Okmeydani Education and Research Hospital Plastic and Reconstructive Surgery Clinic, Istanbul, Turkey.
Int Wound J. 2012 Apr;9(2):199-205. doi: 10.1111/j.1742-481X.2011.00876.x. Epub 2011 Oct 12.
Venous ulcers are characterised by longstanding and recurrent loss of skin integrity. Once occurred, healing is slow and recurrence is high because of inappropriate conditions of the wound bed. This study involves 20 patients with chronic venous ulcers at least 6 weeks of duration treated with negative pressure wound therapy (NPWT). Patients underwent a radical debridement of all devitalised tissues in the first operation. After adequate haemostasis, silver-impregnated polyurethane foam was applied. Once the wounds were determined to be clean and adequate granulation tissue formation was achieved, split-thickness skin grafts were applied. Black polyurethane foam was applied over them. All wounds completely healed without the need for further debridement or regrafting. The mean number of silver-impregnated foam dressing changes prior to grafting was 2·9 (one to eight changes). The mean number of NPWT foam changes was 2·6 after skin grafting (two to five changes). Two patients who did not use conservative treatments for chronic venous insufficiency (CVI) after discharge from the hospital had recurrence of venous ulcers in the follow-up period. Application of NPWT provides quick wound-bed preparation and complete graft take in venous ulcer treatment.
静脉溃疡的特征为皮肤完整性长期且反复丧失。一旦发生,由于伤口床的条件不合适,愈合缓慢且复发率高。本研究纳入了 20 例慢性静脉溃疡患者,溃疡持续时间至少 6 周,采用负压伤口治疗(NPWT)。患者在第一次手术中进行了所有失活组织的彻底清创。充分止血后,应用载银聚氨酯泡沫。一旦伤口被确定为清洁且有足够的肉芽组织形成,就应用中厚皮片。在其上应用黑色聚氨酯泡沫。所有伤口均完全愈合,无需进一步清创或再次植皮。植皮前载银泡沫敷料更换的平均次数为 2.9(1 至 8 次)。植皮后 NPWT 泡沫更换的平均次数为 2.6(2 至 5 次)。出院后未对慢性静脉功能不全(CVI)进行保守治疗的 2 例患者在随访期间出现静脉溃疡复发。NPWT 的应用可快速准备伤口床,并使静脉溃疡治疗中的植皮完全成活。