Mouës C M, van den Bemd G J C M, Heule F, Hovius S E R
Department of Plastic and Reconstructive Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
J Plast Reconstr Aesthet Surg. 2007;60(6):672-81. doi: 10.1016/j.bjps.2006.01.041. Epub 2006 Jun 22.
Vacuum-assisted closure wound therapy (vacuum therapy) has been used in our department since 1997 as a tool to bridge the period between debridement and definite surgical closure in full-thickness wounds. We performed a prospective randomised clinical trial to compare the efficacy of vacuum therapy to conventional moist gauze therapy in this stage of wound treatment.
Treatment efficacy was assessed by semi-quantitative scoring of the wound conditions (signs of rubor, calor, exudate and fibrinous slough) and by wound surface area measurements. Tissue biopsies were performed to quantify the bacterial load. Besides this, the duration until 'ready for surgical therapy' and complications encountered during therapy and postoperatively were recorded.
Fifty-four patients were included (vacuum n=29, conventional n=25). With vacuum therapy, healthier wound conditions were observed. Furthermore, a tendency towards a shorter duration of therapy was found, which was most prominent in late-treated wounds. In addition, the wound surface area reduced significantly faster with vacuum therapy. Surprisingly, these results were obtained without a decrease in the number of bacteria colonising the wound. Complications were minor, except for one case of septicaemia and one case of increased tissue necrosis, which compelled us to stop vacuum therapy. For the treatment of full-thickness wounds, vacuum therapy has proven to be a valid wound healing modality.
自1997年起，我院开始使用负压封闭引流术（负压疗法），作为全层伤口清创与确定性手术闭合之间的过渡手段。我们开展了一项前瞻性随机临床试验，比较负压疗法与传统湿纱布疗法在伤口治疗这一阶段的疗效。
通过对伤口状况（红肿、发热、渗出液和纤维蛋白性痂皮迹象）进行半定量评分以及测量伤口表面积来评估治疗效果。进行组织活检以量化细菌载量。此外，记录直至“准备好接受手术治疗”的持续时间以及治疗期间和术后遇到的并发症。
纳入54例患者（负压组n = 29，传统组n = 25）。采用负压疗法时，观察到伤口状况更健康。此外，发现治疗持续时间有缩短趋势，这在晚期治疗的伤口中最为明显。另外，负压疗法使伤口表面积减小得明显更快。令人惊讶的是，在伤口定植细菌数量未减少的情况下取得了这些结果。并发症较少，除1例败血症和1例组织坏死增加外，这迫使我们停止了负压疗法。对于全层伤口的治疗，负压疗法已被证明是一种有效的伤口愈合方式。
