Clemens Mark W, Broyles Justin M, Le Phi-Nga Jeannie, Attinger Christopher E
Department of Plastic Surgery, MD Anderson Cancer Center, University of Texas, Houston, TX, USA.
Surg Technol Int. 2010 Oct;20:61-71.
Recent innovations in the field of wound healing have created numerous advanced therapies from which clinicians may now choose. The challenge for the reconstructive surgeon is to ensure that these adjunct technologies are used according to an evidence-based protocol to ensure optimal healing. Critical to successful outcomes is that new modes of therapy do not supplant, but are used in tandem with, core principles of wound management: establishing a correct diagnosis, ensuring a good local blood supply, debriding the wound to a clean base, correcting the biomechanical abnormality, and nurturing the wound until it shows signs of healing. Debridement should be performed as often as necessary until the wound is deemed clean and ready for reconstruction. Useful adjuncts in debridement include hydrotherapy and ultrasonic therapy. The majority of reconstructions are accomplished through simple techniques. If a wound is not meeting the expected healing trajectory, management adjuncts such as negative pressure wound therapy, growth factor, cultured skin, and hyperbaric oxygen can then reactivate or expedite the process toward achieving a healed wound.
伤口愈合领域的最新创新成果催生了众多先进疗法，临床医生现在可以从中进行选择。重建外科医生面临的挑战是确保这些辅助技术按照循证方案使用，以确保实现最佳愈合效果。成功治疗的关键在于新的治疗模式并非取代伤口处理的核心原则，而是与之协同使用，这些核心原则包括：做出正确诊断、确保良好的局部血液供应、将伤口清创至清洁创面、纠正生物力学异常以及护理伤口直至其出现愈合迹象。应根据需要尽可能频繁地进行清创，直到伤口被判定为清洁且适合进行重建。清创的有用辅助手段包括水疗和超声治疗。大多数重建手术通过简单技术即可完成。如果伤口未达到预期的愈合进程，那么诸如负压伤口治疗、生长因子、培养皮肤和高压氧等辅助治疗手段可以重新激活或加速伤口愈合进程。
