 May 26.
Vacuum-assisted closure (VAC) is a recently introduced method for the treatment of poststernotomy mediastinitis. The aim was to examine the effects of VAC negative pressure on peristernal soft tissue blood flow after internal mammary artery harvesting.
Microvascular blood flow was measured using laser Doppler velocimetry in a porcine sternotomy wound model. The effect of VAC negative pressure on blood flow to the wound edge was investigated on the right side, where the internal mammary artery was intact, and on the left side, where the internal mammary artery had been removed.
Before removal of the left internal mammary artery, the blood flow was similar in the right and left peristernal wound edges, 2.5 cm from the edge (27+/-4 perfusion units (PU) on the right side and 32+/-3 PU on the left side, in muscle tissue). When the left internal mammary artery was surgically removed, the blood flow on the left side decreased (19+/-3 PU, in muscle tissue), while the skin blood flow was not affected. VAC negative pressure induced an immediate increase in wound edge blood flow both on the right side (43+/-9 PU, in muscle tissue at -75 mmHg), where the internal mammary artery was intact, and on the left side, where the internal mammary artery had been removed (49+/-11 PU, in muscle tissue at -75 mmHg). The increase in blood flow was similar on both sides at -75 mmHg and at -125 mmHg.
The peristernal wound edge microvascular blood flow is decreased when the left internal mammary artery is removed. VAC therapy stimulates blood flow in the peristernal thoracic wall after internal mammary artery harvesting.
真空辅助闭合（VAC）是最近引入的一种治疗胸骨切开术后纵隔炎的方法。本研究旨在探讨VAC负压对内乳动脉采集后胸骨旁软组织血流的影响。
在猪胸骨切开伤口模型中，采用激光多普勒测速仪测量微血管血流。在右侧（内乳动脉完整）和左侧（内乳动脉已被切除）研究VAC负压对伤口边缘血流的影响。
在切除左内乳动脉之前，距边缘2.5 cm处的右侧和左侧胸骨旁伤口边缘血流相似（肌肉组织中，右侧为27±4灌注单位（PU），左侧为32±3 PU）。当手术切除左内乳动脉时，左侧的血流减少（肌肉组织中为19±3 PU），而皮肤血流未受影响。VAC负压使右侧（内乳动脉完整，-75 mmHg时肌肉组织中为43±9 PU）和左侧（内乳动脉已被切除，-75 mmHg时肌肉组织中为49±11 PU）的伤口边缘血流立即增加。在-75 mmHg和-125 mmHg时，两侧的血流增加相似。
切除左内乳动脉后，胸骨旁伤口边缘微血管血流减少。VAC治疗可促进内乳动脉采集后胸骨旁胸壁的血流。
